Purpose There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed
photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer
(HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters
may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence
to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations
for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to
be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are
Methods Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.
Results PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy
(CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength,
typically between 633 and 685 nm or 780–830 nm; energy density, laser or light-emitting diode (LED) output between 10 and
150 mW; dose, 2–3 J (J/cm2), and no more than 6 J/cm2 on the tissue surface treated; treatment schedule, two to three times
a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate
further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for
dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations.
Conclusion PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC
with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications,
are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating
the effects of PBM on oncology treatment outcomes.