Vitale Marina Consuelo, Modaffari Carola, Decembrino Nunzia, Zhou Feng Xiao, Zecca Marco, Defabianis Patrizia
Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Section of Dentistry, Unit of Orthodontics and Paediatric Dentistry, University of Pavia, Pavia, Italy.
Onco-Haematological Paediatric Division, IRCSS S. Matteo, Pavia, Italy.
Lasers Med Sci. 2017 Aug;32(6):1423-1428. doi: 10.1007/s10103-017-2266-y. Epub 2017 Jun 29.
Oral mucositis (OM) is a debilitating and serious side effect in patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Laser therapy is becoming a promising treatment option in these patients, avoiding the necessity of enteral/parenteral nutrition. The aim of this study was to evaluate the efficacy of laser therapy in patients affected by oral mucositis induced by chemotherapy and HSCT. Sixteen onco-hematological pediatric patients receiving chemotherapy and hematopoietic stem cell transplantation, affected by oral mucositis, were enrolled in this study. They were divided in two randomized groups: the laser group and the placebo-control group. Patients in the laser group were treated with HPLT (970 ± 15 nm, 3.2 W (50%), 35-6000 Hz, 240 s) for four consecutive days, once a day; and placebo group underwent sham treatment. The assessment of mucositis was recorded through WHO Oral Mucositis Grading Objective Scale, and pain was evaluated through Visual Analogue Scale (VAS). Patients were monitored and evaluated 3, 7, and 11 days after the first day of laser therapy. Once OM was diagnosed, the patients had mucositis grading assessments before laser or sham application at day 3, 7, and 11 after first application. All patients of laser group demonstrated improvement in pain sensation from day 3 after first application of laser (p < 0.05), ulcerations reduced their dimensions and erythema disappeared. The patients of placebo group had improvement from day 7. In laser group, all mucositis were fully resolved from day 7 (p < 0.05). Oral mucositis negatively impacts on nutritional intake, oral hygiene, and quality of life. Laser therapy appears to be a safe and innovative approach in the management of oral mucositis. In this preliminary study, HPLT encourages to consider laser therapy as a part of onco-hematological protocol, providing to decrease pain and duration of OM induced by CT and HSCT. Further researches will be needed, especially randomized, controlled clinical trials with a large number of enrolled patients and a long term of follow-up to confirm the efficacy of laser therapy in prevention and control of OM in onco-hematological pediatric patients.
口腔黏膜炎（OM）是接受造血干细胞移植（HSCT）和化疗（CT）的患者中一种使人虚弱且严重的副作用。激光治疗正成为这些患者一种有前景的治疗选择，可避免肠内/肠外营养的必要性。本研究的目的是评估激光治疗对化疗和HSCT诱导的口腔黏膜炎患者的疗效。16名接受化疗和造血干细胞移植且患有口腔黏膜炎的儿科血液肿瘤患者被纳入本研究。他们被随机分为两组：激光组和安慰剂对照组。激光组患者连续四天每天接受一次高功率激光治疗（HPLT）（970±15纳米，3.2瓦（50%），35 - 6000赫兹，240秒）；安慰剂组接受假治疗。通过世界卫生组织口腔黏膜炎分级客观量表记录黏膜炎的评估情况，并通过视觉模拟量表（VAS）评估疼痛。在激光治疗第一天后的第3、7和11天对患者进行监测和评估。一旦诊断为OM，患者在首次应用激光或假治疗后的第3、7和11天进行黏膜炎分级评估。激光组所有患者在首次应用激光后第3天疼痛感觉即有改善（p<0.05），溃疡面积减小且红斑消失。安慰剂组患者从第7天开始改善。在激光组，所有黏膜炎从第7天起完全消退（p<0.05）。口腔黏膜炎对营养摄入、口腔卫生和生活质量有负面影响。激光治疗似乎是管理口腔黏膜炎的一种安全且创新的方法。在这项初步研究中，高功率激光治疗促使人们考虑将激光治疗作为血液肿瘤治疗方案的一部分，以减轻CT和HSCT诱导的OM的疼痛并缩短其持续时间。还需要进一步的研究，尤其是大量入组患者的随机对照临床试验以及长期随访，以证实激光治疗在预防和控制儿科血液肿瘤患者口腔黏膜炎方面的疗效。
