Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols
Identifieur interne : 000799 ( Pmc/Checkpoint ); précédent : 000798; suivant : 000800Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols
Auteurs : Judith A. E. M. Zecha [Pays-Bas] ; Judith E. Raber-Durlacher [Pays-Bas] ; Raj G. Nair [Australie] ; Joel B. Epstein [États-Unis] ; Sharon Elad [États-Unis] ; Michael R. Hamblin [États-Unis] ; Andrei Barasch [États-Unis] ; Cesar A. Migliorati [États-Unis] ; Dan M. J. Milstein [Pays-Bas] ; Marie-Thérèse Genot [Belgique] ; Liset Lansaat [Pays-Bas] ; Ron Van Der Brink [États-Unis] ; Josep Arnabat-Dominguez [Espagne] ; Lisette Van Der Molen [Pays-Bas] ; Irene Jacobi [Pays-Bas] ; Judi Van Diessen [Pays-Bas] ; Jan De Lange [Pays-Bas] ; Ludi E. Smeele [Pays-Bas] ; Mark M. Schubert [États-Unis] ; René-Jean Bensadoun [France]Source :
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [ 0941-4355 ] ; 2016.
Abstract
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 discussed.
Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.
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:
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.
Url:
DOI: 10.1007/s00520-016-3153-y
PubMed: 26984249
PubMed Central: 4846551
Affiliations:
- Australie, Belgique, Espagne, France, Pays-Bas, États-Unis
- Californie, Catalogne, Hollande-Septentrionale, Massachusetts, Provence-Alpes-Côte d'Azur, Région de Bruxelles-Capitale, Tennessee, Washington (État), État de New York
- Amsterdam, Barcelone, Bruxelles, Nice
- Université d'Amsterdam
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<author><name sortKey="Elad, Sharon" sort="Elad, Sharon" uniqKey="Elad S" first="Sharon" last="Elad">Sharon Elad</name>
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</placeName>
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<author><name sortKey="Hamblin, Michael R" sort="Hamblin, Michael R" uniqKey="Hamblin M" first="Michael R." last="Hamblin">Michael R. Hamblin</name>
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<affiliation wicri:level="2"><nlm:aff id="A8">Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA</nlm:aff>
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<author><name sortKey="Barasch, Andrei" sort="Barasch, Andrei" uniqKey="Barasch A" first="Andrei" last="Barasch">Andrei Barasch</name>
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<author><name sortKey="Migliorati, Cesar A" sort="Migliorati, Cesar A" uniqKey="Migliorati C" first="Cesar A." last="Migliorati">Cesar A. Migliorati</name>
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</placeName>
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<author><name sortKey="Milstein, Dan M J" sort="Milstein, Dan M J" uniqKey="Milstein D" first="Dan M. J." last="Milstein">Dan M. J. Milstein</name>
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<author><name sortKey="Genot, Marie Therese" sort="Genot, Marie Therese" uniqKey="Genot M" first="Marie-Thérèse" last="Genot">Marie-Thérèse Genot</name>
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<author><name sortKey="Lansaat, Liset" sort="Lansaat, Liset" uniqKey="Lansaat L" first="Liset" last="Lansaat">Liset Lansaat</name>
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<wicri:regionArea>Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
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<author><name sortKey="Van Der Brink, Ron" sort="Van Der Brink, Ron" uniqKey="Van Der Brink R" first="Ron" last="Van Der Brink">Ron Van Der Brink</name>
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<author><name sortKey="Arnabat Dominguez, Josep" sort="Arnabat Dominguez, Josep" uniqKey="Arnabat Dominguez J" first="Josep" last="Arnabat-Dominguez">Josep Arnabat-Dominguez</name>
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<author><name sortKey="Van Der Molen, Lisette" sort="Van Der Molen, Lisette" uniqKey="Van Der Molen L" first="Lisette" last="Van Der Molen">Lisette Van Der Molen</name>
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<author><name sortKey="Jacobi, Irene" sort="Jacobi, Irene" uniqKey="Jacobi I" first="Irene" last="Jacobi">Irene Jacobi</name>
<affiliation wicri:level="3"><nlm:aff id="A13">Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
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<author><name sortKey="Van Diessen, Judi" sort="Van Diessen, Judi" uniqKey="Van Diessen J" first="Judi" last="Van Diessen">Judi Van Diessen</name>
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<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
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</placeName>
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<author><name sortKey="De Lange, Jan" sort="De Lange, Jan" uniqKey="De Lange J" first="Jan" last="De Lange">Jan De Lange</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam</wicri:regionArea>
<orgName type="university">Université d'Amsterdam</orgName>
<placeName><settlement type="city">Amsterdam</settlement>
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</placeName>
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<author><name sortKey="Smeele, Ludi E" sort="Smeele, Ludi E" uniqKey="Smeele L" first="Ludi E." last="Smeele">Ludi E. Smeele</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam</wicri:regionArea>
<orgName type="university">Université d'Amsterdam</orgName>
<placeName><settlement type="city">Amsterdam</settlement>
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</placeName>
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<affiliation wicri:level="3"><nlm:aff id="A13">Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
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<author><name sortKey="Schubert, Mark M" sort="Schubert, Mark M" uniqKey="Schubert M" first="Mark M." last="Schubert">Mark M. Schubert</name>
<affiliation wicri:level="2"><nlm:aff id="A16">Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA 98109, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA 98109</wicri:regionArea>
<placeName><region type="state">Washington (État)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bensadoun, Rene Jean" sort="Bensadoun, Rene Jean" uniqKey="Bensadoun R" first="René-Jean" last="Bensadoun">René-Jean Bensadoun</name>
<affiliation wicri:level="3"><nlm:aff id="A17">World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000 Nice, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000 Nice</wicri:regionArea>
<placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Nice</settlement>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols</title>
<author><name sortKey="Zecha, Judith A E M" sort="Zecha, Judith A E M" uniqKey="Zecha J" first="Judith A. E. M." last="Zecha">Judith A. E. M. Zecha</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam</wicri:regionArea>
<orgName type="university">Université d'Amsterdam</orgName>
<placeName><settlement type="city">Amsterdam</settlement>
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<author><name sortKey="Raber Durlacher, Judith E" sort="Raber Durlacher, Judith E" uniqKey="Raber Durlacher J" first="Judith E." last="Raber-Durlacher">Judith E. Raber-Durlacher</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam</wicri:regionArea>
<orgName type="university">Université d'Amsterdam</orgName>
<placeName><settlement type="city">Amsterdam</settlement>
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</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="A2">Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, P.O. Box 22660 1100 DD, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, P.O. Box 22660 1100 DD, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
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</placeName>
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<author><name sortKey="Nair, Raj G" sort="Nair, Raj G" uniqKey="Nair R" first="Raj G." last="Nair">Raj G. Nair</name>
<affiliation wicri:level="1"><nlm:aff id="A3">Oral Medicine Oral Pathology and Human Diseases, Menzies Health Institute Queensland and Oral Medicine Consultant, Department of Haematology and Oncology/Cancer Services, Gold Coast University Hospital, Queensland Health, Queensland, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Oral Medicine Oral Pathology and Human Diseases, Menzies Health Institute Queensland and Oral Medicine Consultant, Department of Haematology and Oncology/Cancer Services, Gold Coast University Hospital, Queensland Health, Queensland</wicri:regionArea>
<wicri:noRegion>Queensland</wicri:noRegion>
</affiliation>
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<author><name sortKey="Epstein, Joel B" sort="Epstein, Joel B" uniqKey="Epstein J" first="Joel B." last="Epstein">Joel B. Epstein</name>
<affiliation wicri:level="2"><nlm:aff id="A4">Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048</wicri:regionArea>
<placeName><region type="state">Californie</region>
</placeName>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="A5">Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA 91010, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA 91010</wicri:regionArea>
<placeName><region type="state">Californie</region>
</placeName>
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<author><name sortKey="Elad, Sharon" sort="Elad, Sharon" uniqKey="Elad S" first="Sharon" last="Elad">Sharon Elad</name>
<affiliation wicri:level="2"><nlm:aff id="A6">Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY 14620, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY 14620</wicri:regionArea>
<placeName><region type="state">État de New York</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Hamblin, Michael R" sort="Hamblin, Michael R" uniqKey="Hamblin M" first="Michael R." last="Hamblin">Michael R. Hamblin</name>
<affiliation wicri:level="2"><nlm:aff id="A7">Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="A8">Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Dermatology, Harvard Medical School, Boston, MA 02115</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
<affiliation wicri:level="2"><nlm:aff id="A9">Harvard-MIT Division of Health Science and Technology, Cambridge, MA 02139, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Harvard-MIT Division of Health Science and Technology, Cambridge, MA 02139</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Barasch, Andrei" sort="Barasch, Andrei" uniqKey="Barasch A" first="Andrei" last="Barasch">Andrei Barasch</name>
<affiliation wicri:level="2"><nlm:aff id="A10">Division of Oncology, Weill Cornell Medical Center, New York, NY, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Oncology, Weill Cornell Medical Center, New York, NY</wicri:regionArea>
<placeName><region type="state">État de New York</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Migliorati, Cesar A" sort="Migliorati, Cesar A" uniqKey="Migliorati C" first="Cesar A." last="Migliorati">Cesar A. Migliorati</name>
<affiliation wicri:level="2"><nlm:aff id="A11">Department of Diagnostic Sciences and Oral Medicine, Director of Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave. Suite N231, Memphis, TN 38163, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Diagnostic Sciences and Oral Medicine, Director of Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave. Suite N231, Memphis, TN 38163</wicri:regionArea>
<placeName><region type="state">Tennessee</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Milstein, Dan M J" sort="Milstein, Dan M J" uniqKey="Milstein D" first="Dan M. J." last="Milstein">Dan M. J. Milstein</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam</wicri:regionArea>
<orgName type="university">Université d'Amsterdam</orgName>
<placeName><settlement type="city">Amsterdam</settlement>
<region>Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Genot, Marie Therese" sort="Genot, Marie Therese" uniqKey="Genot M" first="Marie-Thérèse" last="Genot">Marie-Thérèse Genot</name>
<affiliation wicri:level="3"><nlm:aff id="A12">Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels</wicri:regionArea>
<placeName><settlement type="city">Bruxelles</settlement>
<region nuts="2">Région de Bruxelles-Capitale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lansaat, Liset" sort="Lansaat, Liset" uniqKey="Lansaat L" first="Liset" last="Lansaat">Liset Lansaat</name>
<affiliation wicri:level="3"><nlm:aff id="A13">Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Van Der Brink, Ron" sort="Van Der Brink, Ron" uniqKey="Van Der Brink R" first="Ron" last="Van Der Brink">Ron Van Der Brink</name>
<affiliation wicri:level="2"><nlm:aff id="A5">Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA 91010, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA 91010</wicri:regionArea>
<placeName><region type="state">Californie</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Arnabat Dominguez, Josep" sort="Arnabat Dominguez, Josep" uniqKey="Arnabat Dominguez J" first="Josep" last="Arnabat-Dominguez">Josep Arnabat-Dominguez</name>
<affiliation wicri:level="3"><nlm:aff id="A15">Department of Oral Surgery, Faculty of Dentistry, University of Barcelona, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Department of Oral Surgery, Faculty of Dentistry, University of Barcelona, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Van Der Molen, Lisette" sort="Van Der Molen, Lisette" uniqKey="Van Der Molen L" first="Lisette" last="Van Der Molen">Lisette Van Der Molen</name>
<affiliation wicri:level="3"><nlm:aff id="A13">Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Jacobi, Irene" sort="Jacobi, Irene" uniqKey="Jacobi I" first="Irene" last="Jacobi">Irene Jacobi</name>
<affiliation wicri:level="3"><nlm:aff id="A13">Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Van Diessen, Judi" sort="Van Diessen, Judi" uniqKey="Van Diessen J" first="Judi" last="Van Diessen">Judi Van Diessen</name>
<affiliation wicri:level="3"><nlm:aff id="A14">Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="De Lange, Jan" sort="De Lange, Jan" uniqKey="De Lange J" first="Jan" last="De Lange">Jan De Lange</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam</wicri:regionArea>
<orgName type="university">Université d'Amsterdam</orgName>
<placeName><settlement type="city">Amsterdam</settlement>
<region>Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Smeele, Ludi E" sort="Smeele, Ludi E" uniqKey="Smeele L" first="Ludi E." last="Smeele">Ludi E. Smeele</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam</wicri:regionArea>
<orgName type="university">Université d'Amsterdam</orgName>
<placeName><settlement type="city">Amsterdam</settlement>
<region>Hollande-Septentrionale</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="A13">Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Pays-Bas</country>
<wicri:regionArea>Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Schubert, Mark M" sort="Schubert, Mark M" uniqKey="Schubert M" first="Mark M." last="Schubert">Mark M. Schubert</name>
<affiliation wicri:level="2"><nlm:aff id="A16">Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA 98109, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA 98109</wicri:regionArea>
<placeName><region type="state">Washington (État)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bensadoun, Rene Jean" sort="Bensadoun, Rene Jean" uniqKey="Bensadoun R" first="René-Jean" last="Bensadoun">René-Jean Bensadoun</name>
<affiliation wicri:level="3"><nlm:aff id="A17">World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000 Nice, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000 Nice</wicri:regionArea>
<placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Nice</settlement>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer</title>
<idno type="ISSN">0941-4355</idno>
<idno type="eISSN">1433-7339</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Purpose</title>
<p id="P1">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 discussed.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">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: <italic>wavelength</italic>
, typically between 633 and 685 nm or 780–830 nm; <italic>energy density</italic>
, laser or light-emitting diode (LED) output between 10 and 150 mW; <italic>dose</italic>
, 2–3 J (J/cm<sup>2</sup>
), and no more than 6 J/cm<sup>2</sup>
on the tissue surface treated; <italic>treatment schedule</italic>
, two to three times a week up to daily; <italic>emission type</italic>
, pulsed (<100 Hz); and <italic>route of delivery</italic>
, 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.</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P4">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.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9302957</journal-id>
<journal-id journal-id-type="pubmed-jr-id">8479</journal-id>
<journal-id journal-id-type="nlm-ta">Support Care Cancer</journal-id>
<journal-id journal-id-type="iso-abbrev">Support Care Cancer</journal-id>
<journal-title-group><journal-title>Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer</journal-title>
</journal-title-group>
<issn pub-type="ppub">0941-4355</issn>
<issn pub-type="epub">1433-7339</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26984249</article-id>
<article-id pub-id-type="pmc">4846551</article-id>
<article-id pub-id-type="doi">10.1007/s00520-016-3153-y</article-id>
<article-id pub-id-type="manuscript">NIHMS773663</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Zecha</surname>
<given-names>Judith A. E. M.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<email>j.zecha@amc.uva.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>Raber-Durlacher</surname>
<given-names>Judith E.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
<email>j.e.raberdurlacher@amc.uva.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>Nair</surname>
<given-names>Raj G.</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
<email>r.nair@griffith.edu.au</email>
</contrib>
<contrib contrib-type="author"><name><surname>Epstein</surname>
<given-names>Joel B.</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
<xref ref-type="aff" rid="A5">5</xref>
<email>joel.epstein@cshs.org</email>
</contrib>
<contrib contrib-type="author"><name><surname>Elad</surname>
<given-names>Sharon</given-names>
</name>
<xref ref-type="aff" rid="A6">6</xref>
<email>SElad@URMC.Rochester.edu</email>
</contrib>
<contrib contrib-type="author"><name><surname>Hamblin</surname>
<given-names>Michael R.</given-names>
</name>
<xref ref-type="aff" rid="A7">7</xref>
<xref ref-type="aff" rid="A8">8</xref>
<xref ref-type="aff" rid="A9">9</xref>
<email>hamblin@helix.mgh.harvard.edu</email>
</contrib>
<contrib contrib-type="author"><name><surname>Barasch</surname>
<given-names>Andrei</given-names>
</name>
<xref ref-type="aff" rid="A10">10</xref>
<email>barasaff@cs.com</email>
</contrib>
<contrib contrib-type="author"><name><surname>Migliorati</surname>
<given-names>Cesar A.</given-names>
</name>
<xref ref-type="aff" rid="A11">11</xref>
<email>migliorati@uthsc.edu</email>
</contrib>
<contrib contrib-type="author"><name><surname>Milstein</surname>
<given-names>Dan M. J.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<email>D.M.Milstein@amc.uva.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>Genot</surname>
<given-names>Marie-Thérèse</given-names>
</name>
<xref ref-type="aff" rid="A12">12</xref>
<email>mtgenot@skynet.be</email>
</contrib>
<contrib contrib-type="author"><name><surname>Lansaat</surname>
<given-names>Liset</given-names>
</name>
<xref ref-type="aff" rid="A13">13</xref>
<email>l.lansaat@nki.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>van der Brink</surname>
<given-names>Ron</given-names>
</name>
<xref ref-type="aff" rid="A5">5</xref>
<email>RVanderbrink@coh.org</email>
</contrib>
<contrib contrib-type="author"><name><surname>Arnabat-Dominguez</surname>
<given-names>Josep</given-names>
</name>
<xref ref-type="aff" rid="A15">15</xref>
<email>joseparnabat@ub.edu</email>
</contrib>
<contrib contrib-type="author"><name><surname>van der Molen</surname>
<given-names>Lisette</given-names>
</name>
<xref ref-type="aff" rid="A13">13</xref>
<email>l.vd.molen@nki.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>Jacobi</surname>
<given-names>Irene</given-names>
</name>
<xref ref-type="aff" rid="A13">13</xref>
<email>i.jacobi@nki.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>van Diessen</surname>
<given-names>Judi</given-names>
</name>
<xref ref-type="aff" rid="A14">14</xref>
<email>j.v.diessen@nki.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>de Lange</surname>
<given-names>Jan</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<email>j.delange@amc.uva.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>Smeele</surname>
<given-names>Ludi E.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A13">13</xref>
<email>l.smeele@nki.nl</email>
</contrib>
<contrib contrib-type="author"><name><surname>Schubert</surname>
<given-names>Mark M.</given-names>
</name>
<xref ref-type="aff" rid="A16">16</xref>
<email>mschuber@seattlecca.org</email>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Bensadoun</surname>
<given-names>René-Jean</given-names>
</name>
<xref ref-type="aff" rid="A17">17</xref>
<email>renejean.bensadoun@che-nice.com</email>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands</aff>
<aff id="A2"><label>2</label>
Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, P.O. Box 22660 1100 DD, Amsterdam, the Netherlands</aff>
<aff id="A3"><label>3</label>
Oral Medicine Oral Pathology and Human Diseases, Menzies Health Institute Queensland and Oral Medicine Consultant, Department of Haematology and Oncology/Cancer Services, Gold Coast University Hospital, Queensland Health, Queensland, Australia</aff>
<aff id="A4"><label>4</label>
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA</aff>
<aff id="A5"><label>5</label>
Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA 91010, USA</aff>
<aff id="A6"><label>6</label>
Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY 14620, USA</aff>
<aff id="A7"><label>7</label>
Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA</aff>
<aff id="A8"><label>8</label>
Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA</aff>
<aff id="A9"><label>9</label>
Harvard-MIT Division of Health Science and Technology, Cambridge, MA 02139, USA</aff>
<aff id="A10"><label>10</label>
Division of Oncology, Weill Cornell Medical Center, New York, NY, USA</aff>
<aff id="A11"><label>11</label>
Department of Diagnostic Sciences and Oral Medicine, Director of Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave. Suite N231, Memphis, TN 38163, USA</aff>
<aff id="A12"><label>12</label>
Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium</aff>
<aff id="A13"><label>13</label>
Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands</aff>
<aff id="A14"><label>14</label>
Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands</aff>
<aff id="A15"><label>15</label>
Department of Oral Surgery, Faculty of Dentistry, University of Barcelona, Barcelona, Spain</aff>
<aff id="A16"><label>16</label>
Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA 98109, USA</aff>
<aff id="A17"><label>17</label>
World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000 Nice, France</aff>
<pub-date pub-type="nihms-submitted"><day>1</day>
<month>4</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>17</day>
<month>3</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="ppub"><month>6</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>6</month>
<year>2017</year>
</pub-date>
<volume>24</volume>
<issue>6</issue>
<fpage>2793</fpage>
<lpage>2805</lpage>
<pmc-comment>elocation-id from pubmed: 10.1007/s00520-016-3153-y</pmc-comment>
<abstract><sec id="S1"><title>Purpose</title>
<p id="P1">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 discussed.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">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: <italic>wavelength</italic>
, typically between 633 and 685 nm or 780–830 nm; <italic>energy density</italic>
, laser or light-emitting diode (LED) output between 10 and 150 mW; <italic>dose</italic>
, 2–3 J (J/cm<sup>2</sup>
), and no more than 6 J/cm<sup>2</sup>
on the tissue surface treated; <italic>treatment schedule</italic>
, two to three times a week up to daily; <italic>emission type</italic>
, pulsed (<100 Hz); and <italic>route of delivery</italic>
, 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.</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P4">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.</p>
</sec>
</abstract>
<kwd-group><kwd>Low-level laser therapy</kwd>
<kwd>Low-level light therapy</kwd>
<kwd>Photobiomodulation</kwd>
<kwd>Mucositis</kwd>
<kwd>Orofacial complications</kwd>
<kwd>Chemotherapy</kwd>
<kwd>Radiation therapy</kwd>
<kwd>Head and neck cancer</kwd>
<kwd>LLLT</kwd>
<kwd>PBM</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Australie</li>
<li>Belgique</li>
<li>Espagne</li>
<li>France</li>
<li>Pays-Bas</li>
<li>États-Unis</li>
</country>
<region><li>Californie</li>
<li>Catalogne</li>
<li>Hollande-Septentrionale</li>
<li>Massachusetts</li>
<li>Provence-Alpes-Côte d'Azur</li>
<li>Région de Bruxelles-Capitale</li>
<li>Tennessee</li>
<li>Washington (État)</li>
<li>État de New York</li>
</region>
<settlement><li>Amsterdam</li>
<li>Barcelone</li>
<li>Bruxelles</li>
<li>Nice</li>
</settlement>
<orgName><li>Université d'Amsterdam</li>
</orgName>
</list>
<tree><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Zecha, Judith A E M" sort="Zecha, Judith A E M" uniqKey="Zecha J" first="Judith A. E. M." last="Zecha">Judith A. E. M. Zecha</name>
</region>
<name sortKey="De Lange, Jan" sort="De Lange, Jan" uniqKey="De Lange J" first="Jan" last="De Lange">Jan De Lange</name>
<name sortKey="Jacobi, Irene" sort="Jacobi, Irene" uniqKey="Jacobi I" first="Irene" last="Jacobi">Irene Jacobi</name>
<name sortKey="Lansaat, Liset" sort="Lansaat, Liset" uniqKey="Lansaat L" first="Liset" last="Lansaat">Liset Lansaat</name>
<name sortKey="Milstein, Dan M J" sort="Milstein, Dan M J" uniqKey="Milstein D" first="Dan M. J." last="Milstein">Dan M. J. Milstein</name>
<name sortKey="Raber Durlacher, Judith E" sort="Raber Durlacher, Judith E" uniqKey="Raber Durlacher J" first="Judith E." last="Raber-Durlacher">Judith E. Raber-Durlacher</name>
<name sortKey="Raber Durlacher, Judith E" sort="Raber Durlacher, Judith E" uniqKey="Raber Durlacher J" first="Judith E." last="Raber-Durlacher">Judith E. Raber-Durlacher</name>
<name sortKey="Smeele, Ludi E" sort="Smeele, Ludi E" uniqKey="Smeele L" first="Ludi E." last="Smeele">Ludi E. Smeele</name>
<name sortKey="Smeele, Ludi E" sort="Smeele, Ludi E" uniqKey="Smeele L" first="Ludi E." last="Smeele">Ludi E. Smeele</name>
<name sortKey="Van Der Molen, Lisette" sort="Van Der Molen, Lisette" uniqKey="Van Der Molen L" first="Lisette" last="Van Der Molen">Lisette Van Der Molen</name>
<name sortKey="Van Diessen, Judi" sort="Van Diessen, Judi" uniqKey="Van Diessen J" first="Judi" last="Van Diessen">Judi Van Diessen</name>
</country>
<country name="Australie"><noRegion><name sortKey="Nair, Raj G" sort="Nair, Raj G" uniqKey="Nair R" first="Raj G." last="Nair">Raj G. Nair</name>
</noRegion>
</country>
<country name="États-Unis"><region name="Californie"><name sortKey="Epstein, Joel B" sort="Epstein, Joel B" uniqKey="Epstein J" first="Joel B." last="Epstein">Joel B. Epstein</name>
</region>
<name sortKey="Barasch, Andrei" sort="Barasch, Andrei" uniqKey="Barasch A" first="Andrei" last="Barasch">Andrei Barasch</name>
<name sortKey="Elad, Sharon" sort="Elad, Sharon" uniqKey="Elad S" first="Sharon" last="Elad">Sharon Elad</name>
<name sortKey="Epstein, Joel B" sort="Epstein, Joel B" uniqKey="Epstein J" first="Joel B." last="Epstein">Joel B. Epstein</name>
<name sortKey="Hamblin, Michael R" sort="Hamblin, Michael R" uniqKey="Hamblin M" first="Michael R." last="Hamblin">Michael R. Hamblin</name>
<name sortKey="Hamblin, Michael R" sort="Hamblin, Michael R" uniqKey="Hamblin M" first="Michael R." last="Hamblin">Michael R. Hamblin</name>
<name sortKey="Hamblin, Michael R" sort="Hamblin, Michael R" uniqKey="Hamblin M" first="Michael R." last="Hamblin">Michael R. Hamblin</name>
<name sortKey="Migliorati, Cesar A" sort="Migliorati, Cesar A" uniqKey="Migliorati C" first="Cesar A." last="Migliorati">Cesar A. Migliorati</name>
<name sortKey="Schubert, Mark M" sort="Schubert, Mark M" uniqKey="Schubert M" first="Mark M." last="Schubert">Mark M. Schubert</name>
<name sortKey="Van Der Brink, Ron" sort="Van Der Brink, Ron" uniqKey="Van Der Brink R" first="Ron" last="Van Der Brink">Ron Van Der Brink</name>
</country>
<country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Genot, Marie Therese" sort="Genot, Marie Therese" uniqKey="Genot M" first="Marie-Thérèse" last="Genot">Marie-Thérèse Genot</name>
</region>
</country>
<country name="Espagne"><region name="Catalogne"><name sortKey="Arnabat Dominguez, Josep" sort="Arnabat Dominguez, Josep" uniqKey="Arnabat Dominguez J" first="Josep" last="Arnabat-Dominguez">Josep Arnabat-Dominguez</name>
</region>
</country>
<country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Bensadoun, Rene Jean" sort="Bensadoun, Rene Jean" uniqKey="Bensadoun R" first="René-Jean" last="Bensadoun">René-Jean Bensadoun</name>
</region>
</country>
</tree>
</affiliations>
</record>
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