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WHAT IS PHOTOTHERAPY?


Phototherapy, a.k.a. light therapy, is a method of treatment in which visible and invisible light are used as healing agents. Light is a form of electromagnetic energy; a type of energy that travels in waves. There is a wide spectrum of different types of electromagnetic energy and visible light forms only a small portion of this spectrum. Other forms of electromagnetic energy are not visible to the human eye; these include radio waves, microwaves, x-rays, gamma rays, ultraviolet light, and infrared light (which is usually felt as heat). These are all sometimes referred to as invisible light. Oftentimes you may hear of phototherapy being referred to as photobiomodulation treatment.


Sometimes phototherapy may include laser therapy. The word “laser” is an acronym for “Light Amplification by Stimulated Emission of Radiation.” A laser is a device which concentrates light into a highly intense, narrow beam. As children many of us have made crude visible-light lasers by using a magnifying glass to focus sunlight into a hot beam to melt ice or burn holes into leaves. There are lasers for visible light as well as invisible light, your oncologist will decide which one, if needed, will be of best use for your treatment. If the tumor is small enough and close enough to the surface this may even allow for the use of a laser to directly attack the tumor. Not only can lasers help destroy skin cancers but with special devices made for entering body cavities the technicians can also treat internal tumors of the esophagus, rectum, cervix, vagina, lung, etc. if a tumor happen to be located near the surface of the affected organ. The benefits of laser therapy include reduced pain, swelling, and scarring in comparison to traditional surgery.


Various forms of phototherapy can be a very useful weapon against cancer depending upon the type, location, and size of the tumor. This page will give a brief overview of the many benefits patients can receive from this method of treatment.




VISIBLE LIGHT-BASED PHOTOTHERAPY


Evicence shows that visible light can directly affect one's physical, mental, and emotional well-being. Because cancer is well-known for causing physical, mental, and emotional problems (such as pain, depression, insomnia, etc.) it is important for patients to know that visible light therapy (VLT) is an option during their treatment. Although studies on VLT specifically for cancer aren't as numerous, evidence is strong that it can help reduce or eliminate these issues during cancer treatment. For example:


Depression: Studies on depression in the general population have shown VLT to significantly relieve symptoms of depression.1 2 In cases of cancer patients there was one small study involving three terminally ill cancer patients which observed the effects of VLT on their depression. The patients, ages 58-73, were exposed to white light for up to three hours each morning for two weeks. It was reported that all three of them experienced signficant reductions in their depression, giving them better quality of life during their remaining days.3


Hair growth: Studies have shown that a treatment known as low level light therapy (“LLLT”) can promote hair growth in people who have lost their hair.4 5 This led to the investigation of using this form of therapy specifically on cancer patients who have lost their hair due to chemotherapy treatments. One particular study followed eleven female breast cancer patients, ages 20-60, and found that those who used LLLT experienced significant increases in their hair counts during six months of using the therapy.6 LLLT uses red light as the vehicle for healing, and is sometimes referred to as low level laser therapy.


Insomnia: Research has shown that the specific color of light influences the production of melatonin – a sleep hormone produced in your body to help you get quality sleep. One study observed that athletes who were exposed to 30 minutes of red light before sleep had higher melatonin levels and enjoyed better sleep quality than the group of athletes who were not given the red light treatments.7 One study looking at several light wavelengths (red, amber, green, blue/green, and blue) found that the shorter wavelengths (green, blue/green, and blue) suppressed melatonin production the most.8 Other studies which targeted single colors of light support this, showing that melatonin suppression occurs when subjects are exposed to blue light,9 green light,10 and white light 11 In the study examining blue light it was found that, when pitting blue light against red, between the two the blue light suppressed melatonin production whereas the red light did not.

If you are experiencing insomnia during your cancer treatments it is important that you remove all sources of non-red light in the room during sleep time (this includes alarm clocks, night lights, computer LEDs, etc.). If you need a night light use a red bulb or simply keep a flashlight with a red bulb next to your bed. If you require an alarm clock you should choose one with a red-light display, or simply turn the clock away from you as you sleep. Since blue light tends to suppress melatonin levels it is important to skip out on using devices which emit blue light at least 30 minutes before bedtime. This includes phone screens, computers, laptops, iPads, etc.


Mouth Sores: Also known as oral mucositis, this condition is a common issue for cancer patients being treated for head and neck cancers; it can be a result of either chemotherapy or radiation treatments. Research has shown that the use of low level light therapy significantly reduces the severity of treatment-based mouth sores.12 13


Neuropathy: Neuropathy is pain caused by nerve damage, which can come from various sources. Chemotherapy induced peripheral neuropathy (CIPN) is a common situation which can develop when a patient is treated with certain chemotherapy agents such as taxanes, platinums, and vinca alkaloids. Studies have shown that using low level light therapy can significantly reduce the discomfort caused by CIPN.14 15


 

HEAT THERAPY

 

Although many forms of heat therapy use sound waves, magnetic fields, or heated water there are also light-based heat therapies available depending upon the type, size, and location of the tumor. Unlike other methods of heat therapy, phototherapeutic methods tend to be used in extremely close proximity to the cancer cells themselves. Some examples of phototherapy-based heat treatments include:

 

  • Plasmonic Photothermal Therapy, which uses gold nanoparticles to absorb light and convert it into heat energy strong enough to kill nearby cancer cells.

  • Microwave Therapy: This form of invisible light may be used to either directly kill cancer cells or make them more vulnerable to the effects of chemotherapy and/or radiation treatments.

  • Laser Therapy: This uses a high-intensity beam of light to directly attack cancer cells on their surfaces. This not only works for skin cancers, but can also be used on internal cancers that are accessible through other body openings such as the nose, mouth/esophagus, rectum, etc. In such cases the laser is positioned at the end of a probe which is inserted and activitated once it reaches the tumor.

  • Radiofrequency Ablation: This type of invisible light therapy uses concentrated radio waves to create heat which directly attacks cancer cells on their surfaces.

 


PHOTO-DYNAMIC THERAPY


Photo-dynamic therapy uses a combination of specialized medications and light to treat certain types of cancer. In short, these medications are made with substances which need certain types of light to activate them (a.k.a. “turn them on”) in order to destroy cancer cells. This kind of therapy is also known as photo-chemotherapy and/or photo-radiation. Depending upon the area being treated, this type of therapy may require the medication to be inserted into a vein or applied to the skin. Time is allowed for the cancer cells to absorb the medication, after which light is applied to activate the medication once the cancer cells have accepted it. The timing between administration of the medication and light exposure will vary depending upon the medication used; this time is often referred to as “drug to light interval.” Depending upon the medication used, this may take anywhere from a few hours to a few days. When the light is applied it causes the medication to chemically react with the oxygen around it, creating a new substance which kills the cancer cells. This type of therapy has no long term side effects, is not as invasive as surgery, and can usually be done on an outpatient basis. The main limitation is that it is only effective in body locations where light can reach the target area. This usually includes the skin, nails, and the surface of inner organs which can have light devices inserted such as the nose, esophagus, rectum, vagina, etc. This is not a commonly used cancer treatment at this time and is available only through certain treatment centers.



PHOTO-IMMUNOTHERAPY


Photo-immunotherapy uses the combination of light and antibodies to kill specific kinds of cancer tumors. In this type of therapy, light-absorbing chemicals are attached to the antibodies which are then injected into the patient. Time is given for the antibodies to attach themselves to the targeted tumor(s). Once the antibodies are attached the light-absorbing chemicals they carry are activated by applying near-infrared light to the site, causing fatal damage to the tumor cells. This type of therapy is not yet widely available as researchers are still testing it through clinical trials, however the results look very promising for cancer patients.


PRECAUTIONS!


Some light-based therapies may induce mania or seizures in sensitive patients therefore it is strongly advised that patients do not use such therapies without a physician's strict oversight. Due to the concentration of light in many of these therapies be sure you never look directly into the light or beam without protective eyewear. Let your treating physician know if you have any type of skin sensitivity to light or ultraviolet light. Be sure that you are not taking medications, herbs, or supplements which may cause light sensitivity in your skin.


1Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients with Nonseasonal Major Depressive Disorder (Lam, et al, 2016)
2Phototherapy for Seasonal Major Depressive Disorder: Effectiveness of Bright Light of High or Low Intensity (Grota, et al, 1989)
3Phototherapy in the Treatment of Depression in the Terminally Ill (Cohen, et al, 1994)
4The Growth of Human Scalp Hair Mediated by Visible Red Light Laser and LED Sources in Males (Lanzafame, et al, 2013)
5The Growth of Human Scalp Hair in Females Using Visible Red Light Laser and LED Sources (Lanzafame, et al, 2014)
6The results were presented on April 7th, 2017 at the Annual Conference of the American Society for Laser Medicine and Surgery, by Raymond Lanzafame, M.D.
7Red Light and the Sleep Quality and Endurance Performance of Chinese Female Basketball Players (Zhao, et al, 2012)
8Effect of Light Wavelength on Suppression and Phase Delay of the Melatonin Rhythm (Wright & Lack, 2001).
9The Effects of Red and Blue Lights On Circadian Variations in Cortisol, Alpha Amylase, and Melatonin (Figueiro, 2010)
10 Green Light Affects Circadian Rhythm Division of Sleep Medicine, Harvard Medical School, (May 2010)
11 Exposure to White Light LEDs Appears to Suppress Body's Production of Melatonin More Than Certain Other Lights, Research Suggests (University of Haifa, September 12, 2011)
12Low-level Laser Therapy: A Standard of Supportive Care for Cancer-therapy Induced Oral Mucositis in Head and Neck Cancer Patients? (Jadaud & Bensadoun, 2012)
13Effect of Prophylactic Low Level Laser Therapy on Oral Mucositis: A Systematic Review and Meta-analysis (Oberoi, et al, 2014)
14Low Level Laser Therapy for Chemotherapy Induced Peripheral Neuropathy (Lee, et al, 2012)
15The Effect of Photobiomodulation on Chemotherapy-induced Peripheral Neuropathy: A Randomized, Sham-controlled, Clinical Trial (Argenta, et al, 2017)