Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jul 12;18(14):7418.
doi: 10.3390/ijerph18147418.

Efficacy of Photobiomodulation in the Treatment of Cancer Chemotherapy-Induced Oral Mucositis: A Meta-Analysis with Trial Sequential Analysis

Ali Hatem Manfi Al-Rudayni  1 , Divya Gopinath  2 , Mari Kannan Maharajan  3 , Sajesh K Veettil  4 , Rohit Kunnath Menon  5
Affiliations
Review

Efficacy of Photobiomodulation in the Treatment of Cancer Chemotherapy-Induced Oral Mucositis: A Meta-Analysis with Trial Sequential Analysis

Ali Hatem Manfi Al-Rudayni et al. Int J Environ Res Public Health. .

Abstract

Oral mucositis is a debilitating complication of chemotherapy, characterized by erythema, ulcers and oedema of the oral mucosa. This review aimed to evaluate the efficacy of Photobiomodulation in the treatment of oral mucositis using meta-analysis and trial sequential analysis, and also to assess the quality of the results by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). A comprehensive search of three databases, including Embase, Medline and Central, was performed to identify randomized controlled trials studying the efficacy of Photobiomodulation in the treatment of cancer chemotherapy-induced oral mucositis. The primary outcome was reduction in the severity of oral mucositis. Secondary outcomes were pain relief, duration of oral mucositis and adverse effects. The meta-analysis was performed using the random-effects model, and random errors of the meta-analyses were detected by trial sequential analysis. A total of 6 randomized controlled trials with 398 participants were included in our analysis. Photobiomodulation significantly reduced the severity of oral mucositis when compared to sham radiation (RR 0.43, 95% CI 0.20 to 0.93; p < 0.05). Sensitivity analysis by excluding trials with high risk of bias reiterated the robustness of our results (RR 0.28, 95% CI 0.16 to 0.48). Trial sequential analysis illustrated that the evidence from the meta-analysis was conclusive. The result of the meta-analyses with trial sequential analysis illustrated that Photobiomodulation is an effective therapeutic intervention for the treatment of oral mucositis, and the evidence gathered can be considered conclusive with a moderate level of certainty according to GRADE. Further trials are recommended to standardize the laser parameters required for the optimal effect.

Keywords: Photobiomodulation; RCTs; chemotherapy-induced oral mucositis; low-level laser; meta-analysis; trial sequential analysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart for the included studies. RCT: randomized control trial, CT: chemotherapy, RT: radiotherapy, GaAIAs: gallium aluminum arsenide, He Ne; helium-neon, low-energy laser.
Figure 2
Figure 2
Risk of bias of the included trails for PBM.
Figure 3
Figure 3
The forest plot illustrating the therapeutic benefit of PBM in reducing the severity of OM.
Figure 4
Figure 4
The sensitivity analysis forest plot illustrating the pooled estimate of PBM in reducing the severity of OM.
Figure 5
Figure 5
Trial sequential analysis evaluating the therapeutic benefit of PBM in inducing partial clinical resolution of OM using random-effects meta-analysis.
Figure 6
Figure 6
Forest plot illustrating the efficacy of PBM in reducing OM duration.
See this image and copyright information in PMC

References

    1. Richardson J.L., Marks G., Levine A. The Influence of Symptoms of Disease and Side Effects of Treatment on Compliance with Cancer Therapy. J. Clin. Oncol. 1988;6:1746–1752. doi: 10.1200/JCO.1988.6.11.1746. - DOI - PubMed
    1. Keefe D.M., Schubert M.M., Elting L.S., Sonis S.T., Epstein J.B., Raber-Durlacher J.E., Migliorati C.A., McGuire D.B., Hutchins R.D., Peterson D.E., et al. Updated Clinical Practice Guidelines for the Prevention and Treatment of Mucositis. Cancer. 2007;109:820–831. doi: 10.1002/cncr.22484. - DOI - PubMed
    1. Sonis S.T., Elting L.S., Keefe D., Peterson D.E., Schubert M., Hauer-Jensen M., Bekele B.N., Raber-Durlacher J., Donnelly J.P., Rubenstein E.B., et al. Perspectives on Cancer Therapy-Induced Mucosal Injury: Pathogenesis, Measurement, Epidemiology, and Consequences for Patients. Cancer. 2004;100:1995–2025. doi: 10.1002/cncr.20162. - DOI - PubMed
    1. Pulito C., Cristaudo A., Porta C.L., Zapperi S., Blandino G., Morrone A., Strano S. Oral Mucositis: The Hidden Side of Cancer Therapy. J. Exp. Clin. Cancer Res. 2020;39:210. doi: 10.1186/s13046-020-01715-7. - DOI - PMC - PubMed
    1. Liu Y.-J., Zhu G.-P., Guan X.-Y. Comparison of the NCI-CTCAE Version 4.0 and Version 3.0 in Assessing Chemoradiation-Induced Oral Mucositis for Locally Advanced Nasopharyngeal Carcinoma. Oral Oncol. 2012;48:554–559. doi: 10.1016/j.oraloncology.2012.01.004. - DOI - PubMed

Substances