| Author: | Tam, Chi Wing |
| Title: | Management of nasopharyngeal cancer treatment toxicities using photobiomodulation therapy |
| Advisors: | Lee, Shara (HTI) Law, Helen (HTI) |
| Degree: | Ph.D. |
| Year: | 2024 |
| Subject: | Lasers in medicine Lasers -- Therapeutic use Phototherapy Nasopharynx -- Cancer -- Chemotherapy -- Complications Nasopharynx -- Cancer -- Radiotherapy -- Complications Hong Kong Polytechnic University -- Dissertations |
| Department: | Department of Health Technology and Informatics |
| Pages: | xxvi, 286 pages : color illustrations |
| Language: | English |
| Abstract: | Nasopharyngeal cancer (NPC) represents the predominant subtype of head and neck cancer (HNC) within Hong Kong. The primary treatment approach for locoregionally advanced NPC encompasses concurrent chemo-radiotherapy (CRT), a regimen notorious for eliciting a broad spectrum of treatment-associated toxicities. This modality subjects the head and neck (H&N) area to high radiation dose, further exacerbated by the adjunctive use of chemotherapy, leading to severe adverse effects such as radiation dermatitis (RD) and oral mucositis (OM), attributed to collateral damage to the surrounding healthy tissues. With the advent of medical advancements prolonging survival, effective management of these side effects is crucial. Without proper management, these side effects may progress into chronic conditions, significantly diminishing patients’ quality of life (QoL). This situation highlights the critical need for developing and implementing extensive supportive care strategies to mitigate the toxicities associated with NPC treatment protocols. In the absence of definitive treatments for preventing and mitigating acute OM and RD, photobiomodulation therapy (PBMT) has emerged as a promising approach for managing cancer treatment-related side effects. Nevertheless, the specific efficacy of PBMT for NPC patients and survivors warrants further investigation, considering the unique treatment protocols and high radiation dose typical for NPC. This project aims to evaluate the utility of PBMT in mitigating toxicities among NPC patients throughout and following concurrent CRT. The structure of this thesis encompasses three key studies: 1) A randomised controlled trial to evaluate the effectiveness of PBMT in reducing the severity of OM and RD, decreasing weight loss, and improving QoL among NPC patients during CRT. Sixty-six NPC patients were recruited from the Department of Clinical Oncology at Queen Mary Hospital and the Department of Clinical Oncology at Prince of Wales Hospital Summary of findings: The results from this clinical trial highlight the potential of PBMT to reduce severe OM and RD incidence towards the end of CRT in NPC patients. Notably, PBMT significantly minimised weight loss in comparison to the SHAM group during CRT. Participants receiving PBMT reported fewer sore throat occurrences and diminished interference from OM throughout the follow-up phase. However, persistent dysgeusia and dry mouth were reported by both groups up to three months following CRT. 2) A cross-sectional survey aimed at examining the severity of late patient-reported toxicities, their association with QoL, and the unmet need for symptom management. Two hundred NPC survivors were surveyed at the Department of Clinical Oncology and the Department of Otorhinolaryngology, Head and Neck Surgery at Prince of Wales Hospital. Summary of findings: NPC survivors identified the five most severe symptoms as dry mouth, mucus issues, difficulty swallowing or chewing, teeth or gum complications, and memory problems. There was a positive correlation between the severity of symptom burden and the unmet need for enhanced symptom management. Notably, more than half of the survivors indicated a requirement for further assistance in managing their toxicities. 3) An in vivo study on 18 male C57/B6 mice to assess the effectiveness of PBMT in mitigating radiation-induced fibrosis (RIF), providing valuable insights into its potential benefits for the management of late toxicities. Summary of findings: The animal study demonstrated that prophylactic application of PBMT before radiation exposure could reduce joint contracture, articular joint fibrillation, and the development of fibrous pannus. These findings underscore the efficacy of PBMT in alleviating RIF, a shared pathology in late radiation toxicities. In summary, the research presented in this thesis highlights the significant potential for PBMT as an effective adjunct in the treatment landscape for NPC, specifically in reducing acute toxicities and offering a hopeful approach for managing late RIF. Although not all results achieved statistical significance, the observed benefits of PBMT, coupled with its safety profile and non-invasive nature, make it an appealing option for managing side effects related to cancer treatment. A noteworthy finding was the positive correlation between the severity of symptom burden and the unmet need for enhanced symptom management in this cohort, highlighting the imperative for more effective strategies in managing side effects associated with cancer therapy. The safety and non-invasive characteristics of PBMT stand out as key advantages, supporting its increased adoption in clinical practice for cancer care. Nevertheless, to fully incorporate PBMT into treatment regimens, further work is required in two essential areas, namely standardising treatment protocols and generating more conclusive evidence of its effectiveness. This thesis contributes important insights toward developing advanced supportive care strategies, supporting the inclusion of PBMT as a standard component to effectively address treatment-induced toxicities, with special emphasis on the need for better strategies in managing side effects associated with CRT. This conclusion not only supports the efficacy and safety of PBMT but also outlines the necessary steps for its integration into standard care practices, aiming to improve patient outcomes and quality of life for those undergoing treatment for NPC. |
| Rights: | All rights reserved |
| Access: | open access |
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