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Low energy Helium-Neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial.

Abstract

PURPOSE

To evaluate the efficiency of Helium-Neon (He-Ne) laser in the prevention of oral mucositis induced by high dose chemoradiotherapy before autologous bone marrow transplantation (BMT).

METHODS AND MATERIALS

Between 1993 and 1995, 30 consecutive patients receiving an autologous peripheral stem-cell or bone marrow transplant (BMT) after high dose chemoradiotherapy were randomized to possibly receive prophylactic laser to the oral mucosa after giving informed consent. Chemotherapy consisted of cyclophosphamide, 60 mg/kg intravenously (I.V.) on day (d)-5 and d-4 in 27 cases, or melphalan 140 mg/kg I.V. on d-4 in three cases. Total body irradiation (TBI) consisted of 12 Gy midplane dose in six fractions (4 Gy/day for three days). He-Ne laser (632.8 nm wavelength, power 60 mW) applications were performed daily from d-5 to d-1 on five anatomic sites of the oral mucosa. Oral examination was performed daily from d0 to d + 20. Mucositis was scored according to an oral exam guide with a 16 item scale of which four were assessed by the patients themselves. Mean daily self assessment scores for oral pain, ability to swallow and oral dryness were measured. A daily mucositis index (DMI) and a cumulative oral mucositis score (COMS) were established. Requirement for narcotics and parenteral nutrition was recorded.

RESULTS

The COMS was significantly reduced among laser treated (L+) patients (p = 0.04). The improvement of DMI in L+ patients was also statistically significant (p < 0.05) from d + 2 to d + 7. Occurrence and duration of grade III oral mucositis were reduced in L+ patients (p = 0.01). Laser applications reduced oral pain as assessed by patients (p = 0.05) and L+ patients required less morphine (p = 0.05). Xerostomia and ability to swallow were improved among the L+ patients (p = 0.005 and p = 0.01, respectively). Requirement for parenteral nutrition was not reduced (p = NS).

CONCLUSION

Helium-Neon laser treatment was well tolerated, feasible in all cases, and reduced high dose chemoradiotherapy-induced oral mucositis. Optimal laser treatment schedules still needs to be defined.

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  • Authors+Show Affiliations

    ,

    Department of Radiotherapy, Institut Paoli-Calmettes, Cancer Center, Marseilles, France.

    , , , , ,

    Source

    MeSH

    Adolescent
    Adult
    Antineoplastic Combined Chemotherapy Protocols
    Bone Marrow Transplantation
    Case-Control Studies
    Double-Blind Method
    Female
    Helium
    Humans
    Laser Therapy
    Leukemia, Myeloid, Acute
    Lymphoma, Non-Hodgkin
    Male
    Middle Aged
    Mouth Mucosa
    Multiple Myeloma
    Neon
    Pain Measurement
    Precursor Cell Lymphoblastic Leukemia-Lymphoma
    Stomatitis
    Transplantation Conditioning
    Whole-Body Irradiation

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    9240635

    Citation

    Cowen, D, et al. "Low Energy Helium-Neon Laser in the Prevention of Oral Mucositis in Patients Undergoing Bone Marrow Transplant: Results of a Double Blind Randomized Trial." International Journal of Radiation Oncology, Biology, Physics, vol. 38, no. 4, 1997, pp. 697-703.
    Cowen D, Tardieu C, Schubert M, et al. Low energy Helium-Neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. Int J Radiat Oncol Biol Phys. 1997;38(4):697-703.
    Cowen, D., Tardieu, C., Schubert, M., Peterson, D., Resbeut, M., Faucher, C., & Franquin, J. C. (1997). Low energy Helium-Neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. International Journal of Radiation Oncology, Biology, Physics, 38(4), pp. 697-703.
    Cowen D, et al. Low Energy Helium-Neon Laser in the Prevention of Oral Mucositis in Patients Undergoing Bone Marrow Transplant: Results of a Double Blind Randomized Trial. Int J Radiat Oncol Biol Phys. 1997 Jul 1;38(4):697-703. PubMed PMID: 9240635.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low energy Helium-Neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. AU - Cowen,D, AU - Tardieu,C, AU - Schubert,M, AU - Peterson,D, AU - Resbeut,M, AU - Faucher,C, AU - Franquin,J C, PY - 1997/7/1/pubmed PY - 1997/7/1/medline PY - 1997/7/1/entrez SP - 697 EP - 703 JF - International journal of radiation oncology, biology, physics JO - Int. J. Radiat. Oncol. Biol. Phys. VL - 38 IS - 4 N2 - PURPOSE: To evaluate the efficiency of Helium-Neon (He-Ne) laser in the prevention of oral mucositis induced by high dose chemoradiotherapy before autologous bone marrow transplantation (BMT). METHODS AND MATERIALS: Between 1993 and 1995, 30 consecutive patients receiving an autologous peripheral stem-cell or bone marrow transplant (BMT) after high dose chemoradiotherapy were randomized to possibly receive prophylactic laser to the oral mucosa after giving informed consent. Chemotherapy consisted of cyclophosphamide, 60 mg/kg intravenously (I.V.) on day (d)-5 and d-4 in 27 cases, or melphalan 140 mg/kg I.V. on d-4 in three cases. Total body irradiation (TBI) consisted of 12 Gy midplane dose in six fractions (4 Gy/day for three days). He-Ne laser (632.8 nm wavelength, power 60 mW) applications were performed daily from d-5 to d-1 on five anatomic sites of the oral mucosa. Oral examination was performed daily from d0 to d + 20. Mucositis was scored according to an oral exam guide with a 16 item scale of which four were assessed by the patients themselves. Mean daily self assessment scores for oral pain, ability to swallow and oral dryness were measured. A daily mucositis index (DMI) and a cumulative oral mucositis score (COMS) were established. Requirement for narcotics and parenteral nutrition was recorded. RESULTS: The COMS was significantly reduced among laser treated (L+) patients (p = 0.04). The improvement of DMI in L+ patients was also statistically significant (p < 0.05) from d + 2 to d + 7. Occurrence and duration of grade III oral mucositis were reduced in L+ patients (p = 0.01). Laser applications reduced oral pain as assessed by patients (p = 0.05) and L+ patients required less morphine (p = 0.05). Xerostomia and ability to swallow were improved among the L+ patients (p = 0.005 and p = 0.01, respectively). Requirement for parenteral nutrition was not reduced (p = NS). CONCLUSION: Helium-Neon laser treatment was well tolerated, feasible in all cases, and reduced high dose chemoradiotherapy-induced oral mucositis. Optimal laser treatment schedules still needs to be defined. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/9240635/Low_energy_Helium_Neon_laser_in_the_prevention_of_oral_mucositis_in_patients_undergoing_bone_marrow_transplant:_results_of_a_double_blind_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S036030169700076X DB - PRIME DP - Unbound Medicine ER -