title: Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, 2200 N, Copenhagen, Denmark, sirib@sund.ku.dk.
authors.forename: Siri Beier
authors.initials: SB
authors.lastname: Jensen
authors.forename: Virginia
authors.initials: V
authors.lastname: Jarvis
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Zadik
authors.forename: Andrei
authors.initials: A
authors.lastname: Barasch
authors.forename: Anura
authors.initials: A
authors.lastname: Ariyawardana
authors.forename: Allan
authors.initials: A
authors.lastname: Hovan
authors.forename: Noam
authors.initials: N
authors.lastname: Yarom
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
authors.forename: Joanne
authors.initials: J
authors.lastname: Bowen
authors.forename: Sharon
authors.initials: S
authors.lastname: Elad
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use*; D000963:Antimetabolites / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002638:Chewing Gum; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D018721:Muscarinic Agonists / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D013280:Stomatitis / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000963:Antimetabolites; D002638:Chewing Gum; D018721:Muscarinic Agonists; D011837:Radiation-Protective Agents; D000493:Allopurinol
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