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

PurposeTo systematically review the literature and update the evidence-based clinical practice guidelines for the use ofphotobiomodulation (PBM), such as laser and other light therapies, for the prevention and/or treatment of oral mucositis (OM).MethodsA systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Carein Cancer/International Society for Oral Oncology (MASCC/ISOO) using PubMed and Web of Science. We followed theMASCC 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 wasdetermined: Recommendation, Suggestion, or No Guideline Possible.ResultsRecommendations are made for the prevention of OM and related pain with PBM therapy in cancer patients treated withone of the following modalities: hematopoietic stem cell transplantation, head and neck (H&N) radiotherapy (without chemo-therapy), and H&N radiotherapy with chemotherapy. For each of these modalities, we recommend 1–2 clinically effectiveprotocols; the clinician should adhere to all parameters of the protocol selected. Due to inadequate evidence, currently, NoGuideline Possible for treatment of established OM or for management of chemotherapy-related OM. The reported clinicalsettings were extremely variable, limiting data integration.ConclusionsThe evidence supports the use of specific settings of PBM therapy for the prevention of OM in specific patientpopulations. Under these circumstances, PBM is recommended for the prevention of OM. The guidelines are subject to contin-uous update based on new published data