国际口腔医学杂志 ›› 2022, Vol. 49 ›› Issue (6): 707-716.doi: 10.7518/gjkq.2022098

• 综述 • 上一篇    下一篇

光生物调节在放射治疗后口腔并发症防治中的应用进展

陈小利1(),张帆2,刘程程1   

  1. 1.口腔疾病研究国家重点实验室;国家口腔疾病临床医学研究中心;四川大学华西口腔医院牙周病科 成都 610041
    2.四川大学华西医院健康管理中心 成都 610041
  • 收稿日期:2022-01-07 修回日期:2022-07-25 出版日期:2022-11-01 发布日期:2022-11-03
  • 通讯作者: 刘程程
  • 作者简介:陈小利,住院医师,学士,Email:2123362260@qq.com
  • 基金资助:
    四川省干部保健科研项目(川干研2022-109)

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

Chen Xiaoli1(),Zhang Fan2,Liu Chengcheng1   

  1. 1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.Physical Examination Center, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2022-01-07 Revised:2022-07-25 Online:2022-11-01 Published:2022-11-03
  • Contact: Chengcheng Liu
  • Supported by:
    Program for Sichuan Provincial Cadre Health Research Project(Sichuan Cadre Research 2022-109)

摘要:

放射治疗是头颈癌的有效治疗方式之一。但大多数接受放射治疗的患者都会出现一系列口腔并发症,例如放射性口腔黏膜炎、口干症、味觉改变、吞咽困难及放射性颌骨坏死等。现有治疗方式主要为对症处理。自1967年Endre Mester发现并开创了光生物调节(PBM)以来,已有较多的临床和基础研究结果表明PBM在防治放射治疗后口腔并发症方面拥有巨大的潜力。本文总结了PBM的作用机制及其应用于放射性口腔黏膜炎、口干症、放射性颌骨坏死、吞咽困难等放射治疗相关口腔疾病预防和治疗的研究进展,旨在为更多头颈癌患者放射治疗后口腔并发症的治疗提供新的方式。

关键词: 光生物调节, 放射治疗, 放射性口腔黏膜炎, 口干症, 放射性颌骨坏死, 吞咽困难

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

中图分类号: 

  • R 739.8

图 1

PBM防治放射治疗后口腔并发症的机制图"

表 1

PBM在放射治疗后口腔并发症中应用参数汇总"

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

121He-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

46He-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)29InGaAlP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

48Ga-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-2PBM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]
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
猖獗龋

随机对照

试验

105CO2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]

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

100He-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]

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]
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]
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