Scolaris Content Display Scolaris Content Display

Comparison 1 Active treatment versus placebo/no treatment, Outcome 1 Mucositis (absent versus present).
Figures and Tables -
Analysis 1.1

Comparison 1 Active treatment versus placebo/no treatment, Outcome 1 Mucositis (absent versus present).

Comparison 1 Active treatment versus placebo/no treatment, Outcome 2 Mucositis (0‐1 versus 2+).
Figures and Tables -
Analysis 1.2

Comparison 1 Active treatment versus placebo/no treatment, Outcome 2 Mucositis (0‐1 versus 2+).

Comparison 1 Active treatment versus placebo/no treatment, Outcome 3 Mucositis (0‐2 versus 3+).
Figures and Tables -
Analysis 1.3

Comparison 1 Active treatment versus placebo/no treatment, Outcome 3 Mucositis (0‐2 versus 3+).

Comparison 2 Comparisons between active interventions, Outcome 1 Mucositis (absent versus present).
Figures and Tables -
Analysis 2.1

Comparison 2 Comparisons between active interventions, Outcome 1 Mucositis (absent versus present).

Comparison 2 Comparisons between active interventions, Outcome 2 Mucositis (0‐1 versus 2+).
Figures and Tables -
Analysis 2.2

Comparison 2 Comparisons between active interventions, Outcome 2 Mucositis (0‐1 versus 2+).

Comparison 2 Comparisons between active interventions, Outcome 3 Mucositis (0‐2 versus 3+).
Figures and Tables -
Analysis 2.3

Comparison 2 Comparisons between active interventions, Outcome 3 Mucositis (0‐2 versus 3+).

Comparison 3 Side effects, Outcome 1 Amifostine.
Figures and Tables -
Analysis 3.1

Comparison 3 Side effects, Outcome 1 Amifostine.

Table 1. Quality assessment of trials

Study

Concealed allocation

Outcome blinded

Explanation of drop outs

Risk of bias

Withdrawals %

Ahmed 1993

B

yes

yes

M

0

Anderson 1998

B

yes

yes

M

46

Antonado 2002

B

no

yes

H

10

Attal 1993

A

unclear

yes

M

0

Biswal 2003

A (B)

unclear

yes

M

0

Borowski 1994

A

no

yes

M

7

Bourhis 2000

A

unclear

no

H

8

Brizel 2000

A

no

yes (no)

M

0

Bubley 1989

A

yes

no

M

unclear

Buentzel 2006

A (B)

yes

no

H

0

Buntzel 1998a

B

unclear

yes

H

0

Cartee 1995

A

yes

no

M

10

Carter 1999

B

yes

yes

M

0

Castagna 2001

B

yes

yes

M

3

Cascinu 1994

A (B)

no

yes

M

0

Cengiz 1999

B

unclear

yes

H

0

Cerchietti 2006

A (B)

yes

yes

L (M)

0

Crawford 1999

B

unclear

yes

H

9

Damon 2004

B

unclear

no

H

0

Dazzi 2003

A (B)

yes

yes

L

0

Dickson 2000

A (B)

yes

yes

L

0

Dodd 1996

A

yes

yes

L

0

Dozono 1989

A

unclear

yes

M

0

Duenas 1996

A (B)

yes

yes

L

0

El Sayed 2002

A (B)

yes

yes

L (M)

0

Elad 2006

A (B)

yes

yes (no)

L (M)

13

Erlichman 1988

B

unclear

no

H

4

Ertekin 2004

A (B)

yes

yes

L

10

Ferretti 1988

A (B)

yes

no

M

10

Ferretti 1990

A

yes

no

M

36

Fidler 1996

B

yes

no

H

1

Foote 1994

A

yes

no

L

0

Frazen 1995

A

yes

yes

L

10

Freytes 2004

A (B)

yes

yes

L (M)

0

Giles 2003

A

yes

yes

H

0

Giles 2004

B

yes

yes

M

0

Gurjral 2001

A

yes

no

M

1

Hartmann 2001

C (B)

unclear

yes

H

0

Huang 2000

B

unclear

yes (unclear)

H

0

Huang 2003

B

unclear

no

H

0

Hwang 2003

B

no

yes

H

2

Ifrah 1999

B

yes

no

H

unclear

Jebb 1994

A (B)

yes

no

M

39

Karacetin 2004

B

unclear

yes

H

0

Katano 1995

B

no

yes

H

0

Kaul 1999

B

no

no

H

unclear

Koukourakis 2000

B

no

no

H

3

Labar 1993

B

yes

yes

M

0

Leborgne 1997

B

yes

no

H

4

Lee 1989

A

unclear

yes

M

unclear

Lilleby 2006

B

no

yes

H

2

Lockhart 2005

A(B)

yes

yes (no)

L (M)

0

Loprinzi 1990

A (B)

yes

yes

L

0

Mahood 1991

B

no

no

H

2

Makkonen 1994

A

unclear

yes

M

0

Makkonen 2000

A

no

yes

M

0

Meropol 2003

B

yes

yes

M

0

Mills 1988

B

unclear

yes

H

0

Nemunaitis 1995

A

yes

yes

L

0

Niibe 1985

A

yes

yes

L

21

Nottage 2003

A

yes

yes

L

1

Oberbaum 2001

A

yes

yes

L

6

Okuno 1999

B

yes

yes

M

0

Papas 2003

A (B)

yes

yes (unclear)

L

2

Pfeiffer 1990

B

yes

no

H

43

Pillsbury 1986

A (B)

yes

yes

L

10

Pitten 2003

A

yes

yes

L

0

Prada 1987

B

yes

no

H

10

Rahn 1997

B

yes (unclear)

yes

M

0

Rocke 1993

B

unclear

yes

H

1

Saarilahti 2002

A

yes

yes

L

0

Scarantino 2006

A (B)

yes

no

H

1

Scherlacher 1990

B

unclear

yes

H

0

Schneider 1999

A

yes

yes

L

0

Sheih 1997

A (B)

yes (unclear)

yes

L

0

Shenep 1988

A

yes

yes

L

0

Spencer 2005

A (B)

unclear

yes

M

0

Spielberger 2004

B

yes

yes (no)

M

0

Spijkervet 1989

B

yes

yes

M

0

Stokman 2003

A

yes

yes

L

11

Su 2003

A (B)

yes

yes

L

0

Symonds 1996

B

yes

yes

M

20

Trotti 2004

A (B)

yes

yes

L

0

Van der Lelie 2001

A (B)

yes

yes

L

0

Vokurka 2005

B

unclear

no

H

4

Wahlin 1989

A (B)

yes

yes

L

0

Wang 2002

B

unclear

no

H

0

Wijers 2001

B

yes

no

H

32

Yuen 2001

B

no

yes

H

0

Figures and Tables -
Table 1. Quality assessment of trials
Comparison 1. Active treatment versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mucositis (absent versus present) Show forest plot

48

risk ratio (Random, 95% CI)

Subtotals only

1.1 Aclyclovir versus placebo

1

57

risk ratio (Random, 95% CI)

1.33 [0.85, 2.08]

1.2 Allopurinol versus placebo/no treatment

2

68

risk ratio (Random, 95% CI)

0.62 [0.15, 2.47]

1.3 Amifostine versus no treatment

5

632

risk ratio (Random, 95% CI)

0.95 [0.92, 0.98]

1.4 Antibiotic (pastille or paste) versus placebo

3

435

risk ratio (Random, 95% CI)

0.93 [0.83, 1.04]

1.5 Benzydamine versus placebo

1

36

risk ratio (Random, 95% CI)

0.67 [0.47, 0.96]

1.6 Chinese medicine versus control (Dobell's solution)

1

147

risk ratio (Random, 95% CI)

0.44 [0.20, 0.96]

1.7 Calcium phosphate versus placebo

1

94

risk ratio (Random, 95% CI)

0.75 [0.58, 0.99]

1.8 Camomile versus placebo

1

135

risk ratio (Random, 95% CI)

0.79 [0.58, 1.07]

1.9 Chlorhexidine versus placebo or no treatment

4

374

risk ratio (Random, 95% CI)

0.79 [0.53, 1.17]

1.10 Folinic acid versus no treatment

1

107

risk ratio (Random, 95% CI)

3.65 [2.39, 5.58]

1.11 Glutamine versus placebo

3

194

risk ratio (Random, 95% CI)

0.85 [0.57, 1.26]

1.12 GM‐CSF versus no treatment

3

299

risk ratio (Random, 95% CI)

0.67 [0.42, 1.07]

1.13 Histamine gel versus placebo

1

39

risk ratio (Random, 95% CI)

1.35 [0.91, 1.99]

1.14 Honey versus control

1

40

risk ratio (Random, 95% CI)

0.85 [0.66, 1.08]

1.15 Hydrolytic enzymes versus no treatment

2

149

risk ratio (Random, 95% CI)

0.67 [0.31, 1.44]

1.16 Ice chips versus no treatment

3

178

risk ratio (Random, 95% CI)

0.64 [0.50, 0.82]

1.17 Iseganan versus placebo

1

221

risk ratio (Random, 95% CI)

0.59 [0.43, 0.80]

1.18 Misonidazole versus control

1

40

risk ratio (Random, 95% CI)

1.19 [0.98, 1.45]

1.19 Oral care protocol versus none

1

30

risk ratio (Random, 95% CI)

0.60 [0.42, 0.85]

1.20 Pilocarpine versus placebo

2

276

risk ratio (Random, 95% CI)

0.89 [0.60, 1.32]

1.21 Povidone versus water

2

172

risk ratio (Random, 95% CI)

0.84 [0.60, 1.18]

1.22 Prednisone versus placebo

1

66

risk ratio (Random, 95% CI)

1.03 [0.85, 1.25]

1.23 Propantheline versus placebo

1

12

risk ratio (Random, 95% CI)

0.40 [0.12, 1.31]

1.24 Prostaglandin versus placebo

2

76

risk ratio (Random, 95% CI)

1.47 [0.47, 4.55]

1.25 Sucralfate versus placebo

2

182

risk ratio (Random, 95% CI)

0.96 [0.85, 1.10]

1.26 Traumeel versus placebo

1

30

risk ratio (Random, 95% CI)

0.71 [0.48, 1.04]

1.27 Zinc sulphate versus placebo

1

27

risk ratio (Random, 95% CI)

0.87 [0.72, 1.06]

2 Mucositis (0‐1 versus 2+) Show forest plot

48

risk ratio (Random, 95% CI)

Subtotals only

2.1 Aloe vera versus placebo

1

58

risk ratio (Random, 95% CI)

0.92 [0.64, 1.32]

2.2 Amifostine versus placebo or no treatment

8

753

risk ratio (Random, 95% CI)

0.88 [0.80, 0.98]

2.3 Antibiotic pastille or paste versus placebo or no treatment

2

204

risk ratio (Random, 95% CI)

1.03 [0.87, 1.22]

2.4 Calcium phosphate versus placebo

1

94

risk ratio (Random, 95% CI)

0.63 [0.42, 0.94]

2.5 Camomile versus placebo

1

164

risk ratio (Random, 95% CI)

0.63 [0.33, 1.21]

2.6 Chinese medicine versus control (Dobell's solution)

2

248

risk ratio (Random, 95% CI)

0.44 [0.33, 0.59]

2.7 Chlorhexidine versus placebo or no treatment

2

99

risk ratio (Random, 95% CI)

1.83 [0.52, 6.43]

2.8 Folinic acid versus no treatment

1

125

risk ratio (Random, 95% CI)

2.38 [1.35, 4.21]

2.9 Glutamine versus placebo

4

243

risk ratio (Random, 95% CI)

0.92 [0.75, 1.12]

2.10 GM‐CSF versus no treatment

3

230

risk ratio (Random, 95% CI)

0.81 [0.56, 1.17]

2.11 Hydrolic enzymes versus no treatment

2

149

risk ratio (Random, 95% CI)

0.52 [0.36, 0.74]

2.12 Ice chips versus no treatment

3

178

risk ratio (Random, 95% CI)

0.38 [0.23, 0.62]

2.13 Indomethacin versus placebo

1

18

risk ratio (Random, 95% CI)

0.0 [0.0, 0.0]

2.14 Iseganan versus placebo

2

926

risk ratio (Random, 95% CI)

0.97 [0.89, 1.06]

2.15 Keratinocyte GF versus placebo

3

335

risk ratio (Random, 95% CI)

0.75 [0.54, 1.06]

2.16 Misonidazole versus control

1

40

risk ratio (Random, 95% CI)

0.97 [0.66, 1.42]

2.17 Oral care protocol versus none

2

408

risk ratio (Random, 95% CI)

1.00 [0.84, 1.19]

2.18 Pentoxifylline versus no treatment

1

140

risk ratio (Random, 95% CI)

1.0 [0.68, 1.47]

2.19 Pilocarpine versus placebo

2

276

risk ratio (Random, 95% CI)

0.99 [0.78, 1.26]

2.20 Povidone versus water

2

172

risk ratio (Random, 95% CI)

0.74 [0.29, 1.88]

2.21 Prednisone versus placebo

1

66

risk ratio (Random, 95% CI)

0.71 [0.47, 1.07]

2.22 Sucralfate versus placebo

3

116

risk ratio (Random, 95% CI)

0.68 [0.41, 1.12]

2.23 Systemic antibiotic clarithromycin versus no treatment

1

70

risk ratio (Random, 95% CI)

0.69 [0.47, 1.01]

2.24 Zinc sulphate versus placebo

1

30

risk ratio (Random, 95% CI)

0.42 [0.20, 0.89]

3 Mucositis (0‐2 versus 3+) Show forest plot

59

risk ratio (Random, 95% CI)

Subtotals only

3.1 Amifostine versus no treatment

10

808

risk ratio (Random, 95% CI)

0.70 [0.49, 1.00]

3.2 Antibiotic pastille or paste versus placebo

3

272

risk ratio (Random, 95% CI)

0.87 [0.73, 1.04]

3.3 Beta carotene versus control

1

20

risk ratio (Random, 95% CI)

0.38 [0.14, 1.01]

3.4 Calcium phosphate versus placebo

1

94

risk ratio (Random, 95% CI)

0.42 [0.23, 0.76]

3.5 Camomile versus placebo

1

164

risk ratio (Random, 95% CI)

1.14 [0.43, 3.00]

3.6 Chinese medicine versus control (Dobell's solution)

2

248

risk ratio (Random, 95% CI)

0.16 [0.07, 0.35]

3.7 Chlorhexidine versus placebo or no treatment

3

110

risk ratio (Random, 95% CI)

0.98 [0.76, 1.27]

3.8 Folinic acid versus no treatment

1

125

risk ratio (Random, 95% CI)

8.58 [0.47, 155.98]

3.9 Glutamine versus placebo

5

240

risk ratio (Random, 95% CI)

0.57 [0.23, 1.38]

3.10 GM‐CSF versus placebo

6

358

risk ratio (Random, 95% CI)

0.69 [0.36, 1.32]

3.11 Histamine gel versus placebo

1

39

risk ratio (Random, 95% CI)

1.05 [0.16, 6.74]

3.12 Honey versus control

1

40

risk ratio (Random, 95% CI)

0.27 [0.11, 0.66]

3.13 Hydrolytic enzymes versus no treatment

2

149

risk ratio (Random, 95% CI)

0.17 [0.06, 0.52]

3.14 Ice chips versus no treatment

3

178

risk ratio (Random, 95% CI)

0.24 [0.12, 0.48]

3.15 Iseganan versus placebo

2

926

risk ratio (Random, 95% CI)

1.00 [0.85, 1.19]

3.16 Keratinocyte GF versus placebo

2

254

risk ratio (Random, 95% CI)

0.69 [0.41, 1.15]

3.17 Misonidazole versus control

1

40

risk ratio (Random, 95% CI)

0.68 [0.17, 2.65]

3.18 Oral care protocol versus none

2

408

risk ratio (Random, 95% CI)

1.06 [0.68, 1.64]

3.19 Pilocarpine versus placebo

1

34

risk ratio (Random, 95% CI)

0.90 [0.58, 1.38]

3.20 Povidone versus water

2

172

risk ratio (Random, 95% CI)

0.57 [0.20, 1.62]

3.21 Prednisone versus placebo

1

66

risk ratio (Random, 95% CI)

0.64 [0.17, 2.46]

3.22 Prostaglandin versus placebo

2

78

risk ratio (Random, 95% CI)

1.06 [0.66, 1.70]

3.23 Sucralfate versus placebo

6

423

risk ratio (Random, 95% CI)

0.78 [0.61, 1.00]

3.24 Zinc sulphate

1

27

risk ratio (Random, 95% CI)

0.05 [0.00, 0.78]

Figures and Tables -
Comparison 1. Active treatment versus placebo/no treatment
Comparison 2. Comparisons between active interventions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mucositis (absent versus present) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Cryotherapy: 30 min versus 60 min

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Etoposide: bolus versus continuous

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Mucositis (0‐1 versus 2+) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Cryotherapy: 30 min versus 60 min

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Etoposide: bolus versus continuous

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 GM‐CFS versus sucralfate

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.4 Keratinocyte: 50 mg versus 25 mg

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Mucositis (0‐2 versus 3+) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Cryotherapy: 30 min versus 60 min

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Etoposide: bolus versus continuous

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.3 GM‐CSF versus sucralfate

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.4 Keratinocyte: 50 mg versus 25 mg

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Comparisons between active interventions
Comparison 3. Side effects

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Amifostine Show forest plot

6

risk ratio (Random, 95% CI)

Subtotals only

1.1 Survival at 24 months

1

66

risk ratio (Random, 95% CI)

1.14 [0.88, 1.48]

1.2 Recurrence at 18 months after cancer treatment

2

213

risk ratio (Random, 95% CI)

1.04 [0.70, 1.55]

1.3 Incomplete response to radiotherapy

2

69

risk ratio (Random, 95% CI)

0.70 [0.33, 1.50]

1.4 Delay to radiotherapy

1

39

risk ratio (Random, 95% CI)

0.44 [0.19, 1.01]

1.5 Hypotension

4

536

risk ratio (Random, 95% CI)

2.32 [1.40, 3.84]

1.6 Nausea

4

500

risk ratio (Random, 95% CI)

1.69 [0.61, 4.67]

1.7 Vomiting

3

370

risk ratio (Random, 95% CI)

5.95 [1.03, 34.29]

Figures and Tables -
Comparison 3. Side effects