Monte Carlo Based Dosimetry of Extraoral Photobiomodulation for Prevention of Oral Mucositis

Overview

Journal Sci Rep

Specialty Science

Date 2023 Nov 22

PMID 37993500

Authors

Anna N Yaroslavsky

Tyler W Iorizzo

Amy F Juliano

Ather Adnan

James D Carroll

Stephen T Sonis

Christine N Duncan

Wendy B London

Nathaniel S Treister

Affiliations

Soon will be listed here.

Abstract

Photobiomodulation therapy (PBMT) is recommended for prevention and treatment of oral mucositis, a painful condition that occurs in cancer patients. Intraoral PBMT is limited to treating distal oral mucosa and oropharynx. Extraoral PBMT may provide a more efficient intervention. The goal of this study was to develop a clinically viable protocol for extraoral PBMT. Monte Carlo modeling was used to predict the distribution of 850 nm light for four treatment sites, using anatomical data obtained from MRI and optical properties from the literature. Simulated incident light power density was limited to 399 mW/cm to ensure treatment safety and to prevent tissue temperature increase. The results reveal that total tissue thickness determines fluence rate at the oral mucosa, whereas the thickness of individual tissue layers and melanin content are of minor importance. Due to anatomical differences, the fluence rate varied greatly among patients. Despite these variations, a universal protocol was established using a median treatment time methodology. The determined median treatment times required to deliver efficacious dose between 1 and 6 J/cm were within 15 min. The developed PBMT protocol can be further refined using the combination of pretreatment imaging and the Monte Carlo simulation approach implemented in this study.

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References

Lalla R, Brennan M, Gordon S, Sonis S, Rosenthal D, Keefe D . Oral Mucositis Due to High-Dose Chemotherapy and/or Head and Neck Radiation Therapy. J Natl Cancer Inst Monogr. 2019; 2019(53). DOI: 10.1093/jncimonographs/lgz011. View

Sperandio F, Giudice F, Correa L, Pinto Jr D, Hamblin M, de Sousa S . Low-level laser therapy can produce increased aggressiveness of dysplastic and oral cancer cell lines by modulation of Akt/mTOR signaling pathway. J Biophotonics. 2013; 6(10):839-47. PMC: 3788041. DOI: 10.1002/jbio.201300015. View

Adnan A, Yaroslavsky A, Carroll J, Selting W, Juliano A, London W . The Path to an Evidence-Based Treatment Protocol for Extraoral Photobiomodulation Therapy for the Prevention of Oral Mucositis. Front Oral Health. 2022; 2:689386. PMC: 8757848. DOI: 10.3389/froh.2021.689386. View

Cronshaw M, Parker S, Anagnostaki E, Mylona V, Lynch E, Grootveld M . Photobiomodulation and Oral Mucositis: A Systematic Review. Dent J (Basel). 2020; 8(3). PMC: 7559189. DOI: 10.3390/dj8030087. View

Keijzer M, Jacques S, Prahl S, Welch A . Light distributions in artery tissue: Monte Carlo simulations for finite-diameter laser beams. Lasers Surg Med. 1989; 9(2):148-54. DOI: 10.1002/lsm.1900090210. View

Holder N, Shiner B, Li Y, Madden E, Neylan T, Seal K . Cognitive Processing Therapy for Veterans with Posttraumatic Stress Disorder: What is the Median Effective Dose?. J Affect Disord. 2020; 273:425-433. DOI: 10.1016/j.jad.2020.04.030. View

Elad S, Cheng K, Lalla R, Yarom N, Hong C, Logan R . MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020; 126(19):4423-4431. PMC: 7540329. DOI: 10.1002/cncr.33100. View

Matsuo K, Suzuki H, Yatagai N, Enomoto Y, Kitayama M, Shigeoka M . Red LED Light Is Influenced by IL-6 to Promote the Migration Ability of Oral Squamous Cell Carcinoma Cell Line. Kobe J Med Sci. 2019; 64(6):E210-E216. PMC: 6668650. View

Patel P, Robinson P, Baggott C, Gibson P, Ljungman G, Massey N . Clinical practice guideline for the prevention of oral and oropharyngeal mucositis in pediatric cancer and hematopoietic stem cell transplant patients: 2021 update. Eur J Cancer. 2021; 154:92-101. DOI: 10.1016/j.ejca.2021.05.013. View

10.

Chung H, Dai T, Sharma S, Huang Y, Carroll J, Hamblin M . The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2011; 40(2):516-33. PMC: 3288797. DOI: 10.1007/s10439-011-0454-7. View

11.

Courtois E, Bouleftour W, Guy J, Louati S, Bensadoun R, Rodriguez-Lafrasse C . Mechanisms of PhotoBioModulation (PBM) focused on oral mucositis prevention and treatment: a scoping review. BMC Oral Health. 2021; 21(1):220. PMC: 8086292. DOI: 10.1186/s12903-021-01574-4. View

12.

Zadik Y, Arany P, Fregnani E, Bossi P, Spindola Antunes H, Bensadoun R . Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019; 27(10):3969-3983. DOI: 10.1007/s00520-019-04890-2. View

13.

Gomes Henriques A, Ginani F, Oliveira R, Keesen T, Barboza C, Rocha H . Low-level laser therapy promotes proliferation and invasion of oral squamous cell carcinoma cells. Lasers Med Sci. 2014; 29(4):1385-95. DOI: 10.1007/s10103-014-1535-2. View

14.

Curra M, Pellicioli A, Kretzmann Filho N, Ochs G, Matte U, Filho M . Photobiomodulation reduces oral mucositis by modulating NF-kB. J Biomed Opt. 2016; 20(12):125008. DOI: 10.1117/1.JBO.20.12.125008. View

15.

Schartinger V, Galvan O, Riechelmann H, Dudas J . Differential responses of fibroblasts, non-neoplastic epithelial cells, and oral carcinoma cells to low-level laser therapy. Support Care Cancer. 2011; 20(3):523-9. DOI: 10.1007/s00520-011-1113-0. View

16.

Scully C, Sonis S, Diz P . Oral mucositis. Oral Dis. 2006; 12(3):229-41. DOI: 10.1111/j.1601-0825.2006.01258.x. View

17.

Zeidan A, Mazoit J, Ali Abdullah M, Maaliki H, Ghattas T, Saifan A . Median effective dose (ED₅₀) of paracetamol and morphine for postoperative pain: a study of interaction. Br J Anaesth. 2013; 112(1):118-23. DOI: 10.1093/bja/aet306. View

18.

Delage N, Maaliki H, Beloeil H, Benhamou D, Mazoit J . Median effective dose (ED50) of nefopam and ketoprofen in postoperative patients: a study of interaction using sequential analysis and isobolographic analysis. Anesthesiology. 2005; 102(6):1211-6. DOI: 10.1097/00000542-200506000-00022. View

19.

Yaroslavsky A, Juliano A, Adnan A, Selting W, Iorizzo T, Carroll J . Validation of a Monte Carlo Modelling Based Dosimetry of Extraoral Photobiomodulation. Diagnostics (Basel). 2021; 11(12). PMC: 8700113. DOI: 10.3390/diagnostics11122207. View

20.

Robijns J, Nair R, Lodewijckx J, Arany P, Barasch A, Bjordal J . Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol. 2022; 12:927685. PMC: 9468822. DOI: 10.3389/fonc.2022.927685. View