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Support Care Cancer. 2019 Jul 8. doi: 10.1007/s00520-019-04890-2. [Epub ahead of print]

Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines.

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Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel.
Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, P.O.Box 12272, Jerusalem, 9112102, Israel.
Department of Oral Biology and Biomedical Engineering, School of Dental Medicine, Engineering and Applied Sciences, University at Buffalo, 3435 Main Street, B36A Foster Hall, Buffalo, NY, 14214, USA.
Oral Medicine Service, Hospital Sírio-Libanês São Paulo, São Paulo, Brazil.
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy.
Clinical Research Division, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil.
Gérant, Responsable de Service, Centre de Haute Energie, Nice, France.
Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, PE, Brazil.
University of Bresciam, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental Clinic Oral Medicine, Brescia, Italy.
Griffith University and Gold Coast University Hospital, Southport, Australia.
Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA.
Division of Pediatric Oncology/Hematology/Immunology, Beatrix Childrens Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
Departments of Physics and Chemistry, Bar-Ilan University, Ramat-Gan, Israel.
College of Dentistry, University of Florida, Gainesville, FL, USA.
Section of Oral Medicine, University of Connecticut Health, Farmington, CT, USA.
Yong Loo Lin School of Medicine, Clinical Research Centre, National University of Singapore, Level 2, Singapore, Singapore.



To systematically review the literature and update the evidence-based clinical practice guidelines for the use of photobiomodulation (PBM), such as laser and other light therapies, for the prevention and/or treatment of oral mucositis (OM).


A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) using PubMed and Web of Science. We followed the MASCC methods for systematic review and guidelines development. The rigorously evaluated evidence for each intervention, in each cancer treatment setting, was assigned a level-of-evidence (LoE). Based on the LoE, one of the following guidelines was determined: Recommendation, Suggestion, or No Guideline Possible.


Recommendations are made for the prevention of OM and related pain with PBM therapy in cancer patients treated with one of the following modalities: hematopoietic stem cell transplantation, head and neck (H&N) radiotherapy (without chemotherapy), and H&N radiotherapy with chemotherapy. For each of these modalities, we recommend 1-2 clinically effective protocols; the clinician should adhere to all parameters of the protocol selected. Due to inadequate evidence, currently, No Guideline Possible for treatment of established OM or for management of chemotherapy-related OM. The reported clinical settings were extremely variable, limiting data integration.


The evidence supports the use of specific settings of PBM therapy for the prevention of OM in specific patient populations. Under these circumstances, PBM is recommended for the prevention of OM. The guidelines are subject to continuous update based on new published data.


Cancer; Chemotherapy; Evidence-based; Guidelines; LED; LLLT; Laser therapy; Low-level laser therapy; Oral complications of cancer therapy; Oral mucositis; Pain; Photobiomodulation; Photobiostimulation; Prevention; Radiotherapy; Stomatitis; Treatment


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