Optimization of Photobiomodulation Protocol for Chemotherapy-Induced Mucositis in Pediatric Patients.

To determine optimal settings of a specific diode laser for reducing the severity of oral mucositis (OM) in pediatric patients. Photobiomodulation (PBM) has been reported to reduce the severity of chemotherapy-induced OM. Treatment parameters for PBM are difficult to determine due to different reports in the literature. Patients with OM graded WHO 3 or 4 were randomly assigned to three groups with different laser settings (group A: power 250 mW, the energy density 8.8 and 15.5 J/cm for WHO grade 3 and 4, respectively; group B: power 500 mW, energy density as in group A; group C: power 250 mW, energy density was half of groups A and B). PBM was performed on all lesion areas. The mean number of PBM sessions to a decrease from WHO 3 or 4 to WHO 2, 1, or 0 was calculated for each patient. Multiple linear regression was used to determine whether the test groups differed in the mean number of sessions to a decrease of OM. The mean number of PBM sessions to reduce from severe mucositis to mild or no mucositis was 3.8 [standard deviation (SD) = 3.5] in group A, 4.4 (SD = 2.3) in group B, and 4.0 (SD = 2.7) in group C. The differences in the number of PBM sessions for OM severity decrease were not statistically significantly different among the three study groups. Because of the lack of statistically significant differences between the groups, more patient practical laser parameters could be applied, that is, a shorter irradiation time.