Lalla R.V. et al. - Photobiomodulation and Cancer Treatment-Related Mucositis: MASCC/ISOO Clinical Practice Recommendations

This is not a study but rather a set of international clinical practice guidelines published by the MASCC and the ISOO for the management of mucositis associated with cancer treatments. They include 32 recommendations, 22 of which pertain to oral mucositis and 10 to gastrointestinal mucositis.

What this publication establishes

Mucositis is a major side effect of cancer treatments, sometimes to the point of limiting the doses administered. This publication is neither an essay nor a simple review: it is an update of the clinical practice guidelines from the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology, two international learned societies.

A clinical practice guideline holds a special place in the hierarchy of scientific documents. It does not generate new data: it evaluates existing data, assigns a level of evidence to it, and then derives a course of action. Its authority stems from the fact that it is endorsed by professional societies and serves as a reference for healthcare teams in many countries. Inclusion in such a guideline elevates an approach from the status of a speculative idea to that of an option evaluated using an explicit methodology.

Photobiomodulation is used here as a supportive therapy—that is, to minimize the side effects of treatment. It is by no means a treatment for cancer.

Key Findings

The method follows a comprehensive systematic review, with each article being independently evaluated by two reviewers, who rate major and minor flaws and assign a level of evidence for each intervention and treatment context.

• 8,279 articles identified through the literature review
• 1,032 articles were selected for detailed evaluation based on their titles and abstracts
• 570 articles were ultimately included in the systematic reviews
• 16 new recommendations have been developed, either supporting or opposing the use of various interventions in specific treatment settings
• A total of 32 recommendations, including 22 for oral mucositis and 10 for gastrointestinal mucositis
• Three possible outcomes of an intervention: a recommendation, a suggestion, or no recommendation possible

The abstract does not detail the content of the 32 recommendations on a procedure-by-procedure basis. The parameters used for photobiomodulation are listed in the dedicated systematic review published separately by the same group.

How does photobiomodulation work for this condition?

The approach is preventive rather than curative: to limit the severity of mucosal damage caused by chemotherapy or radiation therapy, in order to preserve the patient’s ability to eat, speak, and maintain comfort. Another key goal is to avoid having to reduce the doses of cancer treatment due to mucosal toxicity. This document categorizes interventions by context, as what applies after a stem cell transplant does not necessarily apply in the setting of radiation therapy.

Limits You Should Know

A recommendation cannot be separated from its context: it applies to a specific population and treatment regimen and cannot be automatically applied to other situations. The document also notes that, for certain interventions and contexts, no recommendation could be made due to insufficient evidence.

This update dates from 2014—more than ten years ago. The MASCC/ISOO recommendations have been the subject of further work, and the parameters used may have changed. It is therefore advisable to check for a more recent version before applying them.

What This Means in Practice

For a patient, the benefit is clear: the management of mucositis is based on guidelines developed through a review of the literature, not on local practices. This does not mean that precautions can be overlooked. Any use of photobiomodulation during cancer treatment must be decided in consultation with the oncology team, which is the only group familiar with the current protocol and any potential contraindications.

Frequently Asked Questions

What is a MASCC/ISOO recommendation?

These are guidelines developed by two international learned societies based on a systematic review of the literature, with a level of evidence assigned. Depending on the strength of the evidence, the conclusion may be a recommendation, a suggestion, or the absence of a recommendation.

Does photobiomodulation treat cancer?

No. In this context, it is exclusively a supportive care measure: its purpose is to limit treatment-related toxicity, specifically mucositis. This guideline does not claim any effect on the tumor itself.

Are these recommendations still relevant today?

This version is from 2014. More recent studies have been published since then, and the recommended parameters may have changed. Please refer to the most recent version and consult your healthcare team.

Reference

Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy. Cancer, 2014. PMID 24615748. 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.