Terapia de fotobiomodulação associada a l-glutamina e ácido hialurônico para prevenção e controle da mucosite oral em pacientes com câncer de boca e orofaringe submetidos a radioterapia e ou quimioradioterapia: ensaio clínico randomizado controlado
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2024-02-09
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Universidade Federal de Goiás
Resumo
Oral mucositis (OM) is an important adverse effect of radiotherapy (RT) in the mucosal
region of the oral cavity and oropharynx, which can range from erythematous areas to
large confluent ulcerations. The clinical severity of this inflammatory condition can lead
to interruption of oncological treatment and impact the patient's prognosis. In this
context, photobiomodulation therapy (TFBM) has been shown to be effective in
reducing the severity of OM, controlling pain and promoting the repair of compromised
mucous membranes. Other therapies have been investigated to control OM, such as
the use of compounds based on l-glutamine (L-G) and hyaluronic acid (HA) (Topical
Medication Treatment - TTM), both in the form of a gel and as a mouthwash. The
objective, therefore, of this study was to investigate whether the application of TTM
associated with TFBM and the Dental Preventive Protocol (PPO) would be more
effective than the exclusive use of TFBM associated with PPO in preventing and
controlling severe OM. Patients with oral cancer (BC) (lip and oral cavity) and
oropharynx (n=48) undergoing adjuvant radiotherapy (≥60 Gy) and/or
chemoradiotherapy (QRT) were investigated and randomized into two groups: A (
TFBM + PPO) (n=24) and B (TFBM + PPO + TTM) (n=24). To evaluate the
effectiveness of therapies, the degree of clinical severity of OM was evaluated
according to the scales of the National Cancer Institute (NCI) and the World Health
Organization (WHO); patients' quality of life using the OHIP-14 questionnaires and
symptom perception using the PROMS scale; number of RT interruptions and rate of
adherence to cancer treatment. OM was a constant event in the groups evaluated, and
all participants showed signs and symptoms from the 7th RT session onwards.
Evaluation of the 30th session showed that both in group A and group B, severe OM
occurred, 83.3% (n=20) and 87.5% (n=21), respectively. When evaluated based on the
WHO scale, 50% (n=12) of group A had severe OM, while in group B only 8.3 of the
participants had OM grade 3 and no grade 4. Regarding adherence to the PPO, note It is clear that the members of group B had significantly greater adherence than group
A throughout the entire RT treatment [7th, 14th, 21st and 30th RT sessions (p<0.05)].
In the quality of life (QOL) results, it was observed that QRT therapies had a negative
impact on QOL in relation to oral health in both groups, with group A having a higher
score during all moments of treatment. Regarding the scores obtained in the OHIP-14
questionnaire, the results demonstrated that participants in group B had less impacted
QoL throughout the course of RT or QRT, being that in the 14th, 21st, and 30th RT
session assessments (p<0.001) reached statistical significance. In summary, the
results indicate that the therapeutic combination of TTM+TFBM+PPO, although it did
not prevent the clinical manifestation of chemoradio-induced BM, allowed greater
adherence to oncological treatment and less impact on QoL.
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SANTOS, R. W. Terapia de fotobiomodulação associada a l-glutamina e ácido hialurônico para prevenção e controle da mucosite oral em pacientes com câncer de boca e orofaringe submetidos a radioterapia e ou quimioradioterapia: ensaio clínico randomizado controlado. 2024. 95 f. Dissertação (Mestrado em Odontologia) - Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, 2024.