Low Level Laser Therapy Against Radiation Induced Oral Mucositis in Elderly Head and Neck Cancer Patients-a Randomized Placebo Controlled Trial

Objectives: Radiotherapy (RT) is treatment of choice for Elderly Head and Neck Cancer (HNC) patients. Oral mucositis (OM) during RT affects patient's routine oral activities and overall health. Low Level Laser Therapy (LLLT) provided some promising results against cancer therapy induced OM in children and adults. No study specifically evaluated effects of LLLT against RT induced OM in elderly HNC patients until date, hence we did this study.

Material And Methods: This double blinded study randomized 46 elderly HNC patients scheduled for RT [Dosage=66 Gray (2 Gy/fraction), 5 fractions/week, total 33 fractions for 6.5 weeks], into laser (22) and placebo (24) groups. Laser group patients received LLLT [Helium-Neon, λ=632.8 nm, power density=0.024 W/cm(2), dosage=3.0 J/point at six anatomical sites bilaterally i.e. 12 locations, total dose/session=36 J, beam aperture diameter=0.6 mm, beam spot size=1 cm(2), irradiated area diameter=1 cm(2), irradiation time/point=125 s, 5 sessions/week, non-contact method-distance between probe and irradiated tissues <1 cm, whereas placebo group did not receive laser. OM grades (RTOG/EORTC Scale), oral pain, weight loss, need for morphine analgesics and tube feeding, and RT break were recorded by a blinded assessor. Descriptive statistics and repeated measures ANOVA were used for analysis keeping p<0.05.

Results: Significant reduction in the incidence and duration of severe OM (p=0.016) and severe pain (p=0.023) and weight loss (p=0.004) was observed in laser than placebo group. No difference was found for enteral feeding use (p=0.667) between two groups.

Conclusions: LLLT decreased the severity of OM and oral pain in elderly HNC patients. Also, lesser weight loss, morphine analgesic use and radiation break happened in laser group.