Radiation Oncology Department, CHU de Poitiers, Poitiers, France.
Curr Opin Oncol. 2012 Jul;24(4):363-70. doi: 10.1097/CCO.0b013e328352eaa3.
To discuss the promising state of the art low-level laser therapy (LLLT) for preventive and therapeutic usage in oral mucositis due to cancer therapy.
Photomedicine using LLLT is very effective with intraoral and extraoral devices in the management of oral mucositis, based on several studies including randomized control studies. A systematic review identified 33 relevant articles that were subjected to meta-analysis based on which laser parameters in routine practice are being defined. Meta-analysis showed that LLLT reduced risk of oral mucositis with relative risk (RR) 2.45 [confidence interval (CI) 1.85-3.18], reduced duration, severity of oral mucositis and reduced number of days with oral mucositis (4.38 days, P = 0.0009). RR was similar between the red (630-670 nm) and infrared (780-830 nm) LLLT. Pain-relieving effect based on the Cohen scale was at 1.22 (CI 0.19-2.25).
No adverse side effects of LLLT were reported; hence, we recommend red or infrared LLLT with diode output between 10-100 mW, dose of 2-3 J/cm2/cm2 for prophylaxis and 4 J/cm2 (maximum limit) for therapeutic effect, application on single spot rather than scanning motion. Lesions must be evaluated by a trained clinician and therapy should be repeated daily or every other day or a minimum of three times per week until resolution. There is moderate-to-strong evidence in favor of LLLT at optimal doses as a well tolerated, relatively inexpensive intervention for cancer therapy-induced oral mucositis. It is envisaged that LLLT will soon become part of routine oral supportive care in cancer.
讨论低水平激光疗法（LLLT）在癌症治疗相关口腔黏膜炎的预防和治疗中的最新应用进展。
基于多项研究，包括随机对照研究，光医学中使用 LLLT 联合口腔内和口腔外设备对口腔黏膜炎的管理非常有效。一项系统评价确定了 33 篇相关文章，并对其进行了荟萃分析，据此确定了常规实践中的激光参数。荟萃分析显示，LLLT 可降低口腔黏膜炎的风险，相对风险（RR）为 2.45[置信区间（CI）1.85-3.18]，可缩短口腔黏膜炎的持续时间和严重程度，并减少口腔黏膜炎天数（4.38 天，P=0.0009）。红光（630-670nm）和红外光（780-830nm）LLLT 的 RR 相似。基于 Cohen 量表的止痛效果为 1.22（CI 0.19-2.25）。
没有报道 LLLT 有不良反应；因此，我们建议使用二极管输出的红光或红外光，功率为 10-100mW，预防剂量为 2-3J/cm2/cm2，治疗剂量为 4J/cm2（最大限制），应用于单个点而不是扫描运动。病变必须由经过培训的临床医生进行评估，并且治疗应每天或隔天重复，或每周至少重复 3 次，直至痊愈。在最佳剂量下，有中等至强证据支持 LLLT 作为癌症治疗相关口腔黏膜炎的一种耐受良好、相对便宜的干预措施。预计 LLLT 将很快成为癌症常规口腔支持治疗的一部分。
