1115 - Daily Intraoral Photobiomodulation, Severe Oral Mucositis, and Feeding Tube Placement during IMRT for Head and Neck Cancer
Presenter(s)
P. H. Shah1, K. S. Hu2, M. C. Nguyen3, C. M. McCluskey4, A. Kane5, R. Ove6, C. D. Willey7, S. R. Katz8, O. Marathe9, S. Valentin10, J. L. Frustino11, A. Villa12, S. A. Spencer13, C. Holtzapfel1, N. Treister14, and R. Lalla15; 1St. Elizabeth Healthcare, Edgewood, KY, 2NYU Langone Health, New York, NY, 3Oklahoma Cancer Specialists and Research Institute, Tulsa, OK, 4Christ Hospital, Cincinnati, OH, 5University of Alabama at Birmingham, Birmingham, AL, United States, 6Department of Radiation Oncology, MetroHealth Medical Center, Cleveland, OH, 7University of Alabama at Birmingham Department of Radiation Oncology, Birmingham, AL, 8Willis-Knighton Cancer Center, Shreveport, LA, United States, 9The Oncology Institute of Hope and Innovation, Long Beach, CA, 10The Ohio State University Wexner Medical Center, Columbus, OH, 11Erie County Medical Center, Buffalo, NY, 12Miami Cancer Institute, Miami, FL, 13University of Alabama at Birmingham, Department of Radiation Oncology, Birmingham, AL, 14Harvard, Boston, MA, 15University of Connecticut, Farmington, CT
Purpose/Objective(s): Oral mucositis (OM) is a common, debilitating, and costly toxicity of head and neck cancer treatment that can impair nutrition, cause weight loss, and lead to treatment interruptions. Feeding tubes are often placed in high-risk patients to maintain nutrition but are associated with complications, prolonged dependence, and increased healthcare utilization. This analysis evaluated whether intraoral photobiomodulation (PBM) therapy reduces oral mucositis severity and supportive care needs in patients without a feeding tube at treatment initiation, with exploratory assessment of feeding tube placement.
Materials/Methods: This analysis used data from a previously completed prospective, randomized (1:1), double-blind, sham-controlled trial (NCT03972527) across 12 U.S. cancer centers. Patients with head and neck cancer received high-dose IMRT over 6–8 weeks, with or without concurrent chemotherapy, and daily 10-minute intraoral LED-based PBM or sham treatment prior to radiation therapy. This retrospective subgroup analysis included patients who initiated treatment without a feeding tube and completed IMRT. OM severity, patient-reported symptoms, feeding tube placement, and safety were assessed from treatment initiation through two-weeks post-treatment.
Results: Sixty of 85 patients initiated IMRT without a feeding tube and completed IMRT in full (PBM, n=33; sham, n=27). Daily PBM therapy significantly reduced the incidence of severe OM (WHO Grade =3) from IMRT initiation through two-weeks post-treatment (33% vs. 65%; p = 0.019), the duration of severe OM between IMRT initiation and two-weeks post-treatment (13% vs. 26%; p = 0.029), and the incidence of severe OM at two-weeks post-treatment (9% vs. 38%; p = 0.012). After six weeks of IMRT, PBM-treated patients reported greater taste preservation (59% vs. 30%; p = 0.036), lower OM symptom burden (p = 0.007), and smaller increases in mouth pain, throat pain, and overall mouth and throat soreness (all p = 0.003). Critical weight loss (>5%) was reduced in the PBM group (p = 0.034), and feeding tube placement during IMRT occurred less frequently (15.2% vs. 37%; p = 0.073). No OM-related cancer treatment interruptions occurred. Among patients with normal baseline salivary flow, PBM was associated with preservation of baseline salivary function two-weeks post-treatment (defined as salivary flow = baseline; 47% vs 11%; p = 0.029). PBM treatment was well-tolerated (>99% tolerability) and no device-related adverse events occurred.
Conclusion: Intraoral LED-based PBM therapy reduced OM severity, symptom burden, and feeding tube placement in patients undergoing IMRT. PBM represents a safe, workflow-compatible supportive care strategy that may reduce reliance on feeding tube placements in selected patients.