RESUMO
Photobiomodulation therapy (PBMT) is widely used in oncology settings, but lack of assessment standardization is the main barrier to optimization of clinical protocols. This study analyzed three PBMT protocols for preventing oral and oropharyngeal mucositis (OM) in patients undergoing chemotherapy (CT) and/or hematopoietic stem cell transplantation (HSCT). This is a preliminary randomized blind clinical trial. Group 1 received intraoral prophylactic PBMT, Group 2 received intraoral and oropharyngeal PBMT, and Group 3 received intraoral, oropharyngeal, and extraoral PBMT. The applications were from the first day of CT to day + 10. Clinicodemographic data, CT regimens, types of HSCT, hematological exams, occurrence/severity of OM, odynophagia, and OM-related opportunistic infections were assessed. Sixty participants (age range: 18-74 years) were included; 70% of them underwent CT and 30% HSCT. About 43.3% of patients had OM, while odynophagia was reported by 23.3%. Both Groups 1 and 2 revealed better results. Multivariate analysis showed that HSCT directly influenced the occurrence of OM. Individuals who had undergone allogeneic HSCT were 1.93 times more likely to develop OM (p < 0.001). Group 3 exhibited a higher frequency of OM, albeit of lower grades. This group consisted of half the population who had undergone HSCT, had the highest percentage of melphalan use, and had the lowest mean leukocyte count. The three proposed protocols were effective in preventing and reducing OM, with good tolerance and no reported adverse effects. PBMT is a safe and effective approach to OM prophylaxis in adults undergoing CT/HSCT.
Assuntos
Terapia com Luz de Baixa Intensidade , Mucosite , Estomatite , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Antineoplásicos/efeitos adversos , Transplante de Células-Tronco Hematopoéticas , Terapia com Luz de Baixa Intensidade/métodos , Melfalan/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estomatite/induzido quimicamente , Estomatite/prevenção & controleRESUMO
A terapia de fotobiomodulação (TFBM) é amplamente utilizada em contextos oncológicos, mas a falta de padronização das avaliações é a principal barreira para otimizar os protocolos clínicos. Este estudo tem o objetivo de investigar os efeitos clínicos frente a utilização da TFBM na prevenção da mucosite oral e orofaríngea (MO) induzida por quimioterápicos e e/ou transplante de células-tronco hematopoiéticas (TCTH) em pacientes adultos. Foi realizado um ensaio clínico randomizado, no qual os participantes foram designados para três grupos de TFBM. O Grupo 1 recebeu TFBM profilática intraoral, o Grupo 2 recebeu TFBM intraoral e orofaríngea, e o Grupo 3 recebeu TFBM intraoral, orofaríngea e extraoral, desde o primeiro dia da infusão de QT até o dia D+10. Foram avaliadas a ocorrência e gravidade da MO, odinofagia e presença de sinais de infecções na cavidade oral. Também foram avaliadas informações sobre o regime de QT, tipo de TCTH, doença de base, exames hematológicos e dados sociodemográficos. Foram incluídos no estudo 60 pacientes. A distribuição por gênero foi igual (50%) em toda a amostra e a faixa etária variou de 18 a 74 anos. 70% dos indivíduos foram submetidos apenas à QT, enquanto 30% foram submetidos a TCTH. O agente quimioterápico mais utilizado foi a Citarabina (43,3%). A MO foi observada em 43,3% dos pacientes, principalmente nos graus I e II. A odinofagia foi relatada em apenas 23,3% dos indivíduos. A mucosa jugal foi o local mais afetado pela MO (35%). Na análise multivariada, observou-se que o tipo de TCTH influenciou diretamente a ocorrência da MO. Os indivíduos submetidos a TCTH alogênico tiveram 1,93 vezes mais chances de desenvolver MO (p <0,001). O Grupo 3 apresentou uma frequência maior de MO, embora em graus menores. Além disso, esse grupo era composto por metade da população submetida a TCTH, tinha a maior porcentagem de uso de melfalano e a menor contagem média de leucócitos. Todos os três protocolos demonstraram eficácia na prevenção e redução da MO, apresentando boa tolerância e nenhuma toxicidade relatada. Defendemos a utilização da TFBM como uma abordagem segura e eficaz para a profilaxia da MO induzida pela QT em adultos submetidos a QT/TCTH.
Photobiomodulation Therapy (PBMT) is widely used in oncological contexts, but the lack of standardized evaluations is the main barrier to optimizing clinical protocols. This study aims to investigate the clinical effects of PBMT in the prevention of oral and oropharyngeal mucositis (OM) induced by chemotherapy and/or hematopoietic stem cell transplantation (HSCT) in adult patients, as well as to explore and correlate potential risk factors associated with this toxicity. A randomized clinical trial was conducted, in which participants were assigned to three PBMT groups. Group 1 received intraoral prophylactic PBMT, Group 2 received intraoral and oropharyngeal PBMT, and Group 3 received intraoral, oropharyngeal, and extraoral PBMT from the first day of chemotherapy infusion until D+10. The occurrence and severity of OM, odynophagia, and the presence of signs of oral cavity infections were evaluated. Information regarding the chemotherapy regimen, type of HSCT, underlying disease, hematological examinations, and sociodemographic data were also assessed. The study included 60 patients. Gender distribution was equal (50%) across the entire sample, and the age range varied from 18 to 74 years. 70% of individuals underwent chemotherapy alone, while 30% underwent HSCT. The most commonly used chemotherapeutic agent was Cytarabine (43.3%). OM was observed in 43.3% of patients, mainly in grades I and II. Odynophagia was reported in only 23.3% of individuals. The buccal mucosa was the most affected site by OM (35%). In the multivariate analysis, it was observed that the type of HSCT directly influenced the occurrence of OM. Individuals undergoing allogeneic HSCT had 1.93 times more chances of developing OM (p <0.001). Group 3 presented a higher frequency of OM, although in milder grades. Additionally, this group consisted of half of the population who underwent HSCT, had the highest percentage of melphalan use, and the lowest mean leukocyte count. All three protocols exhibited efficacy in the prevention and reduction of OM, displaying good tolerance and no reported toxicity. We assert the utilization of PBMT as a safe and effective approach for CT-induced OM prophylaxis in adults undergoing CT/HSCT.