Photobiomodulation to prevent oral mucositis available in every head and neck radiotherapy centre

The guideline. The MASCC/ISOO mucositis guideline (2020) recommends intraoral photobiomodulation with low-level laser to prevent oral mucositis in adults having chemoradiotherapy for head and neck cancer (level of evidence I) and in those having radiotherapy alone (level II), using the parameters of one of the tested protocols in its Table 2. It asks clinicians to tell patients about the conflicting animal evidence on whether light can affect tumour behaviour, and to consider safety in people with oral cancer.

The measured gap. A 2023 survey of 25 Italian radiation oncology centres found that, although low-energy laser is included in published recommendations and guidelines, "only one center involved in the present survey uses LEL in its clinical practice"; products without supporting evidence, such as mucoadhesive agents, were used more often. No national figure for the UK or the United States was found.

What stands in the way. Equipment, trained staff and treatment time each day of radiotherapy, and the unresolved tumour-safety question, which is why the guideline pairs the recommendation with a conversation.