Non-Cochrane · intervention · PM41880047
Effects of photobiomodulation on oral mucositis, oral pain, xerostomia, salivary flow rate, and quality of life in patients with head and neck cancer: a systematic review and meta-analysis.
Pedroso Mônica N M, Rech Anderson, Casagrande Natalia, et al. · Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026 · PubMed · doi:10.1007/s00520-026-10575-4
Findings
Population Adults with head and neck cancer receiving radiotherapy and/or chemotherapy
26 findings
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention · Grading system: WHO staging | RR 0.24 [0.05, 1.07] GRADE not reported 4 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Salivary flow rate (stimulated and unstimulated) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.75 | SMD 0.97 [0.12, 1.82] GRADE not reported 6 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention · Grading system: RTOG scale | RR 0.34 [0.22, 0.53] GRADE not reported 3 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Quality of life (UW-QOL, FACT-HN, EORTC QLQ-C30, OHIP-14, Skindex-16, WHOQOL-bref, XeQoLS) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.75 | SMD 1.06 [-0.03, 2.14] GRADE not reported 11 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention · Emission spectrum: 810 to 940 nm | RR 0.47 [0.12, 1.08] GRADE not reported Studies not reported |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Quality of life (UW-QOL, FACT-HN, EORTC QLQ-C30, OHIP-14, Skindex-16, WHOQOL-bref, XeQoLS) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.25 | SMD 1.06 [-0.03, 2.14] GRADE not reported 11 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Quality of life (UW-QOL, FACT-HN, EORTC QLQ-C30, OHIP-14, Skindex-16, WHOQOL-bref, XeQoLS) Longest period of the intervention | SMD 1.06 [-0.03, 2.14] Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias 11 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Quality of life (UW-QOL, FACT-HN, EORTC QLQ-C30, OHIP-14, Skindex-16, WHOQOL-bref, XeQoLS) Longest period of the intervention · Emission spectrum: 808 to 940 nm | SMD 1.46 [-0.72, 3.63] GRADE not reported Studies not reported |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention · Emission spectrum: 600 to 660 nm | RR 0.46 [0.26, 0.8] GRADE not reported Studies not reported |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Oral pain (continuous scores: VAS, EORTC QLQ-C30 pain domain) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.75 | SMD -2.53 [-5.7, 0.63] GRADE not reported 6 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Xerostomia (VAS, Treatment-Emergent Symptom Scale, Xerostomia Inventory) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.25 | SMD -0.07 [-0.44, 0.3] GRADE not reported 5 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Oral pain (continuous scores: VAS, EORTC QLQ-C30 pain domain) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.25 | SMD -2.25 [-5.47, 0.96] GRADE not reported 6 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Xerostomia (VAS, Treatment-Emergent Symptom Scale, Xerostomia Inventory) Longest period of the intervention | SMD -0.07 [-0.47, 0.33] Very low Downgraded: risk of bias, imprecision, publication bias 5 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Salivary flow rate (stimulated and unstimulated) Longest period of the intervention | SMD 0.75 [0.03, 1.46] Very low Downgraded: risk of bias, imprecision, publication bias 6 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral pain (VAS >=7) Longest period of the intervention | RR 0.35 [0.23, 0.53] Low Downgraded: risk of bias, publication bias 3 studies · 250 participants |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention · Grading system: NCI staging | RR 0.65 [0.32, 1.29] GRADE not reported 5 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention | RR 0.46 [0.29, 0.71] Low Downgraded: risk of bias, inconsistency 11 studies · 707 participants |
| Photobiomodulation | No photobiomodulation (no intervention, mouthwash or placebo) | Severe oral mucositis (WHO, RTOG or NCI grading) Longest period of the intervention · Sensitivity analysis: omitting one outlier study | RR 0.39 [0.28, 0.54] GRADE not reported 10 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention · Light source: diode | RR 0.49 [0.25, 0.98] GRADE not reported Studies not reported |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Oral pain (continuous scores: VAS, EORTC QLQ-C30 pain domain) Longest period of the intervention | SMD -2.34 [-5.54, 0.85] Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias 6 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Quality of life (UW-QOL, FACT-HN, EORTC QLQ-C30, OHIP-14, Skindex-16, WHOQOL-bref, XeQoLS) Longest period of the intervention · Emission spectrum: 600 to 660 nm | SMD 0.46 [-0.5, 1.41] GRADE not reported Studies not reported |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Severe oral mucositis Longest period of the intervention · Light source: He-Ne | RR 0.35 [0.17, 0.71] GRADE not reported Studies not reported |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Salivary flow rate (stimulated and unstimulated) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.25 | SMD 0.62 [-0.02, 1.27] GRADE not reported 6 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Xerostomia (VAS, Treatment-Emergent Symptom Scale, Xerostomia Inventory) Longest period of the intervention · Sensitivity analysis: SD of change imputed with r = 0.75 | SMD -0.14 [-0.59, 0.31] GRADE not reported 5 studies |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Salivary flow rate (stimulated and unstimulated) Longest period of the intervention · Salivary flow type: unstimulated | SMD 0.69 [-0.16, 1.54] GRADE not reported Studies not reported |
| Photobiomodulation (low-level laser therapy) | Control (no intervention, placebo, mouthwash or usual care) | Salivary flow rate (stimulated and unstimulated) Longest period of the intervention · Salivary flow type: stimulated | SMD 0.75 [-0.32, 1.82] GRADE not reported Studies not reported |
Included primary studies 33
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| de Carvalho 2023 Photobiomodulation for the management of xerostomia and oral mucositis in patients with cancer: a randomized clinical trial. PMID:37060370 | 2023 | 1 other review | not stated | not extracted yet |
| Louzeiro 2020 Effect of photobiomodulation on salivary flow and composition, xerostomia and quality of life of patients during head and neck… PMID:32570059 | 2020 | 1 other review | not stated | not extracted yet |
| Mohamed 2022 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Mozaffari 2024 Evaluation of the Effect of Photobiomodulation on Radiation-Induced Xerostomia in Head and Neck Cancer Patients: A Randomized Clinical… PMID:38655042 | 2024 | 1 other review | not stated | not extracted yet |
| Oton-Leite 2013 Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to… PMID:24164228 | 2013 | 1 other review | not stated | not extracted yet |
| Vianna Camolesi 2025 Photobiomodulation for the prevention of oral side effects secondary to head and neck cancer therapy: results of a randomised,… PMID:40184883 | 2025 | 1 other review | not stated | not extracted yet |
| Antunes 2013 Phase III trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent… PMID:24044799 | 2013 | this review only | not stated | not extracted yet |
| Barati 2025 Effectiveness of Photobiomodulation (low-level laser therapy) on treatment of oral mucositis (OM) induced by chemoradiotherapy in head and… PMID:39889324 | 2025 | this review only | not stated | not extracted yet |
| Bensadoun 1999 Low-energy He/Ne laser in the prevention of radiation-induced mucositis. A multicenter phase III randomized study in patients with head… PMID:10423050 | 1999 | this review only | not stated | not extracted yet |
| Dantas 2020 Evaluation of preventive laser photobiomodulation in patients with head and neck cancer undergoing radiochemotherapy: Laser in patients… PMID:32544269 | 2020 | this review only | not stated | not extracted yet |
| de Lima 2012 Oral mucositis prevention by low-level laser therapy in head-and-neck cancer patients undergoing concurrent chemoradiotherapy: a phase III… PMID:21163585 | 2012 | this review only | not stated | not extracted yet |
| Fernandes 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gautam 2012 Low level helium neon laser therapy for chemoradiotherapy induced oral mucositis in oral cancer patients - a randomized controlled trial. PMID:22502814 | 2012 | this review only | not stated | not extracted yet |
| Gautam 2012 Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients - a triple blinded… PMID:22884841 | 2012 | this review only | not stated | not extracted yet |
| Gautam 2013 Effect of low-level laser therapy on patient reported measures of oral mucositis and quality of life in head and neck cancer patients… PMID:23224689 | 2013 | this review only | not stated | not extracted yet |
| Gautam 2015 Low level laser therapy against radiation induced oral mucositis in elderly head and neck cancer patients-a randomized placebo controlled… PMID:25704314 | 2015 | this review only | not stated | not extracted yet |
| Gonnelli 2016 Low-Level Laser for Mitigation of Low Salivary Flow Rate in Head and Neck Cancer Patients Undergoing Radiochemotherapy: A Prospective… PMID:27196626 | 2016 | this review only | not stated | not extracted yet |
| Kauark-Fontes 2022 Extraoral photobiomodulation for prevention of oral and oropharyngeal mucositis in head and neck cancer patients: interim analysis of a… PMID:34708311 | 2022 | this review only | not stated | not extracted yet |
| Legouté 2019 Low-level laser therapy in treatment of chemoradiotherapy-induced mucositis in head and neck cancer: results of a randomised, triple… PMID:31118057 | 2019 | this review only | not stated | not extracted yet |
| Libik 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Lopes 2006 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Lopez-Garzon 2025 Photobiomodulation for restoring salivary flow after radiotherapy in head and neck cancer: a randomised placebo-controlled trial. PMID:41013422 | 2025 | this review only | not stated | not extracted yet |
| Maiya 2006 Effect of low level helium-neon (He-Ne) laser therapy in the prevention & treatment of radiation induced mucositis in head & neck cancer… PMID:17159259 | 2006 | this review only | not stated | not extracted yet |
| Marín-Conde 2019 Photobiomodulation with low-level laser therapy reduces oral mucositis caused by head and neck radio-chemotherapy: prospective randomized… PMID:30591391 | 2019 | this review only | not stated | not extracted yet |
| Martins 2021 The Effect of Photobiomodulation on Nitrite and Inflammatory Activity in Radiotherapy-Induced Oral Mucositis: A Randomized Clinical Trial. PMID:32997817 | 2021 | this review only | not stated | not extracted yet |
| Martins 2021 Photobiomodulation reduces the impact of radiotherapy on oral health-related quality of life due to mucositis-related symptoms in head and… PMID:33113075 | 2021 | this review only | not stated | not extracted yet |
| Melo 2022 Impact of photobiomodulation for oral mucositis on body weight and BMI of patients with head and neck cancer. PMID:35169872 | 2022 | this review only | not stated | not extracted yet |
| Oton-Leite 2012 Effect of intraoral low-level laser therapy on quality of life of patients with head and neck cancer undergoing radiotherapy. PMID:21472883 | 2012 | this review only | not stated | not extracted yet |
| Oton-Leite 2015 Effect of low-level laser therapy on chemoradiotherapy-induced oral mucositis and salivary inflammatory mediators in head and neck cancer… PMID:25824475 | 2015 | this review only | not stated | not extracted yet |
| Robijns 2021 Photobiomodulation therapy for the prevention of acute radiation dermatitis in head and neck cancer patients (DERMISHEAD trial). PMID:33711412 | 2021 | this review only | not stated | not extracted yet |
| Saleh 2014 Effect of low-level laser therapy on radiotherapy-induced hyposalivation and xerostomia: a pilot study. PMID:25302460 | 2014 | this review only | not stated | not extracted yet |
| Zanin 2010 Use of 660-nm diode laser in the prevention and treatment of human oral mucositis induced by radiotherapy and chemotherapy. PMID:19764899 | 2010 | this review only | not stated | not extracted yet |
| Zhang 2018 Application of red light phototherapy in the treatment of radioactive dermatitis in patients with head and neck cancer. PMID:30419911 | 2018 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults with head and neck cancer who had received or were receiving radiotherapy and/or chemotherapy; excluded pre-existing oral mucositis | 1748 patients with head and neck cancer in 30 RCTs (33 articles); 28 trials in meta-analyses (1653 patients) |
| Intervention | Photobiomodulation protocols | Photobiomodulation (31 protocols; diode 67.7%, He-Ne 16.1%) |
| Comparison | Non-exposed control group (no formal intervention, mouthwash or placebo) | No photobiomodulation, mouthwash or placebo |
| Outcomes | Mucositis, xerostomia, salivary flow rate, oral pain and quality of life measured with validated questionnaires, protocols or scales | Severe oral mucositis (k=11), severe oral pain (k=3), oral pain level (k=6), xerostomia (k=5), salivary flow rate (k=6), quality of life (k=11) |
| Study designs | Randomized controlled trials | 30 RCTs |
| Timing | Longest period of the intervention | Longest period of the intervention (radiotherapy period, mostly 6 to 7 weeks) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Yes | Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | No | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |