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Oncology and supportive care
Published on
October 9, 2019

Zadik Y. et al. - Photobiomodulation for the prevention of oral mucositis in cancer patients

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The MASCC/ISOO systematic review published in 2019 recommends photobiomodulation to prevent oral mucositis and associated pain in three specific cancer treatment scenarios. However, it concludes that no recommendation can be made for the treatment of established mucositis or chemotherapy-related mucositis due to a lack of sufficient evidence.

What this study measured

This study is not a clinical trial but a systematic review accompanied by best-practice recommendations. It was conducted by the Mucitis Study Group of the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology, using PubMed and Web of Science, in accordance with the MASCC methodology for review and recommendation development.

Each intervention was evaluated within each cancer treatment context and then assigned a level of evidence. Based on this level of evidence, one of three possible conclusions was drawn: a recommendation, a suggestion, or no possible recommendation. The objective was to update the recommendations on the use of photobiomodulation, laser therapy, and other light therapies for the prevention and treatment of oral mucositis.

Key Findings

The panel's findings, as published, are as follows.

  • Recommendation for the use of photobiomodulation to prevent oral mucositis and associated pain in patients undergoing hematopoietic stem cell transplantation.
  • Recommendations for prevention in patients undergoing radiation therapy for head and neck cancer without chemotherapy.
  • Recommendations for prevention in patients undergoing radiation therapy to the head and neck region in combination with chemotherapy.
  • For each of these three situations, one or two clinically effective protocols are recommended, and the clinician must adhere to all the parameters of the selected protocol.
  • No recommendation can be made for the treatment of established oral mucositis or chemotherapy-related mucositis due to insufficient evidence.

How photobiomodulation works for this indication

Photobiomodulation involves applying low-power light—from a laser or light-emitting diode—to the oral mucosa. In the MASCC/ISOO guidelines, it is classified as supportive care rather than a cancer treatment: its purpose is to mitigate a complication of cancer treatment.

The text emphasizes an operational point: it is comprehensive protocols that are recommended, not photobiomodulation in general. Full compliance with the parameters of the chosen protocol is essential for the recommendation to be valid.

Limits You Should Know

This is a systematic review accompanied by expert recommendations, not a single-outcome measure: the document does not provide an overall quantitative estimate of the benefit.

The authors note that the clinical parameters reported in the literature varied widely, which limited the ability to synthesize the data. Two negative conclusions should be noted: no recommendations can be made for treating established mucositis or for chemotherapy-induced mucositis. Finally, these recommendations date from 2019 and are presented by their authors as likely to be updated as new publications emerge.

What This Means in Practice

This document serves as an international reference for the integration of photobiomodulation into supportive care protocols in oncology. It clearly outlines the situations in which it is recommended and those in which data are lacking. Implementation is the responsibility of a healthcare team, which defines the protocol and adheres to all its parameters. Photobiomodulation is not a substitute for cancer treatment or oral hygiene practices.

Frequently Asked Questions

Is photobiomodulation a cancer treatment?

No. According to the MASCC/ISOO guidelines, photobiomodulation is considered supportive care: it is intended to treat a complication of cancer treatment, namely oral mucositis. It does not affect the tumor and is not a substitute for any prescribed treatment.

In what cases is photobiomodulation recommended for treating oral mucositis?

The document recommends its preventive use in three situations: hematopoietic stem cell transplantation, ENT radiation therapy without chemotherapy, and ENT radiation therapy with chemotherapy. For each situation, one or two specific protocols are proposed, and all parameters must be followed.

Does photobiomodulation work on mucositis that has already developed?

The authors conclude that no recommendation can be made in this situation due to a lack of sufficient evidence at the time of publication. The same conclusion applies to chemotherapy-related mucositis. This indicates uncertainty, not evidence of ineffectiveness.

Reference

Zadik Y, Arany PR, Fregnani ER, Bossi P, Antunes HS, Bensadoun RJ, et al. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Supportive Care in Cancer, 2019. PMID 31286228. https://pubmed.ncbi.nlm.nih.gov/31286228/

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.