光生物调节在放射治疗后口腔并发症防治中的应用进展

doi:10.7518/gjkq.2022098

Abstract

Abstract:

Radiotherapy is one of the effective treatments for head and neck cancer. However, most patients receiving radiotherapy experience a series of oral complications, including radiotherapy-induced oral mucositis, xerostomia, taste change, dysphagia, and osteoradionecrosis of jaw. The existing treatment methods are mainly symptomatic treatment. Since Endre Mester discovered and pioneered photobiomodulation (PBM) in 1967, many clinical and basic research results have shown that PBM has great potential in preventing and treating oral complications after radiotherapy. This paper summarizes the mechanism of PBM and the new progress of its application in the prevention and treatment of radiotherapy-induced oral mucositis, xerostomia, osteoradionecrosis of jaw, dysphagia, and other radiation-related oral diseases, with the aim to provide a new method to treat oral complications after radiotherapy among patients with head and neck cancer.

Key words: photobiomodulation, radiotherapy, radiotherapy-induced oral mucositis, xerostomia, radiation osteonecrosis of the jaw, dysphagia

CLC Number:

R 739.8

TrendMD:

Chen Xiaoli,Zhang Fan,Liu Chengcheng. Application progress on photobiomodulation in the prevention and treatment of oral complications after radiothe-rapy[J].Int J Stomatol, 2022, 49(6): 707-716.

Figures/Tables 2

Fig 1

Tab 1

Summary of applied parameters of PBM in oral complications after radiotherapy"

并发症	研究类型	样本量	激光类型	参数	治疗时间	参考文献
放射性口腔黏膜炎	随机对照试验	70	InGaAlP二极管激光	第1组：波长660 nm，功率15 mW，能量密度3.8 J·cm^-2；第2组：波长660 nm，功率5 mW，能量密度1.3 J·cm^-2	放射治疗第一天开始，每周5 d，直到放射治疗结束	[21]
	随机对照试验	221	氦氖（helium-neon，He-Ne）激光	实验组：波长632.8 nm，功率24 mW，能量密度3.0 J·cm^-2；对照组：假激光照射	放射治疗第一天开始，每周5 d，直到放射治疗结束	[22]
	随机对照试验	121	He-Ne激光	实验组：波长632.8 nm，功率24 mW，能量密度3.5 J·cm^-2；对照组：假激光照射	放射治疗第一天开始，每周5 d，直到放射治疗结束	[23]
	随机对照试验	46	He-Ne激光	实验组：波长632.8 nm，功率24 mW，能量密度3.0 J·cm^-2；对照组：假激光照射	放射治疗第一天开始，每周5 d，直到放射治疗结束	[24]
	随机对照试验	94	InGaAlP二极管激光	实验组：波长660 nm，功率100 mW，能量密度4 J·cm^-2；对照组：假激光照射	放射治疗第一天开始，每周5 d，直到放射治疗结束	[25]
	回顾性队列研究	361	—	PBM组：波长630 nm，功率100 mW，能量密度2~3 J·cm^-2；非PBM组：未接受治疗	每周3次，直到黏膜炎愈合	[27]
	前瞻性队列研究	94	InGaAlP二极管激光	实验组：波长660 nm，功率100 mw，能量密度1~4 J·cm^-2；对照组：假激光照射	放射治疗第一天开始，每周5 d，直到放射治疗结束	[28]
口干症	随机对照试验	23	InGaAlP二极管激光	实验组：1）口腔内，波长660 nm，功率40 mW，能量密度10.0 J·cm^-2；2）口腔外，波长780 nm，功率15 mW，能量密度3.7 J·cm^-2；对照组：仅临床护理	每周3次，持续7周	[33]
	类实验（自身前后对照）	29	InGaAlP激光	波长808 nm，功率30 mW，辐射度0.75 W·cm^-2，照射时间10 s，能量密度7.5 J·cm^-2	每周2次，持续3个月	[34]
	非随机对照试验	50	镓-砷（Gallium-Arsenic，Ga-As）二极管激光	实验组：波长904 nm，辐射度246 mW·cm^-2，照射时间120 s，能量密度29.5 J·cm^-2；对照组：2%柠檬酸溶液漱口水	连续10 d	[35]
	随机对照试验	23	镓铝砷（Gallium-Aluminium-Arsenic，Ga-Al-As）激光	实验组：波长830 nm，功率100 mW，辐射度3.57 W·cm^-2，照射时间20 s，能量密度71 J·cm^-2；对照组：假激光照射	每周2次，持续6周	[36]
放射性颌骨坏死	自身对照研究	48	Ga-As二极管激光	小鼠左侧照射波长904 nm，功率30 mW，能量密度5.4 J·cm^-2；右侧作为对照组不接受照射	连续3次	[41]
	病例报告	20	二极管激光	红外光谱：波长808 nm，功率100 mW，照射时间40 s，能量密度142.85 J·cm^-2；红色光谱：波长660 nm，功率100 mW，照射时间10 s，能量密度37.71 J·cm^-2	无感染和炎症时采用红外光谱；有感染和炎症时采用红色光谱+红外光谱+aPDT	[42]
	病例报告	1	—	波长660 nm，功率100 mW，能量密度71.42 J·cm^-2	PBM每周2次，aPDT每周3次，交替进行	[43]
	病例报告	1	—	波长808 nm，功率70 mW，能量密度1 J·cm^-2；同时结合aPDT	每15 d 1次，连续6周	[44]
吞咽困难	病例报告	1	二极管激光	波长980 nm，能量密度3 J·cm^-2，照射时间10 s	每天1次，连续5 d	[49]
	指南（国际多学科小组专家推荐方案）	—	二极管激光	预防性：波长750~830 nm，辐射度20~80 mW·cm^-2，能量密度3 J·cm^-2	放射治疗第一天开始，每周5天，直到放射治疗结束	[47]
	指南（国际多学科小组专家推荐方案）	—	二极管激光	治疗性：波长630~680 nm，功率20~150 mW，能量密度3 J·cm^-2	每周至少3次，直到症状改善	[47]
猖獗龋	随机对照试验	105	CO₂激光	激光组：波长9.3 μm，能量密度1.4、1.9、2.2、3.0、3.9 J·cm^-2；对照组：无激光处理	仅照射1次	[52]
猖獗龋	随机对照试验	50	掺钕钇铝石榴石（Nd: YAG）激光	激光组：波长1 064 nm，功率1.5、1.6、1.7、1.8、1.9、2.0 W，照射时间30、60、90 s；对照组：无激光处理	仅照射1次	[53]
张口困难	随机对照试验	100	He-Ne激光	实验组：波长632.8 nm，功率10 mW，能量密度1.8 J·cm^-2；对照组：仅常规口腔护理	放射治疗第一天开始，每周5 d，直到放射治疗结束	[58]
张口困难	随机对照试验	60	—	实验组：波长950 nm，功率15 mW，能量密度4.3 J·cm^-2；对照组：传统运动疗法	每周5次，连续4周	[59]
味觉改变	病例报告	1	二极管激光	波长635 nm，功率100 mW，照射时间30 s，能量密度3 J·cm^-2	每天1次，连续5 d	[48]
味觉改变	病例报告	1	二极管激光	波长980 nm，能量密度3 J·cm^-2	每周3次，持续1周	[9]

Tab 1

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Application progress on photobiomodulation in the prevention and treatment of oral complications after radiothe-rapy

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