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低水平激光治疗癌症口腔黏膜炎的疗效:系统评价和荟萃分析。

Efficacy of low-level laser for treatment of cancer oral mucositis: a systematic review and meta-analysis.

机构信息

Graduation Program on Evaluation and Production of Technologies for the Brazilian National Health System, Hospital Nossa Senhora da Conceição, Av. Francisco Trein, 596 - Cristo Redentor, Porto Alegre, Rio Grande do Sul, 91350-200, Brazil.

Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.

出版信息

Lasers Med Sci. 2019 Aug;34(6):1053-1062. doi: 10.1007/s10103-019-02722-7. Epub 2019 Feb 7.

Abstract

Review effectiveness of low-level laser therapy (LLLT) in the curative treatment of oral mucositis (OM) in patients receiving cancer therapy. A systematic review with meta-analysis was performed using Medline, Embase, and Cochrane Library databases according to PRISMA guidelines, to identify randomized controlled trials (RCT) on OM in patients during and/or after cancer therapy and in which the therapeutic approach was LLLT, with wavelengths between 632 and 970 nm. We considered grade of OM as a dichotomous variable (such as an improvement or not in severe OM on the seventh day of therapy), with the analysis of subgroups of adult patients or children and adolescents and as a continuous variable with determination of the time for the complete resolution and the subgroup analysis occurred with the strata of the samples by treatment only with chemotherapy or chemotherapy and radiotherapy. This paper's protocol was registered a priori at https://www.crd.york.ac.uk/PROSPERO . We found five RCT (total of 315 patients) with adequate methodology. LLLT was effective, presenting a 62% risk reduction of severe mucositis on the seventh day of evaluation (RR = 0.38 [95% CI, 0.19-0.75]). When we analyzed subgroups, RR was 0.28 (95% CI 0.17-0.46) in the adult studies and 0.90 (95% CI, 0.46-1.78) in the studies with children and adolescents. We demonstrated a mean reduction of 4.21 days in the time of complete resolution of OM (CI - 5.65 to - 2.76) in favor of LLLT. There is moderate evidence that LLLT is effective in resolving OM lesions in adult patients undergoing cancer therapy. LLLT demonstrates potential for decreasing the resolution time of OM lesions by approximately 4.21 days.

摘要

评价低水平激光疗法(LLLT)在癌症治疗患者口腔黏膜炎(OM)治疗中的疗效。根据 PRISMA 指南,使用 Medline、Embase 和 Cochrane 图书馆数据库进行系统评价和荟萃分析,以确定癌症治疗期间和/或之后接受 OM 治疗的患者的随机对照试验(RCT),并且治疗方法为 LLLT,波长在 632 和 970nm 之间。我们将 OM 分级视为二分类变量(例如治疗第 7 天严重 OM 是否改善),并对成人患者或儿童和青少年亚组以及连续变量进行了分析,以确定完全缓解时间,并进行了亚组分析,分层因素为仅接受化疗或化疗和放疗的样本。本文的方案已在 https://www.crd.york.ac.uk/PROSPERO 上预先注册。我们发现了五项具有足够方法学的 RCT(共 315 名患者)。LLLT 有效,在第 7 天评估时严重黏膜炎的风险降低了 62%(RR=0.38[95%CI,0.19-0.75])。当我们分析亚组时,成人研究中的 RR 为 0.28(95%CI 0.17-0.46),而儿童和青少年研究中的 RR 为 0.90(95%CI 0.46-1.78)。我们证明 LLLT 使 OM 完全缓解的时间平均减少了 4.21 天(CI-5.65 至-2.76)。有中等证据表明,LLLT 对癌症治疗成人患者 OM 病变的缓解有效。LLLT 有可能将 OM 病变的缓解时间缩短约 4.21 天。

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