New perspectives for extraoral photobiomodulation in oral and oropharyngeal cancer patients

Author(s)

Elisa Kauark Fontes

• Document type: Master's Dissertation
• Press: Piracicaba, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba
• Defense date: 2021-02-12

Examining board members

Alan Roger Santos Silva; Elismauro Francisco de Mendonça; Luiz Alcino Monteiro Gueiros

• Advisor: Karina Morais Faria; Alan Roger Santos Silva

Abstract

Oral and oropharyngeal mucositis (OM) is considered to be the most impactful toxicity for patients undergoing head and neck radiotherapy. The incidence and severity of OM is associated with important limitations, negative impact on quality of life and also an increase in hospital costs. Photobiomodulation (PBM) has been recommended for the management of OM. Although controversial, the impact of PBM in cancer treatment is questioned, and the confirmation of its oncological safety is critical, especially in the context of oral and oropharyngeal cancers. Thus, initially a systematic review was carried out about the cost-effectiveness of PBM for cancer treatment toxicities. Through a standardized selection process, 1490 studies were assessed, 4 articles met the inclusion criteria, 3 for the context of OM and 1 for lymphedema. The incremental cost-effectiveness ratio for OM ranged from 3050.75 USD to 5592.10 USD. The PBM has a cost of 21.47USD for each percentage point of lymphedema reduction compared to 80.51USD of manual lymphatic drainage. The second chapter discusses the use of extraoral PBM as an alternative for management of OM in the context of the COVID-19 pandemic. This new perspective, makes it possible to minimize the risk of transmission of SARS-CoV-2, allowing assistance to cancer patients during radiotherapy (RT) and chemotherapy. The third chapter is an interim analysis of a randomized, prospective, double-blind clinical trial of the photobiomodulation prophylactic use for OM in patients with oral cavity and oropharynx squamous cell carcinoma during RT. Fifty-five patients met the final inclusion criteria and were randomized into two groups: extraoral PBM and placebo. Later onset of OM, with 100% of incidence at sixth week for the PBM group in comparison for the third week for placebo group. Lower mean pain levels, less need for analgesics and anti-inflammatory use, and better overall quality of life results were observed for the PBM group in comparison to placebo. No adverse effects were observed from the use of PBM, as well as no impact on overall survival. Although evidence of PBM cost-effectiveness is limited, PBM has great potential on the management of oncological toxicities. The Extraoral PBM is simple and well tolerated among patients, can delay the OM onset, reduce pain levels and the need of analgesics and anti-inflammatory drugs. However, the optimization of protocols is necessary for better severe OM control (AU)

• FAPESP's process: 18/23479-3 - Oncological safety of extraoral photobiomodulation in patients with oral and oropharyngeal squamous cell carcinoma
• Grantee: Elisa Kauark Fontes
• Support Opportunities: Scholarships in Brazil - Master