Eficácia da fotobiomodulação no tratamento das mucosites orais em pacientes submetidos à terapia antineoplásica: revisão sistemática e metanálise
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Data
2022-05-30
Autores
Cruz, Adriana Regina
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Universidade Estadual Paulista (Unesp)
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Introdução: A mucosite oral (MO) é uma inflamação da mucosa oral decorrente da citotoxicidade causada pela terapia antineoplásica e, é caracterizada por ulcerações que causam dor, disfagia e desconforto ao paciente. A fotobiomodulação (FBM) tem sido aplicada no tratamento da MO por promover a biomodulação celular, a aceleração do processo de cicatrização, a modulação da inflamação e diminuição da dor. Objetivo: Avaliar a eficácia da FBM no tratamento da MO. Métodos: foi realizada revisão sistemática e metanálise de estudos que avaliaram o tratamento da MO com o uso da FBM. Estes estudos foram encontrados nas bases de dados eletrônicos: LILACS, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB OF SCIENCE, CINAHL e no clinical trials. A busca foi iniciada em 2019 e atualizada até setembro de 2021. Os critérios de elegibilidade foram: ensaios clínicos randomizados, não randomizados e observacionais que utilizaram a FBM para o tratamento da MO. Os desfechos foram redução da severidade da MO, duração das lesões de MO e redução da dor na mucosa oral. Para análise dos dados, utilizou-se o progama Review Manager 5.4 e para avaliação da qualidade da evidência no desfecho primário foi empregado o sistema GRADE. Resultados: dos 316 artigos encontrados, 260 foram selecionados para leitura de título e resumo, dos quais 223 foram excluídos. Foram eleitos para leitura na íntegra 37 artigos, sendo que 6 foram incluídos na revisão, totalizando 299 pacientes. O tratamento foi a FBM. Os pacientes foram divididos em dois grupos: grupo FBM isolada ou associada a outras terapias e grupo controle que não usou a FBM. Para o desfecho redução da severidade da MO a chance de redução da MO foi maior no grupo da FBM comparado ao grupo controle. Para os desfechos duração das lesões de MO e redução da dor na mucosa oral foi realizada a diferença ponderada das médias para cada estudo mas, não foi possível realizar a metanálise devido a alta heterogeneidade entre os estudos. Conclusão: A FBM mostrou-se efetiva no tratamento da MO reduzindo a sua severidade e resultando em melhoria clínica e bem estar do paciente submetido ao tratamento antineoplásico.
Introduction: Oral mucositis (OM) is an inflammation of the oral mucosa resulting from cytotoxicity caused by antineoplastic therapy and characterized by ulcerations that cause pain, dysphagia and discomfort to the patient. Photobiomodulation (PBM) applied in the treatment of oral mucositis by promoting cell biomodulation, accelerating the healing process, modulating inflammation and decreasing pain. Objective: To evaluate the effectiveness of PBM in the treatment of OM. Methods: a systematic review and meta-analysis of studies that evaluated the treatment of OM using PBM. These studies founded in the electronic databases: LILACS, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB OF SCIENCE, CINAHL and clinical trials. The search started in 2019 and updated until September 2021. Eligibility criteria: randomized, non-randomized, observational clinical trials that used PBM for the treatment of OM. Outcomes were reduction of OM severity, duration of OM lesions and reduction of pain in the oral mucosa. For data analysis, the Review Manager 5.4 program. The used GRADE system was using to evaluate the quality of evidence in the primary outcome. Results: of the 316 articles founded, 260 selected for reading the title and abstract, of which 223 excluded. These, 37 articles elected for full reading, six of which were included in the review, totaling 299 patients. The treatment was PBM. Patients divided into two groups: the PBM group used PBM only or associated with other therapies and the control group not used PBM. For the outcome reduction of OM severity, the chance of reducing OM was higher in the PBM group compared to the control group. For the outcomes duration of OM lesions and reduction of pain in the oral mucosa, the weighted difference of the means for each study, however, it was not possible to perform the meta-analysis due to the high heterogeneity between the studies. Conclusion: PBM proved to be effective in the treatment of OM, reducing the severity, resulting in clinical improvement and quality of life of the patient undergoing antineoplastic treatment.
Introduction: Oral mucositis (OM) is an inflammation of the oral mucosa resulting from cytotoxicity caused by antineoplastic therapy and characterized by ulcerations that cause pain, dysphagia and discomfort to the patient. Photobiomodulation (PBM) applied in the treatment of oral mucositis by promoting cell biomodulation, accelerating the healing process, modulating inflammation and decreasing pain. Objective: To evaluate the effectiveness of PBM in the treatment of OM. Methods: a systematic review and meta-analysis of studies that evaluated the treatment of OM using PBM. These studies founded in the electronic databases: LILACS, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB OF SCIENCE, CINAHL and clinical trials. The search started in 2019 and updated until September 2021. Eligibility criteria: randomized, non-randomized, observational clinical trials that used PBM for the treatment of OM. Outcomes were reduction of OM severity, duration of OM lesions and reduction of pain in the oral mucosa. For data analysis, the Review Manager 5.4 program. The used GRADE system was using to evaluate the quality of evidence in the primary outcome. Results: of the 316 articles founded, 260 selected for reading the title and abstract, of which 223 excluded. These, 37 articles elected for full reading, six of which were included in the review, totaling 299 patients. The treatment was PBM. Patients divided into two groups: the PBM group used PBM only or associated with other therapies and the control group not used PBM. For the outcome reduction of OM severity, the chance of reducing OM was higher in the PBM group compared to the control group. For the outcomes duration of OM lesions and reduction of pain in the oral mucosa, the weighted difference of the means for each study, however, it was not possible to perform the meta-analysis due to the high heterogeneity between the studies. Conclusion: PBM proved to be effective in the treatment of OM, reducing the severity, resulting in clinical improvement and quality of life of the patient undergoing antineoplastic treatment.
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Terapia com luz de baixa intensidade, Oncologia, Quimioterapia, Estomatite, Oncology, Chemotherapy, Low level laser therapy, Stomatitis, Fotobiomodulação, Laser de baixa intensidade, Mucosite oral, Photobiomodulation, Low-level laser, Oral mucositis