Migliorati C. et al. - Photobiomodulation and Oral Mucositis in Oncology: A MASCC/ISOO Systematic Review

This systematic review by the MASCC/ISOO Mucositis Group evaluated laser and other light therapies for oral mucositis. It resulted in a recommendation and a suggestion, which were subsequently incorporated into the MASCC/ISOO clinical practice guidelines.

What This Publication Assessed

The stated objective is to review the available literature and develop clinical practice guidelines for the use of lasers and other light therapies in the prevention and treatment of oral mucositis. The study was conducted by the Mucositis Study Group of the MASCC and the ISOO, two international learned societies.

This journal provided the factual basis for the “light” section of the MASCC/ISOO recommendations subsequently published in the journal *Cancer*. The link between the two documents is direct: here, the data are analyzed and the parameters are established; there, they are incorporated into the general guidelines on mucositis.

As is the case throughout this field, photobiomodulation is used as a supportive therapy to manage the side effects of cancer treatment, but never as a treatment for cancer itself.

Key Findings

The level of evidence was assigned by intervention and by treatment setting, with three possible outcomes: recommendation, suggestion, or no recommendation possible. Two new conclusions emerged from this.

• Recommendation: low-intensity laser, 650 nm, 40 mW; treat each square centimeter for as long as necessary to reach a tissue energy dose of 2 J/cm², or 2 seconds per spot
• Target population for this recommendation: adults receiving a hematopoietic stem cell transplant following high-dose chemotherapy conditioning, with or without total-body irradiation
• Purpose of this recommendation: prevention of oral mucositis
• Suggestion: low-intensity laser with a wavelength of approximately 632.8 nm for the prevention of oral mucositis in patients receiving radiation therapy without concomitant chemotherapy for head and neck cancer
• Other populations and other light sources: no recommendation can be made due to insufficient evidence

Data on other populations are described as generally encouraging across a range of wavelengths and intensities, though they do not meet the threshold for a recommendation.

How does photobiomodulation work for this condition?

The intended use is preventive: radiation is applied to the oral mucosa before lesions appear, to limit their occurrence and severity during the high-risk phase. This explains the precision of the parameters, which are expressed in terms of wavelength, power, and energy dose per unit area. The review does not describe any biological mechanisms.

Limits You Should Know

The scope of application is narrow. The recommendation applies only to adults who have undergone hematopoietic stem cell transplantation under the conditions described, and the suggestion—which is, by definition, weaker—applies to patients undergoing head and neck radiation therapy without concomitant chemotherapy. In all other cases, no recommendation could be made. The authors themselves call for additional, well-designed research in the various contexts of cancer treatment.

This review is more than ten years old. The MASCC/ISOO guidelines have been updated since then, and the parameters may have changed. Please refer to the most recent version.

What This Means in Practice

This is one of the few cases in which photobiomodulation has quantified parameters based on an international standard. This precision is an advantage, but these values apply only to the situation described and cannot be applied as-is to other indications or devices. Any use during cancer treatment is the responsibility of the oncology team.

Frequently Asked Questions

What settings does this review recommend?

For the prevention of oral mucositis following hematopoietic stem cell transplantation, she recommends a low-intensity laser at 650 nm and 40 mW, with each square centimeter receiving a dose of 2 J/cm², or 2 seconds per spot.

Does this recommendation apply to all oncology patients?

No. It applies to adults who have undergone hematopoietic stem cell transplantation following high-dose chemotherapy. A separate recommendation exists for a wavelength of approximately 632.8 nm in head and neck radiation therapy without concomitant chemotherapy. For other cases, no recommendation could be made.

What is the connection to the MASCC/ISOO recommendations published in *Cancer*?

This systematic review provides the evidence base for the lighting component of these recommendations. Its conclusions were subsequently incorporated into the comprehensive guidelines on mucositis resulting from cancer treatments.

Reference

Migliorati C, Hewson I, Lalla RV, et al. Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Supportive Care in Cancer, 2013 (published online September 22, 2012). PMID 23001179. View the study on PubMed

This summary is provided for informational purposes only and does not constitute medical advice. Photobiomodulation is not a substitute for prescribed treatment. Consult a healthcare professional.