Efficacy of Different Doses of Photo-Biomodulation on Palmo Plantar Erythrodysesthesia Syndrome Associated with Cancer Therapy

Abstract

Aya M. M. Mohamed*, Eman M. Othman, Karim I. Saafan, Amr A. Hafez, Labib A. Gaber Shami, Maha Abd-ELmonem

Background: Hand-Foot Syndrome (HFS) is a common and debilitating side effect of cancer therapies, particularly those involving capecitabine and 5-Fluorouracil (5-FU). HFS manifests as painful redness, swelling, and tingling on the palms and soles, severely impacting patients’ quality of life. Photobiomodulation (PBM), a non-invasive therapy using light to stimulate cellular healing, has been proposed as an effective treatment for HFS. Previous studies have indicated that the intensity of PBM may influence its therapeutic efficacy, with 2 J/ cm² and 4 J/cm² doses showing promise in reducing HFS symptoms.

Purpose: This study aims to compare the efficacy of PBM at two different fluence levels (2 J/cm² and 4 J/ cm²) in reducing the severity of HFS and associated symptoms in cancer patients undergoing chemotherapy. Specifically, it evaluates improvements in pain reduction, functional abilities, and overall symptom burden.

Patients and Methods: This randomized controlled trial included 40 participants (24 females and 16 males) undergoing cancer treatment with capecitabine or 5-FU and diagnosed with palmo-plantar erythrodysesthesia were randomly assigned to two groups (n=20 each). Group A (20 patients) received PBM at 755 nm with a dose of 2 J/cm², while Group B (20 patients) received PBM at 4 J/cm², both three times weekly alongside standard medical therapy. Treatment was applied three times a week for four weeks. Outcomes and Measures: Participants were assessed before and after treatment using the Hand-Foot Syndrome-14 (HFS-14) questionnaire and the Visual Analog Scale (VAS) for pain. Statistical analyses were performed to compare pre- and post-treatment outcomes within and between groups. Results: Statistical analysis revealed significant post-treatment improvements in both groups across all outcome measures: visual analogue scale (VAS), HFS-14 questionnaire scores, and HFS grades. However, Group B demonstrated significantly greater improvements than Group A in VAS reduction (75.13% vs. 45.88%, p<0.0001) and HFS-14 score reduction (88.36% vs. 66.90%, p<0.0001). These findings suggest that higher-dose PBM may offer superior clinical benefits in reducing HFS symptoms in cancer patients.

Conclusion: PBM, especially at 4 J/cm², is an effective non-invasive therapy for managing HFS in cancer patients. The findings suggest that higher fluence levels provide enhanced therapeutic benefits, particularly in reducing pain and improving functional abilities, quality of life, and social participation. PBM should be considered a promising adjunctive treatment in cancer rehabilitation protocols for managing chemotherapy-induced dermatological toxicity.