title: Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols.
abstract: There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed.
  
  
  
  Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.
  
  
  
  PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780-830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2-3 J (J/cm(2)), and no more than 6 J/cm(2) on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations.
  
  
  
  PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Judith A E M
authors.initials: JA
authors.lastname: Zecha
authors.affiliation: Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.|Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, P.O. Box 22660 1100 DD, Amsterdam, the Netherlands.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Raber-Durlacher
authors.affiliation: Oral Medicine Oral Pathology and Human Diseases, Menzies Health Institute Queensland and Oral Medicine Consultant, Department of Haematology and Oncology/Cancer Services, Gold Coast University Hospital, Queensland Health, Queensland, Australia.
authors.forename: Raj G
authors.initials: RG
authors.lastname: Nair
authors.affiliation: Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.|Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, 91010, USA.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.affiliation: Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, 14620, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Elad
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA.|Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA.|Harvard-MIT Division of Health Science and Technology, Cambridge, MA, 02139, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Hamblin
authors.affiliation: Division of Oncology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Andrei
authors.initials: A
authors.lastname: Barasch
authors.affiliation: Department of Diagnostic Sciences and Oral Medicine, Director of Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave. Suite N231, Memphis, TN, 38163, USA.
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Migliorati
authors.affiliation: Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Dan M J
authors.initials: DM
authors.lastname: Milstein
authors.affiliation: Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Genot
authors.affiliation: Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Liset
authors.initials: L
authors.lastname: Lansaat
authors.affiliation: Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, 91010, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: van der Brink
authors.affiliation: Department of Oral Surgery, Faculty of Dentistry, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Arnabat-Dominguez
authors.affiliation: Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Molen
authors.affiliation: Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Irene
authors.initials: I
authors.lastname: Jacobi
authors.affiliation: Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Judi
authors.initials: J
authors.lastname: van Diessen
authors.affiliation: Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: de Lange
authors.affiliation: Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.|Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Ludi E
authors.initials: LE
authors.lastname: Smeele
authors.affiliation: Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA, 98109, USA.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Schubert
authors.affiliation: World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000, Nice, France. renejean.bensadoun@che-nice.com.
authors.forename: René-Jean
authors.initials: RJ
authors.lastname: Bensadoun
mesh_terms: D059248:Chemoradiotherapy / Q000009:adverse effects*; D002985:Clinical Protocols; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000628:therapy*; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*
keywords: Chemotherapy; Head and neck cancer; LLLT; Low-level laser therapy; Low-level light therapy; Mucositis; Orofacial complications; PBM; Photobiomodulation; Radiation therapy