Preemptive, Self-Applied Photobiomodulation in the Treatment of Oral Mucositis: A High-Risk Case Study.

Introduction: Oral mucositis (OM) is a prevalent and debilitating complication of antineoplastic therapy and hematopoietic stem cell transplantation. Effective OM treatment has important economic, quality of life (QoL), and healthcare implications. Photobiomodulation (PBM) emerges as an innovative addition to the treatment paradigm, using red and near-infrared light to relieve pain and stimulate tissue repair without significant toxicity. Although the role of PBM is well established in international guidelines, optimal timing and delivery of therapy remain unclear. Several studies have reported encouraging data, advocating for a preemptive and self-applied approach to PBM.

Case Presentation: We describe a high-risk case of locally advanced (T2N1M0, stage II) nasopharyngeal squamous cell carcinoma. The patient was treated with primary chemoradiation consisting of weekly cisplatin and a radiation dose of 70 Gy in 35 fractions to the nasopharynx, lymph nodes, and surrounding soft tissues. As per the 904 nm laser lymphatic protocol, 3J/point was delivered over 30 s at an output power of 200 mW in the continuous mode, targeting the tongue, gingiva, buccal mucosa, and hard palate. Various clinical outcome measures were documented including self-reported health status (PROMS), oral health-related quality of life (OHIP-14), and objective OM severity (OMAS). Owing to raised PROMS and OHIP-14 scores on Mondays reflecting symptom exacerbation over the weekend, the study protocol was adjusted at day 21 to include a portable SYMBYX 600 nm laser for the patient to self-apply over the weekend. In contrast to expected outcomes for concurrent chemoradiation, the patient developed only mild to moderate OM: PROMS (28/100), OHIP-14 (19/56), and OMAS (6/45). Further, the patient did not require regular analgesia, opioid analgesics, or gastrostomy tube placement.

Conclusion: Preemptive PBM using the 904 nm laser lymphatic protocol, supplemented by a self-applied SYMBYX 600 nm laser to facilitate continued treatment over the weekends, shows promise as an effective therapy for reducing OM severity in high-risk patients. Further studies are required to clarify optimal timing and delivery of PBM within the OM treatment paradigm.