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Radiotherapy mucositis in head and neck cancer: prevention by low-energy surface laser
  1. Vincent Bourbonne1,2,
  2. Joelle Otz1,
  3. René-Jean Bensadoun3,
  4. Gurvan Dissaux1,2,
  5. Francois Lucia1,2,
  6. Jean-Christophe Leclere4,
  7. Olivier Pradier1,2 and
  8. Ulrike Schick1,2
  1. 1 Radiation Oncology Department, CHU Brest, Brest, France
  2. 2 LaTIM, INSERM UMR 1101, Brest University, Brest, France
  3. 3 Centre de Haute Energie, Nice University, Nice, France
  4. 4 Head and Neck Surgery Department, CHU Brest, Brest, France
  1. Correspondence to Dr Vincent Bourbonne, Radiation Oncology Department, CHU Brest, Brest 29200, France; vincent.bourbonne{at}


Background Modern radiotherapy (RT) planning techniques and the use of oral supportive care have reduced the occurrence of acute radiation-induced toxicities. Oral mucositis remains a major concern in patients with head and neck cancer as it can compromise treatment compliance and outcome.

Objective To report the rate of mucositis with the preventive use of surface low-level laser therapy in patients with head and neck cancer.

Methods Forty patients treated with definitive (n=27) or adjuvant (n=13) RT using volumetric arc therapy between August 2014 and October 2015 for squamous cell carcinoma of the head and neck were included. All patients were treated using photobiomodulation using surface low-level laser therapy (Heltschl kind FL 3500, 350 mW), 3 times a week during the whole treatment course. The grade of mucositis was obtained from week 1 to week 7 and at 1 month.

Results The median RT dose was 70 Gy (64–70). Concomitant chemotherapy was administered in 29 patients. According to the Common Terminology Criteria for Adverse Events (CTCAE) v. 3, grade 0, 1, 2 and 3 mucositis was observed in 9 (22.5%), 9 (22.5%), 16 (40%) and 6 (15%) patients at week 7, and 32 (80%), 2 (5%), 3 (7.5%) and 3 (7.5%) patients at 1 month following treatment. No grade 4 occurred. Median average and maximum dose to the oral mucosa was 42 Gy (12.9–66.3) and 66.6 Gy (39–76), respectively.

Conclusion Despite a substantial dose to the oral mucosa, the rate of acute radiation-induced mucositis of grade ≥3 remains low in patients receiving extraoral low-energy laser during RT.

  • head neck cancer
  • laser
  • mucositis
  • prevention
  • supportive care
  • toxicity

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors VB: data analysis. JO: acquisition of data. R-JB, OP, US: supervision. GD, FL, J-CL: interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.