 |
| Title |
Photobiomodulation Therapy Reduces the Severity of Radiation-Induced Oral Mucositis in Patients with Head and Neck Cancer |
| Clinical Question |
In patients receiving radiation therapy for head and neck cancer, does photobiomodulation therapy compared with standard oral care reduce the severity of radiation-induced oral mucositis? |
| Clinical Bottom Line |
For adults receiving radiation therapy for head and neck cancer, adding intraoral photobiomodulation (PBM) therapy, also called low-level laser therapy (LLLT), to their standard oral care reduces the risk and severity of treatment-induced oral mucositis when compared with a placebo or no PBM. This is supported by meta-analyses of randomized trials, including a head-and-neck cancer subgroup with a risk ratio of 0.32, and through MASCC/ISOO recommendations. Although PBM appears to be well tolerated, it requires special equipment and use of a validated protocol, with oral-cancer safety considerations needing to be discussed with the patient. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 32786044 | Elad/2020 | Patients receiving interventions for mucositis, as reported in 1,197 publications | Evidence-based clinical practice guideline | | Key results | The reviewed publications included patients receiving interventions for oral or gastrointestinal mucositis associated with chemotherapy (CT), radiation therapy (RT), chemoradiotherapy (RT-CT), or hematopoietic stem-cell transplantation (HSCT). Based on the systematic review of mucositis research, the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) panel recommended intraoral PBM for preventing oral mucositis in adults receiving head-and-neck radiation alone or with concurrent RT-CT. The evidence level for radiation alone was 2, and for RT-CT was 1. The article did not report PBM-specific effect estimates. | | #2) 25198431 | Oberoi/2014 | 1,144 cancer patients from 18 randomized controlled trials | Meta-Analysis | | Key results | The review included 19 comparisons: eight trials studied head-and-neck cancer patients receiving radiation or chemoradiation, eight studied stem-cell-transplant patients, and two studied patients receiving other chemotherapy. Across 10 trials involving 689 patients, PBM reduced the risk of severe oral mucositis by about 63% when compared with placebo or no PBM (RR 0.37; 95% CI 0.20-0.67; p = 0.001). In the subgroup of 425 head-and-neck cancer patients receiving radiation or chemoradiation, PBM reduced the risk of severe mucositis by about 68% when compared with placebo or no PBM (RR 0.32; 95% CI 0.24-0.42). | | #3) 21660670 | Bjordal/2011 | 415 cancer patients from 11 randomized studies that included placebo controls | Meta-Analysis | | Key results | Patients assessed were receiving chemotherapy, head-and-neck radiation therapy, or treatment related to Hematopoietic Stem Cell Transplantation (HSCT). When compared with the placebo treatment, photobiomodulation therapy, also called low-level laser therapy (LLLT), helped prevent oral mucositis. Patients receiving this therapy were 2.03 times as likely to avoid oral mucositis when compared to placebo (RR 2.03; 95% CI 1.11-3.69; p = 0.02), and 2.72 times as likely in trials using doses above 1 joule (95% CI 1.98-3.74). It helped shorten the duration of grade 2 or worse mucositis by an average of 4.38 days (95% CI 3.35-5.40) and reduced its overall severity as well (SMD 1.33, 95% CI 0.68-1.98). | |
| Evidence Search |
Database: PubMed. Search performed on June 29, 2026. Search keywords: (“photobiomodulation” OR “low-level laser therapy” OR “low level laser therapy”) AND (“oral mucositis” OR “mucositis”) AND (“radiotherapy” OR “chemoradiotherapy” OR “cancer”). |
Comments on
The Evidence |
Oberoi et al. had the strongest review methods, which were a prespecified PRISMA-based process, seven databases without exclusions due to language or publication status, independent duplicate screenings, Cochrane risk-of-bias assessment, sensitivity analyses, and assessment of publication bias. However, only 4 of 19 comparisons were at low risk of bias, only 21% reported allocation concealment, and heterogeneity, or inconsistency, was high for severe mucositis cases with an I-squared value of 80%. Adjusting for possible publication bias weakened the estimated treatment effect but did not completely eliminate the benefit of the treatment (RR 0.51, 95% CI 0.29-0.90). Bjordal et al. sourced multiple databases and publications, which included randomized trials with placebos, used blinded assessors as a criterion for eligibility, and had two independent reviewers to determine the trial quality. However, sample sizes were small, publication bias was not fully assessed, and treatment protocols varied as studies used different doses, techniques, or wavelengths. Additionally, the two meta-analyses overlap notably, and should not be viewed separately. The MASCC/ISOO guidelines used two independent reviewers, standardized assessment of articles, formal rules for identifying study flaws and evidence strength, and setting-specific recommendations for treatments. However, they did not report a PBM-specific estimate or total patient count, and the search included randomized controlled trials (RCTs) only through June 2019. Overall, the benefit is consistent and clinically important, but the exact magnitude of benefit is not as clear. |
| Applicability |
The evidence is mostly related to adults with head-and-neck cancer receiving radiation therapy, with or without chemotherapy. It is not as applicable to children or patients receiving chemotherapy without head-and-neck radiation. Photobiomodulation is generally well tolerated and noninvasive and did not cause more short-term side effects than placebo. It may help reduce pain and opioid use; however, trained personnel and specialized equipment are required for utilizing this treatment. Additionally, it requires a validated protocol and careful usage of the same wavelengths, dosages, schedule, and treatment locations. It may also be uncomfortable to apply the treatment inside the mouth for patients with ulcers. The long-term effects on tumor behavior are still not certain, so the benefits and possible risks should be discussed with oral-cancer patients. Photobiomodulation should also be used in addition to regular oral care, not as a replacement for it. |
| Specialty/Discipline |
(Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) |
| Keywords |
Photobiomodulation therapy; low-level laser therapy; oral mucositis; head and neck cancer; radiotherapy; chemoradiotherapy; cancer
|
| ID# |
3766 |
| Date of submission: |
07/20/2026 |
| E-mail |
mattinrastgar@gmail.com |
| Author |
Mattin Rastgar |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Cara B. Gonzales, DDS, PhD |
| Faculty mentor/Co-author e-mail |
gonzalesc5@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
|
|
