SAN ANTONIO (FRONTLINE MEDICAL NEWS)Low-level laser therapy proved highly effective in managing chemotherapy-induced oral mucositis in a retrospective study.

Although this was the first study of low-level laser therapy in breast cancer patients, this form of therapy is already widely used to prevent and treat oral mucositis in hematopoietic stem cell transplant recipients as well as in patients with head and neck cancer. These preliminary findings in a breast cancer population warrant confirmation in a randomized controlled trial, Sandrine Censabella, Ph.D., said at the San Antonio Breast Cancer Symposium.

Roughly 40% of patients develop oral mucositis as a consequence of standard-dose chemotherapy. Oral mucositis is the most debilitating, severe, and costly nonhematologic complication of oncologic therapy. It compromises both quality of life and treatment outcomes, said Dr. Censabella of Jessa Hospital in Hasselt, Belgium.

She reported on 93 patients with stage 0-IV breast cancer and chemotherapy-induced oral mucositis who received low-level laser therapy using a gallium arsenide laser at 665-nm wavelength and 100 mW of output power combined with a continuous-emission infrared laser with an output power of 500 mW. The laser energy, 4 J per application point, was delivered via a 600-mcm optical fiber.

The treatment schedule was two sessions per week until lesion healing occurred. Depending on the extent of the oral mucositis, up to seven oral sites could be treated: lips, tongue, palate, inside of the two cheeks, tonsils, and mouth floor.

Outcomes were assessed in a standardized fashion by trained nurses using the World Health Organization 0-4 grading scale, where 0 means unaffected, 1 represents soreness and erythema, 2 means erythema and ulcers but with an ability to eat solid foods, 3 is for patients with ulcers who require a liquid diet only, and 4 is for patients incapable of oral nutritional intake. In addition, investigators calculated an oral mucositis score for every patient by adding up the WHO grades at all affected sites.

Laser therapy began a mean of 49 days after the start of chemotherapy, which was anthracycline based in two-thirds of cases. The mean age of the women was 54.8 years.

Subjects received a mean of 5.7 laser treatment sessions, during which they showed a significant reduction in oral mucositis severity. At baseline, 60% of patients had WHO grade 2 lesions, a rate that dropped to 30% at the end of treatment several weeks later. While only 12% of patients were WHO grade 1 at baseline, 65% were at the conclusion of the laser treatment program. Twenty-eight percent of women were WHO grade 3 at entry, compared with just 5.4% after laser treatment.

The mean baseline combined oral mucositis score averaged 6.6, improving to 2.78 at treatment’s end.

Self-reported pain scores improved from 5.14 at baseline on a 10-point scale to 1.64 at the conclusion of laser therapy.

At the end of laser therapy, only 2% had a worse WHO grade than at baseline, 8.6% had a worse composite oral mucositis score, and no one reported more pain than at entry.

“These findings are the first to document a beneficial effect of low-level laser therapy in a large group of breast cancer patients and suggest that low-level laser therapy might become a standard management for oral mucositis in all cancer patients,” Dr. Censabella said.

She reported having no financial conflicts regarding this study.