Chemotherapy-induced oral mucositis: effect of LED and laser phototherapy treatment protocols.

BACKGROUND AND OBJECTIVE: Over the last few decades, many studies have focused on the effect of lasers on the management of oral mucositis in oncologic patients treated with chemotherapy and/or radiotherapy. However, the effect of light-emitting diode (LED) has been poorly studied, and was not compared with that of laser phototherapy (LPT). For this reason, the aim of the present study was to clinically compare the effect of these two therapies on chemotherapy-induced oral mucositis (CIOM) and pain. METHODS: Forty patients with CIOM were divided into two groups: G1, patients treated with LPT; G2, patients treated with LED. The treatment was administered during 10 consecutive days, with exception of weekends. LPT was applied using an InGaAlP laser (660 nm/40 mW/6.6 J cm-(2)/0.24 J per point/0.036 cm(2) of spot size). LED phototherapy was applied using 0.24 J per point/80 mW/630 nm/1 cm(2) of spot size. CIOM was assessed during each session in accordance to the World Health Organization (WHO) score. The patient self-assessed pain was scored on a visual analog scale (VAS). RESULTS: The mean VAS and WHO scores were significantly smaller in the LED group (p<0.05). However, both groups required the same number of days to reach score zero for mucositis and pain (p>0.05). Moreover, in the group with severe mucositis (score III), there was a lower frequency of patients with complete healing and pain relief, with the exception of analgesia in G2, in which almost all patients were completely relieved from pain. CONCLUSIONS: These findings suggest that LED therapy is more effective than LPT in the treatment of COIM, with the parameters used in the present study.

Estudo comparativo do efeito das fototerapias LED e LASER de baixa intensidade no tratamento da mucosite oral em pacientes submetidos à quimioterapia / Comparative study of the effects of LASER and LED phototherapies in the treatment of oral mucositis in patients submitted to chemotherapy

A mucosite oral é uma lesão induzida pelo tratamento quimioterápico, radioterápico ou pela associação de ambos. Esta consiste em uma inflamação da mucosa oral que pode gerar dor, interferir na qualidade de vida, predispor a infecções e gerar interrupções no tratamento do câncer. Devido a estes motivos, o seu tratamento se faz necessário. Há evidências científicas que comprovam que a terapia com LASER de baixa intensidade é uma forma de tratamento eficaz para estas lesões orais e, alguns autores, defendem que o LED representa uma alternativa ao LASER, sendo uma terapia mais barata e mais rápida que este. No entanto, poucas pesquisas foram realizadas com o LED e não há na literatura nenhum trabalho que compare clinicamente o efeito da terapia LED e LASER de baixa intensidade no tratamento das mucosites. Com isso, o objetivo desta pesquisa foi comparar o efeito das fototerapias LED e LASER no tratamento da mucosite oral induzida por quimioterapia. Quarenta pacientes com mucosite oral induzida por quimioterapia, foram divididos em dois grupos, onde um recebia o tratamento com LASER diodo (660nm, 40mW, 6J/cm2, 0,24J por ponto) e o outro com LED (630nm, 80mW, 0,24J/cm2, 0,24J por ponto) durante 10 dias consecutivos, excluindo os finais de semana. Os pontos anatômicos de aplicação eram os mesmos para ambas as fototerapias e foram distribuídos pelos lábios, comissuras, mucosa labial e jugal, palato mole e duro, língua e assoalho bucal.

A cada consulta, antes da aplicação das fototerapias, foi realizada a avaliação do grau de mucosite por meio da escala da Organização Mundial da Saúde (OMS) e da dor através da Escala Visual Analógica (EVA). Após a realização das análises estatísticas, observou-se que o LED para os graus iniciais 1 e 2 de mucosite apresentou ação analgésica estatisticamente melhor do que a do LASER (p=0,012 e 0,022, respectivamente), mas seu efeito sobre a cicatrização das lesões de mucosite foi semelhante ao do LASER. Para o grau inicial 3 de mucosite, o LED promoveu uma melhor cicatrização (p=0,028) e uma ação analgésica semelhante a do LASER. Em conclusão, a fototerapia com LED mostrou-se mais eficaz que o LASER para a diminuição do grau de mucosite e do escore de dor nas condições do presente trabalho.

Patients submitted to chemotherapy and/or head and neck radiotherapy are usually affected by oral complications, especially oral mucositis and severe pain, which demands support therapy. Although the management of such oral complications by phototherapy with LASER (Laser Phototherapy - LPT) and with LEDs has been studied, the comparison between these therapies has not been studied yet. Thus, the aim of this study is to compare the effect of these two therapies against chemotherapy-induced oral mucositis (CIOM) and pain. Forty patients with CIOM were submitted to phototherapy according to 2 groups: G1, red low power LASER; G2, red LED. The treatment was done during 10 days. The LPT was done using an InGaAlP LASER (660nm/40mW/6Jcm-²/0,24J per point). The LED phototherapy was done using 0,24J per point/80mW/630nm. CIOM grade was assessed at each session in accordance to the World Health Organization (WHO). The patient self-assessed pain was measured by means of the visual analogue scale (VAS). The results showed that both treatments were effective, however, patients with initial mucositis grade 3, submitted to LED phototherapy presented significant decrease in the mean CIOM grades when compared with patients submitted to LASER phototherapy. In addition, LED showed better results in pain relief of patients with initial mucositis grade 1 and 2 (p=0,012 e 0,022, respectively) when compared with LASER therapy. In conclusion, phototherapy with LED is more effective than LPT on the management of CIOM which in turn would improve the patients quality of life.