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Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients
Authors:Siri Beier Jensen  Virginia Jarvis  Yehuda Zadik  Andrei Barasch  Anura Ariyawardana  Allan Hovan  Noam Yarom  Rajesh V. Lalla  Joanne Bowen  Sharon Elad
Affiliation:1. Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, N?rre Allé 20, 2200 N, Copenhagen, Denmark
2. Department of Nursing, The Ottawa Hospital Cancer Centre, Ottawa, Canada
3. Israeli Air Force Surgeon General Headquarters, and Department of Oral Medicine, Israel Defense Forces Medical Corps, Tel Hashomer, Israel
4. Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
5. Department of Dental Medicine, Winthrop University Hospital, Mineola, NY, USA
6. School of Medicine and Dentistry, James Cook University, Cairns, Australia
7. Griffith Health Institute, Griffith University, Gold Coast, Australia
8. Department of Dentistry, BC Cancer Agency, Vancouver, BC, Canada
10. Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
9. Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel
11. Section of Oral Medicine and Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT, USA
12. School of Medical Sciences, The University of Adelaide, Adelaide, Australia
13. Division of Oral Medicine, Eastman Institute for Oral Medicine, University of Rochester Medical Center, Rochester, NY, USA
Abstract:

Purpose

The aim of this systematic review was to analyze the available literature and define clinical practice guidelines for the use of the following agents for the prevention and treatment of oral mucositis (OM): allopurinol, midline mucosa-sparing radiation blocks, payayor, pentoxifylline, timing of radiation therapy (RT) (morning versus late afternoon), pilocarpine, bethanechol, chewing gum, propantheline, and tetrachlorodecaoxide.

Methods

A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, no guideline possible.

Results

A total of 32 papers across 10 interventions were examined. New suggestions were developed against the use of systemic pilocarpine administered orally for prevention of OM during RT in head and neck cancer patients and in patients receiving high-dose chemotherapy, with or without total body irradiation, prior to hematopoietic stem cell transplantation. A suggestion was also made against the use of systemic pentoxifylline administered orally for the prevention of OM in patients undergoing bone marrow transplantation. No guideline was possible for any other agent reviewed due to inadequate and/or conflicting evidence.

Conclusions

None of the agents reviewed was determined to be effective for the prevention or treatment of OM. Two agents, pilocarpine and pentoxifylline, were determined to be ineffective, in the populations listed above. Additional well-designed research is needed on other interventions.
Keywords:
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