Helium-Neon laser to treat radiation induced oral mucositis in oral cancer- A comparative study
PO-1097
Abstract
Helium-Neon laser to treat radiation induced oral mucositis in oral cancer- A comparative study
Authors: Tasneem Nalawala1, Satyajeet Rath1, Suryanarayan Kunikullaya1, Krishna Ratanchandani1
1The Gujarat Cancer and Research Institute, Radiation Oncology, Ahmedabad, India
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Purpose or Objective
The objective of this study was to evaluate the
efficacy of low-level Helium-Neon laser
for the treatment of radiation induced oral mucositis and reducing pain
associated with it in oral cavity cancer patients.
Material and Methods
60 patients with oral cavity cancer undergoing
post-operative radiotherapy without concurrent chemotherapy were enrolled in
the present study and assigned to the laser (Group 1)/ control (Group 2). All
patients received proper nutrition counseling, mouth wash containing betadine
and bendydamine and painkillers were given according to the WHO pain ladder. After
developing grade 2 mucositis, Group 1 received low level Helium-Neon laser
therapy (wavelength- 630nm, frequency- 1500
Hz, intensiy- 100% and energy- 396.364 Joule) daily
1 hour before receiving radiation. The laser was directed in
the oral cavity and the whole oral mucosa was treated. Patients
were made to wear googles to protect the eyes from the laser beam. The
patients were monitored for oral mucositis (RTOG grading), pain severity (Numerical
Pain Rating Scale) and weight reduction on every 3rd day during
radiotherapy. Statistical analysis of parameters between two groups was
done using SPSS version 22 software and R environment ver.3.2.2.
Results
- Laser therapy significantly delayed the
progression of mucositis from grade 2 to grade 3 (p<0.001).
- Patients in Group 1 experienced lower grade of
mucositis at the end of each week as compared to Group 2. At the end
of week 4, more patients in Group 2 progressed to grade 3 mucositis as
compared to Group 1 (80% vs 3.3%, p<0.001). At the end of week 5,
almost all patients in Group 2 developed grade 3 mucositis (96.7% vs
56.7%, p<0.001). On completion of radiotherapy, 90% patients in Group 2
had grade 3 and 10% had grade 4 mucositis as compared to only 56.7% and
3.3% respectively in Group 1 (p<0.001).
- The mean dose of radiotherapy which led to development
of grade 3 mucositis was significantly more in Group 1 (43.92 Gy vs 35.47
Gy, p<0.001).
- Pain associated with mucositis was significantly
reduced during and on completion of radiotherapy in the patients receiving
laser therapy. At the end of radiotherapy, 73.3% in Group 2 had pain score
> 5 as compared to only 26.7% in Group 1 (p<0.001) which
resulted into significantly lower number of patients requiring higher
painkillers in Group 1.
- The mean number of days of WHO step 2 painkiller
requirement was 3.2 vs 7.8 days in Group 1 and 2 respectively (p=0.004).
- Patients in Group 1 had lesser treatment interruption
due to severe mucositis as compared to Group 2 (p=0.029).
Conclusion
Laser therapy for radiation induced oral
mucositis may prove useful in the treatment of oral cavity cancers by treating
mucositis and hence reducing the treatment interruptions providing better
tumour control, reducing the pain associated with it and improving the quality
of life of patients.