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Purpose To assess the safety and efficacy of prophylactic extraoral photobiomodulation (PBM) for the prevention of oral and oropharyngeal mucositis (OM) on clinical outcomes and survival in patients with oral cavity and oropharyngeal squamous cell carcinoma (OOPSCC). Methods OOPSCC patients who received radiotherapy (RT) were prospectively randomized to two groups: prophylactic extraoral PBM and placebo. OM grade (NCI), pain (VAS), analgesia, and anti-inflammatory prescriptions were assessed weekly. Quality of life questionnaires (QoL) were performed at the first and last day of RT. Following RT, participants were evaluated quarterly for oncological outcomes follow-up. Results Fifty-five patients met the inclusion criteria. The first occurrence of OM was observed at week 1, for the placebo group (p = 0.014). Later, OM onset and severity was observed for the PBM group, with first occurrence at week 2 (p = 0.009). No difference in severe OM incidence was observed (p > 0.05). Lower mean pain score was noted at week 7 for the PBM group (2.1) compared to placebo group (4.5) (p = 0.009). Less analgesics (week 3; p = 0.009/week 7; p = 0.02) and anti-inflammatory prescription (week 5; p = 0.0346) were observed for the PBM group. Better QoL scores were observed for the PBM group at last day of RT (p = 0.0034). No difference in overall survival among groups was observed in 1 year of follow-up (p = 0.889). Conclusion Prophylactic extraoral PBM can delay OM onset, reduce pain, and reduce analgesic and anti-inflammatory prescription requirements. Extraoral PBM was associated with better QoL. There was no evidence of PBM impact on oncological outcomes. Trial registration TRN:RBR-4w4swx (date of registration: 01/20/2020). Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06625-8.

To identify and summarize the evidence on the cost-effectiveness of photobiomodulation (PBM) therapy for the prevention and treatment of cancer treatment-related toxicities. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE). Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 1490 studies were identified, and after a two-step review, 4 articles met the inclusion criteria. The included studies analyzed the cost-effectiveness of PBM therapy used in the context of lymphedema for breast cancer and oral mucositis (OM) induced by chemotherapy and radiotherapy. Better outcomes were associated with PBM therapy. The incremental cost-effectiveness ratio ranged from 3050.75 USD to 5592.10 USD per grade 3–4 OM case prevented. PBM therapy cost 21.47 USD per percentage point reduction in lymphedema in comparison with 80.51 USD for manual lymph drainage and physical therapy. There is limited evidence that PBM therapy is cost-effective in the prevention and treatment of specific cancer treatment-related toxicities, namely, OM and breast cancer-related lymphedema. Studies may have underreported the benefits due to a lack of a comprehensive cost evaluation. This suggests a wider acceptance of PBM therapy at cancer treatment centers, which has thus far been limited by the number of robust clinical studies that demonstrate cost-effectiveness for the prevention and treatment of toxicities.

Photobiomodulation therapy (PBMT) has been considered an effective method for preventing and managing certain cancer-related toxicities in head and neck cancer (HNC) patients treated with radiotherapy and chemotherapy. However, the potential effects of PBMT on pain control and analgesia resulting from these toxicities is still controversial. The aim of this systematic review was to compile available evidence of the effects of PMBT on pain control and reduced use of analgesics in HNC patients. We searched three indexed databases: MEDLINE/PubMed, Embase, and Scopus. The databases were reviewed up to and including December 2018. Only human clinical studies in English language were selected. Information was only available for mucositis and radiodermatitis. Fifteen out of 1112 studies met the inclusion criteria (14 for oral mucositis (OM) and 1 for radiodermatitis). From the 14 studies involving the prevention and treatment of OM, 10 had the study subjects compared to a placebo group. Of these 10 studies, all but 1 showed statistically significant difference related to pain control favoring the PBMT group. The study that compared PBMT with other treatment modality showed better results in pain control with PBMT. It appears that PBMT application frequency and potency impact on pain control. The only study involving the prevention and treatment of radiodermatitis was compared to placebo arm and showed statistically significant difference related to pain control favoring the PBMT group. Seven studies compared the need of analgesic medication between PBMT and placebo groups. Of these, five studies showed that the use of analgesic medication was significantly higher in the placebo group. The current evidence supports that PBMT is effective in pain control resulting from OM and radiodermatitis and may also reduce the need for analgesics. The evidence is not yet available of the effects of PBMT in other HNC treatment-related toxicities.

OBJECTIVE: To evaluate whether the coronavirus disease 2019 has increased anxiety, depression, and distress levels in head and neck cancer (HNC) patients undergoing radiotherapy (RT). METHODS: In this cross-sectional study, RT-HNC patients were surveyed using the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression and the distress thermometer (DT) for distress. HADS scores were compared with data pre-COVID-19. Additionally, we evaluated the COVID-19 impact on daily routines, treatment, and cancer care through a questionnaire. RESULTS: Fifty patients were included. The HADS mean score and estimated rates were 4.34 (±4.06)/22% for anxiety and 5.08 (±4.82)/22% for depression; in comparison, our historical control had 4.04 (±3.59)/20% for anxiety (p = .79) and 4.03 (±3.62)/17% for depression (p = .49). Mean DT score was 3.68 (±2.77). Responders were aware of COVID-19, afraid of having medical complications, believed it was life-threatening, did not miss appointments, believed their treatment was not impacted, and felt safe at the hospital amid the pandemic. CONCLUSION: This study suggests that anxiety, depression, and distress levels found in RT-HNC patients did not increase during the pandemic. Patients were afraid of being infected by COVID-19; however, they complied with their cancer treatment.

This communication discusses the current challenges of oral mucositis (OM) management during the pandemic COVID-19 outbreak and reflects about an extraoral photobiomodulation protocol as an optimal alternative for preventing and treating OM in advanced cancer patients while minimizing the risk of infection by avoiding intraoral manipulation.

Background Photobiomodulation therapy (PBMT) has increasingly been used to manage oral toxicities secondary to cancer treatment; however, its impact on the stimulation of malignant cells is currently unknown. Objective This 4-arm, double-blind, phase III randomized controlled clinical trial (RBR-4w4wwx) was designed to assess the impact of prophylactic PBMT for oral and oropharyngeal mucositis (OM) in the survival rates of patients with oral and oropharyngeal squamous cell carcinoma (OPSCC). Methods Patients were randomly allocated to 4 groups: intraoral prophylactic PBMT (G1), placebo intraoral PBMT (G2), extraoral prophylactic PBMT (G3), and placebo extraoral PBMT (G4). OM grade (NCI) and OM-associated pain (EVA scale) were assessed weekly during OPSCC treatment. Tumor outcomes were evaluated quarterly during 12 months. Data analysis was performed using descriptive statistics. Results A total of 45 OPSCC patients were included. OM peak ulcerations (grade 2 or higher) were observed at week 3 for G1, G2, and G4 and at week 5 for G3. Placebo groups had the highest levels of pain when compared with the treatment/intervention groups (P Conclusions No negative impact of prophylactic PBMT for OM could be detected in terms OPSCC treatment outcomes.

The epithelial to mesenchymal transition (EMT) is the process, in which, the neoplastic cells lose epithelial phenotype, assuming a mesenchymal aspect. Among the proteins that contribute to EMT in oral squamous cell carcinoma (OSCC) there are E-cadherin and N-cadherin. Objective: To evaluate the protein expression of E-cadherin and N-cadherin after exposure to methyl-beta-cyclodextrin (MβCD) in OSCC cell line (SCC-9). Study Design: Protein expression was determined by Western blotting and immunofluorescence. Results: The cholesterol depletion resulted in the change of cell morphology, with the acquisition of mesenchymal phenotype. The protein expression of the cadherins in the treated SCC-9 was shown to be increased in relation to the parental sample. No difference was observed in E-cadherin and N-cadherin expression (P = .543 and P = .849 respectively, Kruskal-Wallis Test). Although the negative correlation was not statistically significant (P = .898; r = -0.08, Pearson), N-cadherin showed the highest median expression (median = 2557; SD = 0.261) in relation to E-cadherin (median = 4575; SD = 1.581). Furthermore, a decreased of E-cadherin membrane expression, and nuclear and cytoplasmic N-cadherin expression gain was observed on the immunofluorescence. Conclusions: The present study demonstrated that cholesterol depletion is able to regulate the protein expression of E-cadherin and N-cadherin, favoring EMT in OSCC.

A 60-year-old male patient with a history of chronic drinking and smoking was diagnosed as having squamous cell carcinoma on the tongue beyond surgical therapeutic possibility. Radiotherapy and chemotherapy were indicated. After the fifth cycle of chemotherapy concomitant with radiotherapy, the patient reported pain in the oral cavity, which worsened after the use of methotrexate to treat peripheral neuropathy. The condition progressed to extensive oral ulcers requiring the use of a nasogastric tube for feeding. Low-intensity laser (AsGaAl, 680 nm, 2 J/cm2) was applied on the ulcers in a punctual and continuous manner. After 4 sessions, there was a significant improvement of the condition, with catheter removal and the patient being released from the hospital. The laser therapy proved to be effective in the treatment of oral mucositis lesions, reducing the pain and severity of the lesions, being a noninvasive and safe form of treatment.