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PURPOSE: This study aimed to evaluate the efficacy of 1W extraoral photobiomodulation (EOPBM) and to compare with our previous results of 2W EOPBM and intraoral photobiomodulation (IOPBM) protocols in the management of oral mucositis (OM) related to hematopoietic stem cell transplantation (HSCT). METHODS: A total of 30 patients underwent autologous or allogenic HSCT. Experimental protocol of 1W EOPBM was performed daily beginning in the first day of the conditioning regimen until 5 days after transplantation. The application areas included six points on the face and three points on the cervical area. Additional application of IOPBM was performed if patients had ulcered mucositis. Its severity was assessed daily according to WHO (World Health Organization) and NCI (National Cancer Institute) scales. Oral and oropharynx pains were scored daily by visual analogue scale (VAS). RESULTS: The 1W EOPBM protocol was well tolerated without any complaints. Of total, 13 patients were male and 17 were female and the mean age was 49.3 years old. Most patients (21 patients - 70%) received autologous HSCT, and 24 patients (80%) underwent myeloablative conditioning (MAC) regime and 6 patients (20%) reduced intensive conditioning regime. Nineteen patients (63.3%) developed OM according to WHO criteria, 3 patients grade I, 10 grade II and 6 grade III. NCI mucositis grades were similar to WHO grades. OM outcomes of 1W EOPBM were similar when compared to our previous groups and no significant differences were observed. No differences were found between pain and the protocols (1W EOPBM, IOPBM and 2W EOPBM). CONCLUSION: This 1W EOPBM protocol seemed to be as effective as IOPBM and 2W EOPBM in the prevention of OM in HSCT patients. In addition, we might assume that there is a window of application on EOPBM.

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To compare the efficacy of intraoral and extraoral photobiomodulation (PBM) protocols for the prevention of oral mucositis (OM) in hematopoietic stem cell transplantation (HSCT) patients. A total of 60 patients was randomized into intraoral PBM (IOPBM) and extraoral PBM (EOPBM) groups. Both PBM protocols were well tolerated and no side effects were observed. EOPBM session times were one fourth of IOPBM durations. Of 60 patients, 35 (58.3%) developed ulcerated OM between day +3 and day +12. No intergroup difference was observed in OM healing times (p = 0.424). The lateral border of the tongue was the most common site affected in both groups. However, the incidence of mucositis on buccal mucosa was significantly reduced in the EOPBM group (p = 0.021). Young patients (OR.5.35, 95%CI 0.94-30.4, p = 0.058) and those who had received myeloablative conditioning (OR.55.1, 95%CI 2.69-1129.3, p = 0.009) were more likely to develop ulcerated OM, whereas autologous HSCT recipients (OR 0.079, 95% CI 0.009-0.67, p = 0.021) had a lower probability of developing ulcerated OM independent of PBM protocol. EOPBM protocol was as effective as IOPBM in the management of OM in HSCT patients, with the advantage of shorter treatment sessions. Trial registration number: RBR-7nww56. Date of trial registration submission: 30th September 2019.

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A mucosite oral (MO) é a condição aguda mais frequente em pacientes submetidos ao transplante de células tronco hematopoiéticas (TCTH). Há um consenso sobre os protocolos preventivos de fotobiomodulação (FBM) utilizando lasers de baixa potência intraorais na redução da intensidade da MO. Entretanto, existe a possibilidade de que uma aplicação extraoral possa reduzir o tempo de sessão da FBM e ser mais efetivo no manejo da mucosite em região orofaríngea. Este estudo teve como objetivo comparar a eficácia de dois protocolos de FBM (intraoral e extraoral) na prevenção da MO em pacientes submetidos ao TCTH. Sessenta pacientes foram estratificados em dois grupos: Grupo intraoral (FBIO - 660 nm, 100 mW, 0.03 cm2, 33,3 J/cm2, 10s /ponto) e Grupo extraoral (FBEO - 810 + 980 nm, 2000 mW, 4,07 J/cm2, 4,91 cm2, 10s /ponto) através de uma randomização pelas variáveis de sexo, idade, tipo de TCTH e tipo de condicionamento. Todos os pacientes foram avaliados diariamente e a MO foi classificada pelas escalas da OMS e NCI. Além disso, foram avaliadas as mucosas orais afetadas pela MO ulcerada, a dor em boca e em orofaringe e o tempo de sessão. Todos os protocolos de FBM foram bem tolerados e nenhum efeito adverso foi observado. O tempo de sessão do grupo FBEO foi quatro vezes menor que o FBIO. Dos 60 pacientes, 35 (58,3%) desenvolveram MO ulcerada entre os dias +3 e +12 após o transplante. Nenhuma diferença foi observada entre os grupos de acordo com o período de cicatrização da MO (p=0,424). A borda lateral de língua foi o local mais afetado pela MO ulcerada em ambos os grupos. Entretanto, a mucosa jugal foi significativamente menos afetada no grupo FBEO (p=0,021). Pacientes jovens (OR. 5,35, 95%CI 0,94-30,4, p=0,058) e aqueles submetidos ao condicionamento MA (OR. 55,1, 95%CI 2,69-1129,3, p=0,009) tiveram maiores chances de desenvolver a MO ulcerada, enquanto que os pacientes submetidos ao TCTH autólogo (OR 0,079, 95% CI 0,009-0,67, p= 0,021) tiveram uma menor chance independentemente do protocolo de FBM. A FBEO foi tão efetiva quanto a FBIO no manejo da MO em pacientes submetidos ao TCTH com a vantagem de ser um protocolo mais rápido e por controlar melhor a MO na mucosa jugal.

Oral mucositis (OM) is the most frequent acute complication during the conditioning regimen in the patients submitted to hematopoietic stem cell transplantation (HSCT). There is a consensus about preventive protocols of photobiomodulation (PBM) using intraoral low-level laser for reducing the rates and intensity of OM. However, there is a possibility that extraoral application may reduce the time of PBM sessions and may be more effective in the management of OM on the oropharyngeal area. The purpose of this study was to compare the efficacy of intraoral and extraoral photobiomodulation protocols on oral mucositis in HSCT patients. A total of sixty patients were stratified into two groups of PBM: intraoral group (660 nm, 100 mW, 0.03 cm2, 33,3 J/cm2, 10s/per point) and extraoral group (810 + 980 nm, 2000 mW, 4,07 J/cm2, 4,91 cm2, 10s/ per point) from randomization according to sex, age, type of graft and type of conditioning regimen. All the patients were evaluated daily and OM classified according to the WHO and NCI scales. In addition, the oral mucosal sites affected by ulcerated mucositis, oral pain, and throat pain (VAS scale), and the time of session were also evaluated. All PBM protocols were well tolerated for both groups and no side effects were observed. Extraoral protocol session times were one-fourth of IOPBM durations. Of 60 patients, 35 (58.3%) developed ulcerated OM between day +3 and day +12. No difference was observed between groups regarding the period of OM healing times (p=0.424). The lateral border of tongue was the most common OM site observed in both groups. However, buccal mucosa was significantly reduced in the extraoral group (p=0.021). Young patients (OR.5.35, 95%CI 0.94-30.4, p=0.058) and those submitted to MAC (OR.55.1, 95%CI 2.69-1129.3, p=0.009) had a higher chances of develop ulcerated OM, whereas autologous recipients (OR 0.079, 95% CI 0.009-0.67, p= 0.021) had a lower chances of develop ulcerated OM independently of PBM protocol used. Extraoral PBM protocol was as effective as intraoral in the management of OM in HSCT patients with the advantage of being a faster protocol and better control of the buccal mucosa lesions

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Humans may be exposed to pesticides such as fungicides, herbicides, and insecticides, during occupational and non-occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science, and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred and thirty-two studies were identified. Thirty-two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high-quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure, and type of pesticide.

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