OpenLB
Open Library of Bioscience
Advanced Search
BMC oral health
Apr 17, 2024;24 (1): 469.

Laser therapy decreases oral leukoplakia recurrence and boosts patient comfort: a network meta-analysis and systematic review.

Rui Luo, Yanan Wang, Ruixin Li, Yanan Ma, Haitao Chen, Jian Zhang, Jun Shen
Author Information
  1. Rui Luo: National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
  2. Yanan Wang: Tianjin Medical University, Tianjin, 300070, China.
  3. Ruixin Li: Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, Hospital of Stomatological, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China.
  4. Yanan Ma: School of Stomatology, Weifang Medical University, Weifang, 261053, China.
  5. Haitao Chen: Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, Hospital of Stomatological, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China.
  6. Jian Zhang: School of Stomatology, Hospital of Stomatology, Tianjin Medical University, 12 Observatory Road, Tianjin, 300070, China. zj301doctor@126.com.
  7. Jun Shen: National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China. 13902143866@163.com.
PMID: 38632580 DOI: 10.1186/s12903-024-04179-9

Abstract

BACKGROUND: Oral leukoplakia (OLK) is a prevalent precancerous lesion with limited non-pharmacological treatment options. Surgery and various lasers are the mainstay of treatment; however, their relative efficacy and optimal choice remain unclear. This first network meta-analysis compared the effects of different lasers and surgical excision on post-treatment recurrence and comfort in OLK patients.
METHODS: We searched four databases for relevant randomized controlled trials (RCTs) up to April 2023. The primary outcome was post-treatment recurrence, and secondary outcomes included intraoperative hemorrhage and postoperative pain scores. The Cochrane Risk of Bias tool was used to assess the study quality. Meta-analysis and network meta-analysis were employed to determine efficacy and identify the optimal intervention.
RESULTS: A total of 11 RCTs including 917 patients and 1138 lesions were included. Er,Cr:YSGG laser treatment showed significantly lower recurrence rates compared to CO laser (OR: 0.04; 95% CI: 0.01-0.18), CO laser with margin extension (OR: 0.06; 95% CI: 0.01-0.60), Er:YAG laser (OR: 0.10; 95% CI: 0.03-0.37), electrocautery (OR: 0.03; 95% CI: 0.00-0.18), and standard care (OR: 0.08; 95% CI: 0.02-0.33). Er,Cr:YSGG laser also ranked the best for reducing recurrence, followed by standard care and CO laser combined with photodynamic therapy (PDT). Er:YAG and Er:Cr:YSGG lasers minimized bleeding and pain, respectively. None of the interventions caused severe adverse effects.
CONCLUSION: For non-homogeneous OLK, Er:YAG, Er:Cr:YSGG, and CO laser combined with PDT offer promising alternatives to surgical excision, potentially reducing recurrence and improving patient comfort. Further high-quality RCTs are necessary to confirm these findings and determine the optimal laser-PDT combination for OLK treatment.

Keywords

Laser Network meta-analysis Oral leukoplakia Photodynamic therapy Precancerous lesion

References

  1. Prev Sci. 2022 Apr;23(3):415-424 [PMID: 34387806]
  2. Laser Ther. 2017 Sep 30;26(3):195-202 [PMID: 29133967]
  3. Oral Oncol. 2020 Jun 12;109:104850 [PMID: 32540612]
  4. Rev Assoc Med Bras (1992). 2023 Feb 20;69(3):469-472 [PMID: 36820779]
  5. Oral Oncol. 2019 Jan;88:91-94 [PMID: 30616804]
  6. BMC Med. 2013 Jul 04;11:159 [PMID: 23826681]
  7. Lasers Surg Med. 2005 Jul;37(1):29-36 [PMID: 15954115]
  8. Photomed Laser Surg. 2018 Dec;36(12):631-633 [PMID: 30339489]
  9. Cancer Prev Res (Phila). 2021 Feb;14(2):275-284 [PMID: 32958584]
  10. BMJ. 2018 Feb 28;360:k585 [PMID: 29490922]
  11. Virchows Arch. 2020 Apr;476(4):585-595 [PMID: 31468114]
  12. Dent J (Basel). 2023 Jan 18;11(2): [PMID: 36826173]
  13. Int J Clin Oncol. 2011 Feb;16(1):5-14 [PMID: 21225307]
  14. J Oral Maxillofac Surg. 2017 Apr;75(4):723-734 [PMID: 27865803]
  15. Oral Oncol. 2005 Jan;41(1):31-7 [PMID: 15598583]
  16. Dent Clin North Am. 2024 Jan;68(1):133-149 [PMID: 37951630]
  17. Semin Immunol. 2021 Oct;57:101595 [PMID: 35125298]
  18. Oral Oncol. 2021 Oct;121:105451 [PMID: 34329869]
  19. Res Synth Methods. 2022 Mar;13(2):164-175 [PMID: 34643333]
  20. Lasers Med Sci. 2019 Feb;34(1):209-221 [PMID: 30443884]
  21. Photodiagnosis Photodyn Ther. 2021 Dec;36:102523 [PMID: 34487871]
  22. J Hematol Oncol. 2021 Oct 21;14(1):173 [PMID: 34674757]
  23. Med Oral Patol Oral Cir Bucal. 2013 Jan 01;18(1):e38-44 [PMID: 23229239]
  24. Nanoscale. 2020 Oct 22;12(40):20598-20603 [PMID: 33047748]
  25. Photobiomodul Photomed Laser Surg. 2019 Jun;37(6):362-368 [PMID: 31081716]
  26. BMJ. 2021 Mar 29;372:n71 [PMID: 33782057]
  27. Photobiomodul Photomed Laser Surg. 2022 Aug;40(8):522-531 [PMID: 35904936]
  28. BMC Oral Health. 2023 Sep 6;23(1):645 [PMID: 37670255]
  29. J Periodontol. 2003 Sep;74(9):1368-75 [PMID: 14584872]
  30. Photomed Laser Surg. 2015 Dec;33(12):604-9 [PMID: 26588688]
  31. Int J Oral Maxillofac Surg. 2020 Jan;49(1):99-106 [PMID: 31230766]
  32. Lasers Med Sci. 2023 Nov 11;38(1):263 [PMID: 37952038]
  33. Global Spine J. 2022 Sep;12(7):1624-1626 [PMID: 35723546]
  34. Oral Dis. 2021 May;27(4):803-812 [PMID: 33448555]
  35. Front Pharmacol. 2022 Apr 20;13:825266 [PMID: 35517828]
  36. Medicine (Baltimore). 2020 Jul 24;99(30):e20942 [PMID: 32791674]
  37. BMC Med Res Methodol. 2020 Feb 7;20(1):26 [PMID: 32028897]
  38. Gene. 2021 Sep 25;798:145796 [PMID: 34175393]
  39. Urol Oncol. 2008 May-Jun;26(3):320-9 [PMID: 18452828]
  40. J Biophotonics. 2018 Mar;11(3): [PMID: 29045028]
  41. Lasers Med Sci. 2002;17(4):246-52 [PMID: 12417978]
  42. Photodiagnosis Photodyn Ther. 2022 Mar;37:102713 [PMID: 34999271]
  43. Br Dent J. 2017 Dec;223(9):655-661 [PMID: 29097794]
  44. J Oral Pathol Med. 2023 Sep;52(8):691-700 [PMID: 37224426]
  45. Clin Ter. 2020 May-Jun;171(3):e209-e215 [PMID: 32323707]
  46. Periodontol 2000. 2015 Jun;68(1):217-69 [PMID: 25867988]
  47. Laryngoscope Investig Otolaryngol. 2021 Jul 10;6(4):690-698 [PMID: 34401493]
  48. Int J Biostat. 2023 Mar 27;: [PMID: 36961993]
  49. Korean J Anesthesiol. 2021 Oct;74(5):371-382 [PMID: 34551467]
  50. Photodiagnosis Photodyn Ther. 2017 Dec;20:193-195 [PMID: 29037909]
  51. Med Oral Patol Oral Cir Bucal. 2018 Jan 1;23(1):e59-e64 [PMID: 29274164]
  52. BMC Oral Health. 2023 Aug 13;23(1):568 [PMID: 37574560]
  53. Eur J Oral Implantol. 2012;5 Suppl:S71-81 [PMID: 22834396]
  54. Oral Oncol. 2003 Dec;39(8):759-69 [PMID: 13679199]
  55. Ann Otol Rhinol Laryngol. 2013 Sep;122(9):547-9 [PMID: 24224396]
  56. BMC Oral Health. 2021 Oct 10;21(1):512 [PMID: 34629065]

MeSH Term

Leukoplakia, Oral
Humans
Laser Therapy
Network Meta-Analysis
Patient Comfort
Neoplasm Recurrence, Local
Randomized Controlled Trials as Topic
Lasers, Gas
Lasers, Solid-State
Recurrence
Pain, Postoperative
Journal Article Systematic Review Meta-Analysis

Word Cloud

Created with Highcharts 10.0.00laserrecurrenceOR:95%CI:OLKtreatmentmeta-analysisCOleukoplakialasersoptimalnetworkRCTsEr:YAGtherapyOrallesionefficacycomparedeffectssurgicalexcisionpost-treatmentcomfortpatientsincludedpaindetermineErCr:YSGG01-018standardcarereducingcombinedPDTEr:Cr:YSGGpatientLaserBACKGROUND:prevalentprecancerouslimitednon-pharmacologicaloptionsSurgeryvariousmainstayhoweverrelativechoiceremainunclearfirstdifferentMETHODS:searchedfourdatabasesrelevantrandomizedcontrolledtrialsApril2023primaryoutcomesecondaryoutcomesintraoperativehemorrhagepostoperativescoresCochraneRiskBiastoolusedassessstudyqualityMeta-analysisemployedidentifyinterventionRESULTS:total11including9171138lesionsshowedsignificantlylowerrates04marginextension06601003-037electrocautery0300-00802-033alsorankedbestfollowedphotodynamicminimizedbleedingrespectivelyNoneinterventionscausedsevereadverseCONCLUSION:non-homogeneousofferpromisingalternativespotentiallyimprovinghigh-qualitynecessaryconfirmfindingslaser-PDTcombinationdecreasesoralboostscomfort:systematicreviewNetworkPhotodynamicPrecancerous

Similar Articles

Cited By