Abstract：
OBJECTIVE: Considering the tumor in the oral cavity or the oropharynx and nasopharynx region might be an aggravating factor for oral mucositis (OM) manifestation, the present study aimed to evaluate whether the location of the tumor and the use of photobiomodulation therapy (PBMT) might affect the frequency of oral candidiasis (OC) during radiotherapy (RT) and/or chemotherapy (CT) treatments.
METHODS: The medial records of seventy-four patients with head and neck cancer treated in a public service from 2016 to 2019 were evaluated. All these patients were submitted to RT in an accumulated dose of 48 to 70 Gy of radiation. Data about OM and OC were collected and presented according to the application of a therapeutic protocol with laser photobiomodulation (PBMT) to control oral mucositis, or not (No-PBM), and the location of tumor (head and neck or oral cavity). In the PBMT group patients, a low-power laser device composed of InGaAlP diode (maximum output power of 86.7 mW, active tip area of 0.1256 cm2, and continuous wavelength of 660 nm), was applied to the lips (three points each), right and left jugal mucosa (three points each), the limit between hard and soft palate (three points), buccal floor/sublingual gland (one point), lateral edge of the tongue (three points on each side), and back of the tongue (six points), three times weekly, for 5 weeks. The dosimetry used in each application was 2 J for 3 s, thus totaling 56 J. The correlation between clinical characteristics such as age, tumor size (T), metastatic lymph node (N), number of RT and CT sessions, candidiasis, and OM were analyzed.
RESULTS: Mucositis grades 1 and 2 were the most common among all patients, especially before the 12th radiotherapy session, regardless of the treatment with PBM (p > 0.05). Additionally, no difference in the grade of OM and OC was significantly observed when comparing the two laser therapy groups. OC was more frequent after the 12th radiotherapy session in all groups. Nonetheless, OM and OC had a different correlation regarding to tumor location (head and neck and oral cavity) being PBMT a positive therapy to delay OM. It was observed a positive and statistically significant correlation between tumors at oral cavity and OM, regardless PBMT (R = 0.84, p < 0.05 to PBMT and R = 0.13, p < 0.05 to No-PBM). Otherwise, OC was positively correlated to local metastasis in patients with oral tumors undergoing PBMT (R = 0.84, p < 0.05).
CONCLUSIONS: Patients with oral cavity tumor presented more OM, especially high grades, then patients with tumors in other regions of the head and neck, which seems to be related to the irradiation parameters of radiotherapy and/or with the limitation of conduction of PBMT in tumor areas. OM and OC were not changed by PBMT, although it helped to reduce the incidence of severe cases of OM.
METHODS: The medial records of seventy-four patients with head and neck cancer treated in a public service from 2016 to 2019 were evaluated. All these patients were submitted to RT in an accumulated dose of 48 to 70 Gy of radiation. Data about OM and OC were collected and presented according to the application of a therapeutic protocol with laser photobiomodulation (PBMT) to control oral mucositis, or not (No-PBM), and the location of tumor (head and neck or oral cavity). In the PBMT group patients, a low-power laser device composed of InGaAlP diode (maximum output power of 86.7 mW, active tip area of 0.1256 cm2, and continuous wavelength of 660 nm), was applied to the lips (three points each), right and left jugal mucosa (three points each), the limit between hard and soft palate (three points), buccal floor/sublingual gland (one point), lateral edge of the tongue (three points on each side), and back of the tongue (six points), three times weekly, for 5 weeks. The dosimetry used in each application was 2 J for 3 s, thus totaling 56 J. The correlation between clinical characteristics such as age, tumor size (T), metastatic lymph node (N), number of RT and CT sessions, candidiasis, and OM were analyzed.
RESULTS: Mucositis grades 1 and 2 were the most common among all patients, especially before the 12th radiotherapy session, regardless of the treatment with PBM (p > 0.05). Additionally, no difference in the grade of OM and OC was significantly observed when comparing the two laser therapy groups. OC was more frequent after the 12th radiotherapy session in all groups. Nonetheless, OM and OC had a different correlation regarding to tumor location (head and neck and oral cavity) being PBMT a positive therapy to delay OM. It was observed a positive and statistically significant correlation between tumors at oral cavity and OM, regardless PBMT (R = 0.84, p < 0.05 to PBMT and R = 0.13, p < 0.05 to No-PBM). Otherwise, OC was positively correlated to local metastasis in patients with oral tumors undergoing PBMT (R = 0.84, p < 0.05).
CONCLUSIONS: Patients with oral cavity tumor presented more OM, especially high grades, then patients with tumors in other regions of the head and neck, which seems to be related to the irradiation parameters of radiotherapy and/or with the limitation of conduction of PBMT in tumor areas. OM and OC were not changed by PBMT, although it helped to reduce the incidence of severe cases of OM.
摘要：
目的：考虑到口腔或口咽部和鼻咽部肿瘤可能是口腔黏膜炎（OM）表现的加重因素，本研究旨在评估肿瘤的位置和光生物调节疗法(PBMT)的使用是否会影响放疗(RT)和/或化疗(CT)治疗期间口腔念珠菌病(OC)的发生频率.
方法：评估了2016年至2019年在公共服务部门接受治疗的74例头颈部癌症患者的医疗记录。所有这些患者均以48至70Gy的累积剂量接受RT。根据激光光生物调节（PBMT）控制口腔粘膜炎的治疗方案的应用，收集并提供有关OM和OC的数据。或不（无PBM），和肿瘤的位置（头颈部或口腔）。在PBMT组患者中，由InGaAlP二极管组成的低功率激光器件(最大输出功率为86.7mW，有源尖端面积为0.1256cm2，连续波长为660nm)，涂在嘴唇上（每个三个点），左、右粘膜（各3点），硬腭和软腭之间的界限（三点），颊底/舌下腺（一点），舌的横向边缘（每侧三个点），和舌头的背面（六个点），每周三次,5周。每次应用中使用的剂量测定为2J，持续3s，因此总计56J。年龄等临床特征之间的相关性，肿瘤大小(T),转移性淋巴结（N），RT和CT会话的数量，念珠菌病,和OM进行了分析。
结果：粘膜炎1级和2级在所有患者中最常见，特别是在第12次放射治疗之前，与PBM治疗无关(p>0.05)。此外,比较两个激光治疗组时，OM和OC的等级没有显着差异。在第12次放疗后，所有组的OC频率更高。尽管如此，OM和OC与肿瘤位置（头颈部和口腔）具有不同的相关性，PBMT是延迟OM的积极疗法。观察到口腔肿瘤与OM之间呈正相关且具有统计学意义。无论PBMT（PBMT为R=0.84，p<0.05，PBMT为R=0.13，无PBM为p<0.05）。否则,在接受PBMT的口腔肿瘤患者中，OC与局部转移呈正相关（R=0.84，p<0.05）。
结论：口腔肿瘤患者表现出更多的OM，特别是高年级，然后是头部和颈部其他区域的肿瘤患者，这似乎与放射治疗的照射参数和/或PBMT在肿瘤区域的传导限制有关。OM和OC没有被PBMT改变，尽管它有助于降低严重OM病例的发生率。
方法：评估了2016年至2019年在公共服务部门接受治疗的74例头颈部癌症患者的医疗记录。所有这些患者均以48至70Gy的累积剂量接受RT。根据激光光生物调节（PBMT）控制口腔粘膜炎的治疗方案的应用，收集并提供有关OM和OC的数据。或不（无PBM），和肿瘤的位置（头颈部或口腔）。在PBMT组患者中，由InGaAlP二极管组成的低功率激光器件(最大输出功率为86.7mW，有源尖端面积为0.1256cm2，连续波长为660nm)，涂在嘴唇上（每个三个点），左、右粘膜（各3点），硬腭和软腭之间的界限（三点），颊底/舌下腺（一点），舌的横向边缘（每侧三个点），和舌头的背面（六个点），每周三次,5周。每次应用中使用的剂量测定为2J，持续3s，因此总计56J。年龄等临床特征之间的相关性，肿瘤大小(T),转移性淋巴结（N），RT和CT会话的数量，念珠菌病,和OM进行了分析。
结果：粘膜炎1级和2级在所有患者中最常见，特别是在第12次放射治疗之前，与PBM治疗无关(p>0.05)。此外,比较两个激光治疗组时，OM和OC的等级没有显着差异。在第12次放疗后，所有组的OC频率更高。尽管如此，OM和OC与肿瘤位置（头颈部和口腔）具有不同的相关性，PBMT是延迟OM的积极疗法。观察到口腔肿瘤与OM之间呈正相关且具有统计学意义。无论PBMT（PBMT为R=0.84，p<0.05，PBMT为R=0.13，无PBM为p<0.05）。否则,在接受PBMT的口腔肿瘤患者中，OC与局部转移呈正相关（R=0.84，p<0.05）。
结论：口腔肿瘤患者表现出更多的OM，特别是高年级，然后是头部和颈部其他区域的肿瘤患者，这似乎与放射治疗的照射参数和/或PBMT在肿瘤区域的传导限制有关。OM和OC没有被PBMT改变，尽管它有助于降低严重OM病例的发生率。
