Évaluer les indications actuelles et potentielles de la thérapie par photobiomodulation et leur niveau de preuve dans la prévention ou le traitement des effets secondaires liés aux traitements cytotoxiques en oncologie.

Les bases de données Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, et LILACS ont systématiquement été passées en revue afin d’inclure et d’analyser les publications d’études cliniques ayant évalué la photobiomodulation dans la prévention ou la prise en charge des effets secondaires liés aux traitements anticancéreux.

La photobiomodulation dans le spectre du rouge ou de l’infrarouge a démontré son efficacité dans des essais contrôlés randomisés dans la prévention et la prise en charge de certaines complications liées à la radiothérapie, en particulier de la mucite aiguë, de l’épithéliite aiguë et du lymphœdème du membre supérieur. Sur la base de ces résultats, il a été possible d’établir des paramètres et des doses de pratiques sécurisées de photobiomodulation.

Les données publiées suggèrent que la photobiomodulation pourrait être considérée comme un soin de support à part entière pour les patients traités par radiothérapie, chimiothérapie, immunothérapie, hormonothérapie ou thérapies ciblées, que ce soit dans le cadre de la pratique clinique ou d’essais cliniques thérapeutiques.

Assess the current and potential indications of photobiomodulation (PBM) therapy and their level of evidence in the prevention or treatment of side effects related to oncology treatments (radiation therapy, and to a minimal extent favored and hematopoietic stem cell transplants). And report on the recommended modalities (parameters and doses) of PBM therapy.

The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed to include and analyze publications of clinical studies that evaluated PBM in the prevention or management side effects related to cancer treatments. The keywords used were “photobiomodulation”; “low level laser therapy”; “acute oral mucositis”; “acute dysphagia”; “acute radiation dermatitis”; “lymphedema”; “xerostomia”; “dysgeusia”; “hyposalivation”; “lockjaw”; “bone necrosis”; “osteoradionecrosis”; “radiation induced fibrosis”; “voice and speech alterations”; “palmar-plantar erythrodysesthesia”; “graft versus host disease”; “peripheral neuropathy”; “chemotherapy induced alopecia”. Prospective studies were included, while retrospective cohorts and non-original articles were excluded from the analysis.

PBM in the red or infrared spectrum has been shown to be effective in randomized controlled trials in the prevention and management of certain complications related to radiotherapy, in particular acute mucositis, epitheliitis and upper limb lymphedema. The level of evidence associated with PBM was heterogeneous, but overall remained moderate. The main limitations were the diversity and the lack of precision of the treatment protocols which could compromise the efficiency and the reproducibility of the results of the PBM. For other effects related to chemo/radiation therapy (dysgeusia, osteonecrosis, peripheral neuropathy, alopecia, palmar-plantar erythrodysaesthesia) and haematopoietic stem cell transplantation (graft versus host disease), treatment with PBM suffers from a lack of studies or limited studies at the origin of a weakened level of proof. However, based on these results, it was possible to establish safe practice parameters and doses of PBM.

Published data suggest that PBM could therefore be considered as supportive care in its own right for patients treated with radiation, chemotherapy, immunotherapy, hormone therapy or targeted therapies, whether in clinical practice or clinical trials. therapies. However, until solid data have been published on its long-term safety, the use of PBM should be considered with caution and within the recommended parameters and doses, particularly when practiced in areas of known or possible tumours. In this case, the patient should be informed of the theoretical benefits and risks of PBM in order to obtain informed consent before treatment.