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Journal of Oral Laser Applications

Year 2002
Volume 2 , Issue 2

Pages: 115 - 120

Radiation- and Chemotherapy-induced Mucositis in Oncology: Results of Multicenter Phase III Studies

René-Jean Bensadoun/Gaston Ciais

Purpose: Following several positive randomized trials in the field of chemotherapy-induced mucositis, a randomized multicenter trial was conducted to evaluate low-level He:Ne laser therapy (LLLT) for the prevention of acute radiation-induced oropharyngeal mucosal lesions. Materials and Methods: The trial was open to patients with carcinoma of the oropharynx, hypopharynx, and oral cavity being treated by external radiotherapy, with a total dose of 65 Gy at a rate of 1 fraction of 2 Gy/day, 5 days a week, from cobalt-60 or linear accelerator photons. Patients were assigned to either laser treatment (L+) or sham-treatment (L-) by computer blocked randomization. The protocol called for the inclusion of 30 patients, 15 in each arm. Analgesics could be prescribed, but not during the 2 days preceding each week evaluation. Patients received He:Ne laser applications daily for five consecutive days during the seven days of head and neck radiotherapy. The 9 treatment areas included: posterior third of buccal mucosa, soft palate, and anterior tonsillar pillars. The treatment time (t) for each application point was given by the equation: t (s) = energy (j/cm2) x surface (cm2)/Power (W). The average energy density delivered to the treatment areas was 2 J/cm2. All laser illuminations were performed by the same individual in each center. Criteria for evaluation were the standard WHO scale for mucositis in the oropharynx and a segmented visual analogic scale for pain (patient self-evaluation). Results: Laser applications delayed time of onset, attenuated the peak severity, and shortened the duration of oral mucositis. The difference between L+ and L- patients was statistically significant from week 4 to week 7. During the 7 weeks of treatment, the mean grade of mucositis in L+ patients was significantly lower (p = 0.01) than the mean grade in L- patients. Results of decrease in pain intensity were also quite convincing. Laser applications reduced the incidence and duration of morphine administration. Ability to swallow was also improved. Conclusion: Low level He:Ne laser (LLL) seems to be a safe and efficient method for the prevention of radiation-induced stomatitis and chemo-induced mucositis, with a tremendous potential interest for combined modality treatment.


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