Bensadoun René-Jean

Bensadoun René-Jean

Radiation Oncologist, MD, MSc, HDR

Professor in Radiation Oncology,

Current Position: Chairman, Centre de Haute Energie, NICE (France)

Fields of Interest:  Photobiomodulation (Low Level LaserTherapy), Radiation Oncology, Head & Neck Cancer, Prostate Cancer, Supportive Care in Cancer, New techniques in Radiation Oncology (IMRT, VMAT, 4D Stereotaxy), Targeted agents, Prevention and management of cancer-treatment complications.

Boards:

Title: State of art of photobiomodulation (PBM) in the management of cancer-therapy side effects: Indications and levels of evidence.

Objective. – Assess the current and potential indications of photobiomodulation therapy (PBMT) and their level of evidence in the prevention or treatment of side effects related to oncology treatments (radiotherapy, and to a lesser extent chemotherapy and cell transplants hematopoietic strains). And report on the current indications (parameters and doses) of photobiomodulation therapy.

Materials and methods. – The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed in order to include and analyze the publications of clinical studies that evaluated photobiomodulation in the prevention or management of burden of side effects related to radiotherapy. The keywords used were “photobiomodulation”; “low level laser therapy”; “acute oral mucositis”; “acute dysphagia”; “acute radiation dermatitis”; “lymphedema”; “xerostomia”; “dysgeusia”; “hyposalivation”; “lockjaw”; “bone necrosis”; “osteoradionecrosis”; “radiation induced fibrosis”; “voice and speech alterations”; “palmar-plantar erythrodysesthesia”; “graft versus host disease”; “peripheral neuropathy”; “chemotherapy induced alopecia”. Prospective studies were included, while retrospective cohorts and non-original articles were excluded from the analysis.

Results. – Photobiomodulation in the red or infrared spectrum has demonstrated its effectiveness in randomized controlled trials in the prevention and management of certain complications related to radiotherapy, in particular acute mucositis, epitheliitis and upper limb lymphedema. The level of evidence associated with photobiomodulation was heterogeneous, but overall remained moderate. The main limitations were the diversity and the lack of precision of the treatment protocols which could compromise the efficiency and the reproducibility of the results of the photobiomodulation. For other effects related to chemo/radiation therapy (dysphagia, dysgeusia, osteonecrosis, peripheral neuropathy, alopecia, palmar-plantar erythrodysaesthesia) and haematopoietic stem cell transplantation (host graft disease), treatment with photobiomodulation suffers from a lack of studies or limited studies causing a weakened level of evidence. However, based on these results it was possible to establish parameters and doses of safe photobiomodulation practices.

Conclusion. – Published data suggest that photobiomodulation could therefore be considered as a supportive care in its own, for patients treated with irradiation, chemotherapy, immunotherapy, hormone therapy or targeted therapies, whether in clinical practice or in therapeutic trials. However, until solid data have been published on its long-term safety, the use of photobiomodulation should be considered with caution and within the parameters and recommended doses, particularly when practiced in areas of known or possible tumours. In this case, the patient must be informed of the theoretical benefits and risks of photobiomodulation in order to obtain informed consent before treatment.