Fighting Oral Mucositis With Light Therapy

Low-dose light therapy may help prevent oral mucositis, a common treatment-related side effect in many patients with cancer, according to new study findings. Therefore, researchers have released new guidelines in Supportive Care in Cancer.

Oral mucositis is a large group of diseases that causes painful sores in the mouth. Patients who are treated with chemotherapy, radiation therapy or stem cell transplantation can experience the side effect.

"Sixty percent of chemotherapy patients get (oral mucositis), and the number can be as high as 100% with radiation. Similarly, the number varies between 40% to 60% with transplant," co-corresponding author Dr. Praveen Arany, a doctor of dental surgery and assistant professor of oral biology at the University at Buffalo School of Dental Medicine, said in an interview with CURE®.

Although these treatments work to kill the cancer, they also kill some of the normal cells which helps to heal the oral lining, Arany explained. “By compromising those cells, you’re not eating, drinking and brushing — those trauma causes the subsidized healing to the mucositis,” he said.

Arany was part of a team of researchers and clinicians around the world who are part of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). They searched two scientific databases, PubMed and Web of Science, for research papers published on photobiomodulation therapy, a form of light therapy, for oral mucositis and found more than 700. They included 33 papers for the guideline analysis.

"Light therapy stimulates the healing response inside and outside the cell," Arany said. "Inside the cell, it directly acts on the mitochondria and increases the amount of (two) molecules inside the mitochondria that help the normal healing responses. Outside the cell, there is a growth factor and it’s necessary for the healing response. The light treatment has been shown to directly stimulate both, which leads to its beneficial effects."

A systematic review of the research papers showed that the light therapy helped reduce oral mucositis with no reported side effects from the therapy itself. However, some skin changes needed to be adjusted for, Arany noted. In addition, he said, if patients are treated with light therapy before cancer treatment, oral mucositis can be prevented.

The researchers were able to create guidelines for the prevention of oral mucositis in hematopoietic stem cell transplantation and in patients with head and neck cancer who were treated with radiation therapy with or without chemotherapy. For the three groups, MASCC/ISOO recommended that patients receive intra-oral photobiomodulation therapy using low-level lasers.

Although the researchers examined light therapy in patients treated with chemotherapy, no guidelines were possible for the management of oral mucositis in these patients, according to the researchers.

An added benefit to the light therapy, according to Arany, is it could serve as an alternative for oral mucositis-related pain rather than patients being prescribed opioids.

"Light has been shown to directly reduce the amount of pain and, therefore, in this particular case, these patients will not need to be put on opioids," he said.

Photobiomodulation therapy is already used in some cancer centers, and extensively in Europe, Arany explained, adding that the team is one step away from light therapy becoming clinical practice guidelines in the United States.

"Mucositis is an unfortunate side effect of essential cancer treatment," Arany said. "People getting chemotherapy, radiation or transplant absolutely need this treatment to get rid of their tumor. The quality-of-life (issues) that this side effect causes is significant. (People) are unable to eat, which compromises (their) nutrition. There is discomfort and pain. For patients, this treatment means they’re being decorated to handle routine cancer treatments."