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Risk of bias assessment graph: review authors' judgements about each risk of bias domain presented as percentages across all included studies.

Figuras y tablas -
Figure 1

Risk of bias assessment graph: review authors' judgements about each risk of bias domain presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias domain for each included study.

Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias domain for each included study.

Comparison 1: Allopurinol versus placebo/no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 1.1

Comparison 1: Allopurinol versus placebo/no treatment, Outcome 1: Mucositis (any)

Comparison 1: Allopurinol versus placebo/no treatment, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 1.2

Comparison 1: Allopurinol versus placebo/no treatment, Outcome 2: Mucositis (moderate plus severe)

Comparison 1: Allopurinol versus placebo/no treatment, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 1.3

Comparison 1: Allopurinol versus placebo/no treatment, Outcome 3: Mucositis (severe)

Comparison 2: Aloe vera versus placebo, Outcome 1: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 2.1

Comparison 2: Aloe vera versus placebo, Outcome 1: Mucositis (moderate plus severe)

Comparison 3: Amifostine versus placebo/no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 3.1

Comparison 3: Amifostine versus placebo/no treatment, Outcome 1: Mucositis (any)

Comparison 3: Amifostine versus placebo/no treatment, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 3.2

Comparison 3: Amifostine versus placebo/no treatment, Outcome 2: Mucositis (moderate plus severe)

Comparison 3: Amifostine versus placebo/no treatment, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 3.3

Comparison 3: Amifostine versus placebo/no treatment, Outcome 3: Mucositis (severe)

Comparison 4: Chlorhexidine versus placebo/no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 4.1

Comparison 4: Chlorhexidine versus placebo/no treatment, Outcome 1: Mucositis (any)

Comparison 4: Chlorhexidine versus placebo/no treatment, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 4.2

Comparison 4: Chlorhexidine versus placebo/no treatment, Outcome 2: Mucositis (moderate plus severe)

Comparison 4: Chlorhexidine versus placebo/no treatment, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 4.3

Comparison 4: Chlorhexidine versus placebo/no treatment, Outcome 3: Mucositis (severe)

Comparison 5: Cryotherapy versus no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 5.1

Comparison 5: Cryotherapy versus no treatment, Outcome 1: Mucositis (any)

Comparison 5: Cryotherapy versus no treatment, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 5.2

Comparison 5: Cryotherapy versus no treatment, Outcome 2: Mucositis (moderate plus severe)

Comparison 5: Cryotherapy versus no treatment, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 5.3

Comparison 5: Cryotherapy versus no treatment, Outcome 3: Mucositis (severe)

Comparison 6: Glutamine versus placebo, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 6.1

Comparison 6: Glutamine versus placebo, Outcome 1: Mucositis (any)

Comparison 6: Glutamine versus placebo, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 6.2

Comparison 6: Glutamine versus placebo, Outcome 2: Mucositis (moderate plus severe)

Comparison 6: Glutamine versus placebo, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 6.3

Comparison 6: Glutamine versus placebo, Outcome 3: Mucositis (severe)

Comparison 7: G‐CSF versus placebo or no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 7.1

Comparison 7: G‐CSF versus placebo or no treatment, Outcome 1: Mucositis (any)

Comparison 7: G‐CSF versus placebo or no treatment, Outcome 2: Mucositis (severe)

Figuras y tablas -
Analysis 7.2

Comparison 7: G‐CSF versus placebo or no treatment, Outcome 2: Mucositis (severe)

Comparison 8: GM‐CSF versus no treatment/placebo, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 8.1

Comparison 8: GM‐CSF versus no treatment/placebo, Outcome 1: Mucositis (any)

Comparison 8: GM‐CSF versus no treatment/placebo, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 8.2

Comparison 8: GM‐CSF versus no treatment/placebo, Outcome 2: Mucositis (moderate plus severe)

Comparison 8: GM‐CSF versus no treatment/placebo, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 8.3

Comparison 8: GM‐CSF versus no treatment/placebo, Outcome 3: Mucositis (severe)

Comparison 9: Honey versus control, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 9.1

Comparison 9: Honey versus control, Outcome 1: Mucositis (any)

Comparison 9: Honey versus control, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 9.2

Comparison 9: Honey versus control, Outcome 2: Mucositis (moderate plus severe)

Comparison 9: Honey versus control, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 9.3

Comparison 9: Honey versus control, Outcome 3: Mucositis (severe)

Comparison 10: Hydrolytic enzymes versus no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 10.1

Comparison 10: Hydrolytic enzymes versus no treatment, Outcome 1: Mucositis (any)

Comparison 10: Hydrolytic enzymes versus no treatment, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 10.2

Comparison 10: Hydrolytic enzymes versus no treatment, Outcome 2: Mucositis (moderate plus severe)

Comparison 11: Iseganan versus placebo, Outcome 1: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 11.1

Comparison 11: Iseganan versus placebo, Outcome 1: Mucositis (moderate plus severe)

Comparison 11: Iseganan versus placebo, Outcome 2: Mucositis (severe)

Figuras y tablas -
Analysis 11.2

Comparison 11: Iseganan versus placebo, Outcome 2: Mucositis (severe)

Comparison 12: Keratinocyte GF versus placebo, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 12.1

Comparison 12: Keratinocyte GF versus placebo, Outcome 1: Mucositis (any)

Comparison 12: Keratinocyte GF versus placebo, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 12.2

Comparison 12: Keratinocyte GF versus placebo, Outcome 2: Mucositis (moderate plus severe)

Comparison 12: Keratinocyte GF versus placebo, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 12.3

Comparison 12: Keratinocyte GF versus placebo, Outcome 3: Mucositis (severe)

Comparison 13: Laser versus no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 13.1

Comparison 13: Laser versus no treatment, Outcome 1: Mucositis (any)

Comparison 13: Laser versus no treatment, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 13.2

Comparison 13: Laser versus no treatment, Outcome 2: Mucositis (moderate plus severe)

Comparison 13: Laser versus no treatment, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 13.3

Comparison 13: Laser versus no treatment, Outcome 3: Mucositis (severe)

Comparison 14: Pilocarpine versus placebo, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 14.1

Comparison 14: Pilocarpine versus placebo, Outcome 1: Mucositis (any)

Comparison 14: Pilocarpine versus placebo, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 14.2

Comparison 14: Pilocarpine versus placebo, Outcome 2: Mucositis (moderate plus severe)

Comparison 15: Povidone versus water, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 15.1

Comparison 15: Povidone versus water, Outcome 1: Mucositis (any)

Comparison 15: Povidone versus water, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 15.2

Comparison 15: Povidone versus water, Outcome 2: Mucositis (moderate plus severe)

Comparison 15: Povidone versus water, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 15.3

Comparison 15: Povidone versus water, Outcome 3: Mucositis (severe)

Comparison 16: Prostaglandin versus placebo, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 16.1

Comparison 16: Prostaglandin versus placebo, Outcome 1: Mucositis (any)

Comparison 16: Prostaglandin versus placebo, Outcome 2: Mucositis (severe)

Figuras y tablas -
Analysis 16.2

Comparison 16: Prostaglandin versus placebo, Outcome 2: Mucositis (severe)

Comparison 17: PTA antibiotic pastille or paste versus placebo/no treatment, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 17.1

Comparison 17: PTA antibiotic pastille or paste versus placebo/no treatment, Outcome 1: Mucositis (any)

Comparison 17: PTA antibiotic pastille or paste versus placebo/no treatment, Outcome 2: Mucositis (severe)

Figuras y tablas -
Analysis 17.2

Comparison 17: PTA antibiotic pastille or paste versus placebo/no treatment, Outcome 2: Mucositis (severe)

Comparison 18: Radiotherapy: am versus pm, Outcome 1: Mucositis (severe)

Figuras y tablas -
Analysis 18.1

Comparison 18: Radiotherapy: am versus pm, Outcome 1: Mucositis (severe)

Comparison 19: Sucralfate versus placebo/usual care, Outcome 1: Mucositis (any)

Figuras y tablas -
Analysis 19.1

Comparison 19: Sucralfate versus placebo/usual care, Outcome 1: Mucositis (any)

Comparison 19: Sucralfate versus placebo/usual care, Outcome 2: Mucositis (moderate plus severe)

Figuras y tablas -
Analysis 19.2

Comparison 19: Sucralfate versus placebo/usual care, Outcome 2: Mucositis (moderate plus severe)

Comparison 19: Sucralfate versus placebo/usual care, Outcome 3: Mucositis (severe)

Figuras y tablas -
Analysis 19.3

Comparison 19: Sucralfate versus placebo/usual care, Outcome 3: Mucositis (severe)

Summary of findings 1. Cryotherapy versus no treatment for preventing oral mucositis for patients with cancer receiving treatment

Cryotherapy versus no treatment for preventing oral mucositis for patients with cancer receiving treatment

Patient or population: preventing oral mucositis for patients with cancer receiving treatment
Settings:
Intervention: Cryotherapy versus no treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Cryotherapy versus no treatment

Mucositis (any)
0‐4 scale
Follow‐up: median 28 days

Low risk population1

RR 0.74
(0.57 to 0.95)

472
(5 studies)

⊕⊕⊝⊝
low2,3

600 per 1000

444 per 1000
(342 to 570)

High risk population1

950 per 1000

703 per 1000
(541 to 902)

Mucositis (severe)
0‐4 scale
Follow‐up: median 28 days

Low risk population4

RR 0.36
(0.17 to 0.77)

472
(5 studies)

⊕⊕⊝⊝
low2,5

300 per 1000

108 per 1000
(51 to 231)

High risk population4

650 per 1000

234 per 1000
(111 to 501)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Based on the range of absolute risk of developing any mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
2 3 studies at high risk of bias and 2 unclear
3 Substantial heterogeneity Chi squared = 14.77, df=4, P=0.005, I squared =73%,
4 Based on the range of absolute risk of developing severe mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
5 Substantial heterogeneity Chi squared=14.31, df=4, P=0.006, I squared =72%.

Figuras y tablas -
Summary of findings 1. Cryotherapy versus no treatment for preventing oral mucositis for patients with cancer receiving treatment
Summary of findings 2. Amifostine versus placebo/no treatment for preventing oral mucositis for patients with cancer receiving treatment

Amifostine versus placebo/no treatment for preventing oral mucositis for patients with cancer receiving treatment

Patient or population: preventing oral mucositis for patients with cancer receiving treatment
Settings:
Intervention: Amifostine versus placebo/no treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Amifostine versus placebo/no treatment

Mucositis (any)
0‐4 scale
Follow‐up: median 28 days

Low risk population1

RR 0.95
(0.91 to 0.99)

430
(3 studies)

⊕⊕⊕⊝
moderate2

600 per 1000

570 per 1000
(546 to 594)

High risk population1

950 per 1000

902 per 1000
(865 to 941)

Mucositis (severe)
0‐4 scale
Follow‐up: median 28 days

Low risk population3

RR 0.68
(0.45 to 1.03)

845
(9 studies)

⊕⊝⊝⊝
very low4,5,6

300 per 1000

204 per 1000
(135 to 309)

High risk population3

650 per 1000

442 per 1000
(292 to 669)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Based on the range of absolute risk of developing any mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
2 Two trials at high risk of bias and one unclear.
3 Based on the range of absolute risk of developing severe mucositis of patients (with different cancer types and treatments) in the control groups of included studies.
4 Six trials at high risk of bias and three unclear.
5 Substantial heterogeneity, Chi squared 40.39, df=8, P<0..0001, I squared =80% with inconsistency (one trial favouring control)
6 Wide confidence intervals, small studies and/or low event rates

Figuras y tablas -
Summary of findings 2. Amifostine versus placebo/no treatment for preventing oral mucositis for patients with cancer receiving treatment
Summary of findings 3. Keratinocyte GF versus placebo for preventing oral mucositis for patients with cancer receiving treatment

Keratinocyte GF versus placebo for preventing oral mucositis for patients with cancer receiving treatment

Patient or population: patients with preventing oral mucositis for patients with cancer receiving treatment
Settings:
Intervention: Keratinocyte GF versus placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Keratinocyte GF versus placebo

Mucositis (any)
0‐4 scale
Follow‐up: median 28 days

Low risk population1

RR 0.82
(0.71 to 0.94)

160
(2 studies)

⊕⊕⊝⊝
low2,3

600 per 1000

492 per 1000
(426 to 564)

High risk population1

950 per 1000

779 per 1000
(674 to 893)

Mucositis (severe)
0‐4 scale
Follow‐up: median 28 days

Low risk population4

RR 0.72
(0.58 to 0.9)

559
(6 studies)

⊕⊕⊝⊝
low5,6

300 per 1000

216 per 1000
(174 to 270)

High risk population4

650 per 1000

468 per 1000
(377 to 585)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Based on the range of absolute risk of developing any mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
2 Two studies at unclear risk of bias
3 Substantial heterogeneity Chi squared =10.11 df=1, P=0.001, I squared =90%.
4 Based on the range of absolute risk of developing severe mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
5 One study at high risk of bias and five at unclear risk of bias.
6 Moderate heterogeneity Chi squared 10.37, df=5,P=0.07, I squared =52%

Figuras y tablas -
Summary of findings 3. Keratinocyte GF versus placebo for preventing oral mucositis for patients with cancer receiving treatment
Summary of findings 4. Sucralfate versus placebo/usual care for preventing oral mucositis for patients with cancer receiving treatment

Sucralfate versus placebo/usual care for preventing oral mucositis for patients with cancer receiving treatment

Patient or population: preventing oral mucositis for patients with cancer receiving treatment
Settings:
Intervention: Sucralfate versus placebo/usual care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Sucralfate versus placebo/usual care

Mucositis (any)
0‐4 scale
Follow‐up: median 28 days

Low risk population1

RR 0.98
(0.88 to 1.1)

222
(3 studies)

⊕⊕⊕⊝
moderate2

600 per 1000

588 per 1000
(528 to 660)

High risk population1

950 per 1000

931 per 1000
(836 to 1000)

Mucositis (severe)
0‐4 scale
Follow‐up: median 28 days

Low risk population3

RR 0.67
(0.48 to 0.92)

428
(7 studies)

⊕⊕⊕⊝
moderate4

300 per 1000

201 per 1000
(144 to 276)

High risk population3

650 per 1000

435 per 1000
(312 to 598)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Based on the range of absolute risk of developing any mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
2 All studies at unclear risk of bias
3 Based on the range of absolute risk of developing severe mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
4 One study at low risk of bias and six at unclear risk of bias

Figuras y tablas -
Summary of findings 4. Sucralfate versus placebo/usual care for preventing oral mucositis for patients with cancer receiving treatment
Summary of findings 5. Chlorhexidine versus placebo/no treatment for preventing oral mucositis for patients with cancer receiving treatment

Chlorhexidine versus placebo/no treatment for preventing oral mucositis for patients with cancer receiving treatment

Patient or population: preventing oral mucositis for patients with cancer receiving treatment
Settings:
Intervention: Chlorhexidine versus placebo/no treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Chlorhexidine versus placebo/no treatment

Mucositis (any)
0‐4 scale
Follow‐up: median 28 days

Low risk population1

RR 0.76
(0.47 to 1.24)

454
(4 studies)

⊕⊕⊝⊝
low2,3

600 per 1000

456 per 1000
(282 to 744)

High risk population1

950 per 1000

722 per 1000
(446 to 1000)

Mucositis (severe)
0‐4 scale
Follow‐up: median 28 days

Low risk population4

RR 0.82
(0.54 to 1.23)

244
(4 studies)

⊕⊕⊝⊝
low5,6

300 per 1000

246 per 1000
(162 to 369)

High risk population4

650 per 1000

533 per 1000
(351 to 800)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Based on the range of absolute risk of developing any mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
2 One study at low risk of bias and three unclear.
3 Substantial heterogeneity Chi squared 30.49, df=3, P<0.0001, I squared = 90%.
4 Based on the range of absolute risk of developing severe mucositis of patients (with different cancer types and treatments) in the control groups of the included studies.
5 One high risk of bias, two unclear and one low
6 Moderate heterogeneity Chi squared 7.44,df=3, P=0.06, I squared = 60%, with some inconsistency (only one study, at unclear risk of bias, showing benefit)

Figuras y tablas -
Summary of findings 5. Chlorhexidine versus placebo/no treatment for preventing oral mucositis for patients with cancer receiving treatment
Table 1. Outcome categories where only one study provided data ‐ active versus placebo/no treatment

 

 

Experimental

Control

RR (95%CI)

P value

Mucositis category

Events/ Mean (SD)

Total

Events/ Mean (SD)

Total

Aciclovir versus placebo

Bubley 1989

Any

 

18

27

15

30

1.33 (0.85, 2.08)

0.21

Aloe vera versus placebo

 

Any

Puataweepong 2009

29

30

31

31

0.97 (0.88, 1.06)

0.46

Severe

Su 2004

1

30

8

31

0.13 (0.02, 0.97)

0.05

BCoG antibiotic pastilles El Sayed 2002

Any

62

69

60

68

1.02 (0.91, 1.15)

0.76

Moderate plus severe

50

69

53

68

0.93 (0.77, 1.13)

0.46

Severe

31

69

34

68

0.90 (0.63, 1.28)

0.55

Benzydamine versus placebo

Any

 Prada 1987

12

19

16

17

0.67 (0.47, 0.97)

0.03

Severe

Kazemian 2009

17

39

33

42

0.55 (0.38, 0.82)

0.003

Beta carotene versus no treatment control

Severe

 Mills 1988

3

10

8

10

0.38 (0.14, 1.02)

0.05

Camomile versus placebo

Fidler 1996

Any

 

33

82

37

82

0.89 (0.62, 1.27)

0.53

Moderate plus severe

 

12

82

19

82

0.63 (0.33, 1.22)

0.17

Severe

 

8

82

7

82

1.14 (0.43, 3.01)

0.79

Chewing gum versus no chewing gum

Gandemer 2007

Any

 

48

70

55

70

0.87 (0.71, 1.07)

0.18

Severe

 

36

70

31

70

1.16 (0.82, 1.64)

0.40

Clarithromycin (systemic antibiotic) versus no treatment

Yuen 2001

 

Moderate plus severe

 

18

35

26

35

0.69 (0.48, 1.01)

0.06

Dental stent versus no treatment control Qin 2007

Moderate plus severe

 

14

19

21

24

0.84 (0.62, 1.15)

0.27

Severe

 

5

19

9

24

0.70 (0.28, 1.75)

0.45

Epidermal growth factor versus placebo Wu 2009

 

Moderate plus severe

 

32

76

17

27

0.67 (0.45, 0.99)

0.04

G‐CSF versus placebo Su 2006

 

Moderate plus severe

 

11

19

15

21

0.81 (0.51, 1.30)

0.38

Histamine gel versus placebo Elad 2006

 

Any

 

17

20

12

19

1.35 (0.91, 1.99)

0.14

Severe

 

2

20

2

19

0.95 (0.15, 6.08)

0.96

Hydrolytic enzymes (papain, trypsin, chymotrypsin, pancreatin, bromelain) versus no treatment Kaul 1999

Severe

0

25

2

25

0.20 (0.01, 3.97)

0.29

Indomethacin versus placebo Pillsbury 1986

 

Moderate plus severe

 

10

10

8

8

1.00 (0.82, 1.23)

1.00

Indigo wood root versus saline (placebo) You 2009

Moderate to severe

8

11

9

9

0.75 (0.50, 1.10)

0.14

Severe

1

11

6

9

0.14 (0.02, 0.93)

0.04

Intestinal trefoil factor versus placebo Peterson 2009

 

Any

 

23

66

22

33

0.52 (0.35, 0.79)

0.002

Moderate plus severe

 

7

66

16

33

0.22 (0.10, 0.48)

0.0001

Severe

1

66

0

33

1.52 (0.06, 36.39)

0.80

Oral care protocol versus none

 

Any

Shieh 1997

12

20

10

10

0.62 (0.43, 0.91)

0.01

Moderate plus severe Borowski 1994

 

64

75

70

75

0.91 (0.82, 1.02)

0.12

Severe

Borowski 1994

49

75

58

75

0.84 (0.69, 1.04)

0.11

Pentoxifylline versus no treatment Attal 1993

 

Moderate plus severe

 

30

70

30

70

1.00 (0.68, 1.47)

1.00

Pilocarpine versus placebo Lockhart 2005

 

 

Severe

12

18

12

16

0.89 (0.58, 1.37)

0.59

Prednisone versus placebo Leborgne 1997

 

Any

 

28

32

29

34

1.03 (0.85, 1.24)

0.79

Moderate plus severe

 

16

32

24

34

0.71 (0.47, 1.07)

0.10

Severe

 

3

32

5

34

0.64 (0.17, 2.45)

0.51

Prostaglandin versus placebo (Veness 2006)

Moderate plus severe

36

42

37

41

0.95 (0.81, 1.11)

0.53

Propantheline versus placebo Ahmed 1993

 

Any

2

6

5

6

0.40 (0.12, 1.31)

0.13

PTA antibiotic paste (Wijers 2001)

Moderate plus severe

26

39

28

38

0.90 (0.68, 1.21)

0.5

Shenqi‐fanghou versus no treatment Hu 2005

Any

60

70

67

70

0.90 (0.80, 1.00)

0.04

Moderate plus severe

30

70

59

70

0.51 (0.38, 0.68)

0.00001

Severe

10

70

50

70

0.20 (0.11, 0.36)

0.00001

Superoxide dismutase versus placebo Tu 1998

Any

59

119

17

40

1.17 (0.78, 1.75)

0.45

Sucralfate mouthwash plus gel on skin versus placebo mouthwash plus gel on skin (Evensen 2001)

Any

30

30

28

30

1.07 (0.96, 1.20)

0.24

Moderate plus severe

29

30

24

30

1.21 (1.00, 1.46)

0.05

Severe

26

30

23

30

1.13 (0.89, 1.44)

0.32

Traumeel versus placebo Oberbaum 2001

 

Any

10

15

14

15

0.71 (0.49, 1.05)

0.08

Zinc sulphate versus placebo Ertekin 2004

Any

13

15

12

12

0.88 (0.69, 1.11)

0.28

Moderate plus severe

 

5

15

12

12

0.36 (0.18, 0.71)

0.003

Severe

 

0

15

8

12

0.05 (0.00, 0.75)

0.03

CI = confidence interval; RR = risk ratio; SD = standard deviation.

Figuras y tablas -
Table 1. Outcome categories where only one study provided data ‐ active versus placebo/no treatment
Table 2. Text only inclusions

Intervention

Study

Text

Amifostine versus no treatment

Vacha 2003

CTC mucositis index used. Results presented as weekly means for both arms with standard deviations. Text indicated statistically significant difference in favour of amifostine at 2 weeks but does not mention overall result.

Benzydamine versus placebo

Epstein 1989

Signs of mucositis were recorded by area of involvement, severity of inflammation, severity of ulceration and maximum size of ulceration for each region of the oral cavity. Results in Table 3 indicate borderline statistically significant differences in favour of benzydamine. Maximum size of ulcerations (P = 0.04); total area of ulcerations (P = 0.05); average area of mucositis (P = 0.050).

Benzydamine versus placebo

Epstein 2001

Area under the curve of mean mucositis cores presented for different radiotherapy intervals. Overall there was a statistically significant difference in favour of benzydamine  (P = 0.006), Table 4.

Chlorhexidine versus placebo

McGaw 1985

Hickey (0‐3 scale) index for mucositis used over 4‐week period. During the third and fourth weeks the average mucositis scores were significantly higher in the control group.

Chlorhexidine versus povidone‐iodine, salt/soda versus water

Madan 2008

After 4 weeks there was a statistically significant decrease in mean mucositis scores in each of the active treatment groups compared to placebo.

Cryotherapy versus no treatment control

Svanberg 2007

"The results demonstrated that oral cryotherapy alleviated the development of mucositis and oral pain, which resulted in a reduction in the number of days of iv opioids for patients treated with autologous BMT."

GM‐CSF versus no treatment control

Chi 1995

Cross‐over study showing period effect but indicating GM‐CSF significantly prevents mucositis (P < 0.001).

Laser versus placebo light treatment

Bensadoun 1999

Parallel group study mucositis measured on 0‐4 scale. Mean calculated for each patient over 7 weeks. Quote "the mean grade of mucositis during radiotherapy was 2.1 +/ 0.26 for the group without laser and 1.7 +/‐ 0.26 for the group with laser (P = 0.01)." 

Laser versus sham laser treatment

Schubert 2007

OMI appropriate index (Schubert 1992).

Quote: "Figure 1 shows the mean OMI over time by treatment group. The placebo patient scores are higher on average than the laser patient scores at nearly every time point, signifying more severe mucositis over the course of the study.." The authors then present day 11 data and statistical test for that day (P = 0.06).

"The peak severity of mucositis that generally occurs during the second week of transplant was reduced in the 650 nm laser group."

The results of the overall burden over time in Table 2 showed the differences in the unadjusted model to be non‐significant. Only one difference comparing low‐level laser with placebo was significant in the adjusted model (P = 0.03).

Prostaglandin versus placebo

Hanson 1995

Data from 2 centres reported separately. Overall ANOVA for 1 centre showed no significant difference. The other centre found statistically significant differences for weeks 4 and 5 with less mucositis in the intervention group (P < 0.05).

Sucralfate versus placebo

Epstein 1994

Signs of mucositis were recorded by area of involvement, severity of inflammation, severity of ulceration and maximum size of ulceration for each region of the oral cavity. No statistically significant difference was seen in mucositis ulceration or the composite mucositis score (Table 3). 

Total mucositis score:
Placebo (n = 17) mean = 18.7 +/‐ 21.3
Sucralfate (n = 16) mean = 22.3 +/‐ 31.2

Total mucosal ulceration:
Placebo (n = 17) mean = 15.3 +/‐ 17.6
Sucralfate (n = 16) mean = 19.4 +/‐ 19.8.

Sucralfate versus placebo

Lievens 1998

Mucositis scores on 0‐6 ECOG scale. Graph (fig 1) displays mean mucositis scores for each week 1‐7. Quote: "Comparing the time course of the mean scores for . . .mucositis. . . no statistically significant differences between the two treatment arms were observed."

Quote: "At 5 week when the mucosal reaction tends to be most severe a clear but not statistically significant advantage is seen for sucralfate as opposed to placebo."

Zinc versus placebo

Lin 2006

RTOG mucositis index used. Results presented as graphs. Quote: "This study no significant difference was found in the improvement of radiation mucositis and dermatitis during the 2 weeks between the patients with zinc supplement and those without."

ANOVA = analysis of variance; BMT = bone marrow transplant; CTC = Common Toxicity Criteria; ECOG = Eastern Cooperative Oncology Group; GM‐CSF = granulocyte/macrophage colony‐stimulating factor; OMI = oral mucositis index; RTOG = Radiation Therapy Oncology Group.

Figuras y tablas -
Table 2. Text only inclusions
Table 3. Outcome categories where only one study provided data ‐ two active interventions

 

Experimental

RR (95%CI)

RR (95%CI)

P value

Mucositis category

Events/ Mean (SD)

Total

Events/ Mean (SD)

Total

Chinese herbs (coastal glenhnia, dwarf lilyturf tuber root, rehmannia dried root, figwort root, spreading hedyotis herb, belamcaude rhizome, platycodom root, shinyleaf pricklyoash root, honeysuckle flower, licorice root, lalang grass rhizome) versus Dobell's solution Huang 2003

Moderate

23

52

47

49

0.46 (0.34, 0.63)

0.00001

Severe

5

52

30

49

0.16 (0.07, 0.37)

0.0001

Chinese herbs (corktree bark, Chinese gall, European vebena herb, catechu, weeping forsythia fruit and burneol) versus Dobell's solution Wang 2002

Any

8

76

17

71

0.44 (0.20, 0.95)

0.04

Moderate plus severe

4

76

14

71

0.27 (0.09,  0.77)

0.01

Severe

0

76

5

71

0.09 (0.00, 1.51)

0.09

Chlorhexidine versus cryotherapy Sorensen 2008

 

Any

 

39

70

34

63

1.03 (0.76, 1.41)

0.84

Moderate plus severe

20

70

16

63

1.13 (0.64, 1.97)

0.68

Severe

9

70

7

63

1.16 (0.46, 2.92)

0.76

Cryotherapy 30 versus 60 minutes Rocke 1993

 

Any

 

33

89

37

89

0.89 (0.62, 1.29)

0.54

Moderate plus severe

13

89

19

89

0.68 (0.36, 1.30)

0.25

Severe

6

89

10

89

0.60 (0.23, 1.58)

0.30

GM‐CSF versus sucralfate

Saarilahti 2002

Moderate plus severe

 

19

21

18

19

0.96 (0.80, 1.14)

0.61

Severe

 

6

21

10

19

0.54 (0.24, 1.21)

0.13

Keratinocyte 50 versus 25 mg Freytes 2004

Moderate plus severe

 

7

14

9

14

0.78 (0.40, 1.49)

0.45

Severe

 

1

14

3

14

0.33 (0.04, 2.83)

0.31

Laser versus povidone Arun Maiya 2006

Moderate plus severe

 

7

25

25

25

0.29 ( 0.16, 0.54)

< 0.0001

Severe

 

0

25

25

25

0.02 (0.00, 0.31)

0.005

Polaprezinc versus azulene oral rinse Watanabe 2010

Any

13

16

15

15

0.82 (0.63, 1.06)

0.13

Moderate plus severe

 

6

16

13

15

0.43 (0.22, 0.84)

0.01

Severe

 

1

16

10

15

0.09 (0.01, 0.65)

0.02

Radiotherapy morning versus afternoon Goyal 2009

 

Moderate plus severe

 

29

88

42

89

0.70 (0.48, 1.01)

0.06

Yangyin humo decoctalion versus 'traditional Western medicine' (lidocaine (iv), dexamethasone, gentamycin, vitamin B12, bicarbonate) Dai 2009

Moderate

11

21

17

21

0.65 (0.41, 1.02)

0.06

Severe

4

21

7

21

0.57 (0.20, 1.66)

0.30

CI = confidence interval; RR = risk ratio; SD = standard deviation.

Figuras y tablas -
Table 3. Outcome categories where only one study provided data ‐ two active interventions
Comparison 1. Allopurinol versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Mucositis (any) Show forest plot

4

Risk Ratio (IV, Random, 95% CI)

0.77 [0.50, 1.19]

1.2 Mucositis (moderate plus severe) Show forest plot

2

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.50, 0.86]

1.3 Mucositis (severe) Show forest plot

2

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.63, 1.04]

Figuras y tablas -
Comparison 1. Allopurinol versus placebo/no treatment
Comparison 2. Aloe vera versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Mucositis (moderate plus severe) Show forest plot

2

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.58, 0.96]

Figuras y tablas -
Comparison 2. Aloe vera versus placebo
Comparison 3. Amifostine versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Mucositis (any) Show forest plot

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.91, 0.99]

3.2 Mucositis (moderate plus severe) Show forest plot

6

757

Risk Ratio (M‐H, Random, 95% CI)

0.75 [0.58, 0.96]

3.3 Mucositis (severe) Show forest plot

9

845

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.45, 1.03]

Figuras y tablas -
Comparison 3. Amifostine versus placebo/no treatment
Comparison 4. Chlorhexidine versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Mucositis (any) Show forest plot

4

454

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.47, 1.24]

4.2 Mucositis (moderate plus severe) Show forest plot

3

233

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.72, 1.21]

4.3 Mucositis (severe) Show forest plot

4

244

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.54, 1.23]

Figuras y tablas -
Comparison 4. Chlorhexidine versus placebo/no treatment
Comparison 5. Cryotherapy versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Mucositis (any) Show forest plot

5

Risk Ratio (IV, Random, 95% CI)

0.74 [0.57, 0.95]

5.2 Mucositis (moderate plus severe) Show forest plot

5

Risk Ratio (IV, Random, 95% CI)

0.53 [0.31, 0.91]

5.3 Mucositis (severe) Show forest plot

5

Risk Ratio (IV, Random, 95% CI)

0.36 [0.17, 0.77]

Figuras y tablas -
Comparison 5. Cryotherapy versus no treatment
Comparison 6. Glutamine versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Mucositis (any) Show forest plot

6

Risk Ratio (IV, Random, 95% CI)

Subtotals only

6.1.1 Oral suspension/supplementation

5

Risk Ratio (IV, Random, 95% CI)

0.78 [0.57, 1.08]

6.1.2 IV supplementation

1

Risk Ratio (IV, Random, 95% CI)

0.33 [0.04, 2.63]

6.2 Mucositis (moderate plus severe) Show forest plot

6

Risk Ratio (IV, Random, 95% CI)

Subtotals only

6.2.1 Oral suspension/supplementation

5

Risk Ratio (IV, Random, 95% CI)

0.88 [0.69, 1.12]

6.2.2 IV supplementation

1

Risk Ratio (IV, Random, 95% CI)

0.33 [0.04, 2.63]

6.3 Mucositis (severe) Show forest plot

8

Risk Ratio (IV, Random, 95% CI)

Subtotals only

6.3.1 Oral suspension/supplementation

5

Risk Ratio (IV, Random, 95% CI)

0.69 [0.37, 1.29]

6.3.2 IV supplementation

3

Risk Ratio (IV, Random, 95% CI)

0.25 [0.10, 0.62]

Figuras y tablas -
Comparison 6. Glutamine versus placebo
Comparison 7. G‐CSF versus placebo or no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Mucositis (any) Show forest plot

4

263

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.48, 1.23]

7.2 Mucositis (severe) Show forest plot

2

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.15, 0.86]

Figuras y tablas -
Comparison 7. G‐CSF versus placebo or no treatment
Comparison 8. GM‐CSF versus no treatment/placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

8.1 Mucositis (any) Show forest plot

2

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.84, 1.04]

8.2 Mucositis (moderate plus severe) Show forest plot

2

138

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.76, 1.05]

8.3 Mucositis (severe) Show forest plot

6

373

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.39, 1.40]

Figuras y tablas -
Comparison 8. GM‐CSF versus no treatment/placebo
Comparison 9. Honey versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

9.1 Mucositis (any) Show forest plot

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.56, 0.88]

9.2 Mucositis (moderate plus severe) Show forest plot

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.31, 0.74]

9.3 Mucositis (severe) Show forest plot

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.13, 0.52]

Figuras y tablas -
Comparison 9. Honey versus control
Comparison 10. Hydrolytic enzymes versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

10.1 Mucositis (any) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

10.2 Mucositis (moderate plus severe) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 10. Hydrolytic enzymes versus no treatment
Comparison 11. Iseganan versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

11.1 Mucositis (moderate plus severe) Show forest plot

2

926

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.89, 1.03]

11.2 Mucositis (severe) Show forest plot

2

926

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.89, 1.10]

Figuras y tablas -
Comparison 11. Iseganan versus placebo
Comparison 12. Keratinocyte GF versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

12.1 Mucositis (any) Show forest plot

2

160

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.71, 0.94]

12.2 Mucositis (moderate plus severe) Show forest plot

7

640

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.62, 0.89]

12.3 Mucositis (severe) Show forest plot

6

559

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.58, 0.90]

Figuras y tablas -
Comparison 12. Keratinocyte GF versus placebo
Comparison 13. Laser versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

13.1 Mucositis (any) Show forest plot

3

131

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.71, 1.17]

13.2 Mucositis (moderate plus severe) Show forest plot

2

97

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.38, 1.08]

13.3 Mucositis (severe) Show forest plot

2

97

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.06, 0.62]

Figuras y tablas -
Comparison 13. Laser versus no treatment
Comparison 14. Pilocarpine versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

14.1 Mucositis (any) Show forest plot

2

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [1.00, 1.10]

14.2 Mucositis (moderate plus severe) Show forest plot

2

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.94, 1.16]

Figuras y tablas -
Comparison 14. Pilocarpine versus placebo
Comparison 15. Povidone versus water

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

15.1 Mucositis (any) Show forest plot

2

172

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.76, 1.08]

15.2 Mucositis (moderate plus severe) Show forest plot

2

172

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.62, 1.10]

15.3 Mucositis (severe) Show forest plot

2

172

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.40, 1.06]

Figuras y tablas -
Comparison 15. Povidone versus water
Comparison 16. Prostaglandin versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

16.1 Mucositis (any) Show forest plot

3

159

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.94, 1.12]

16.2 Mucositis (severe) Show forest plot

2

143

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.72, 1.43]

Figuras y tablas -
Comparison 16. Prostaglandin versus placebo
Comparison 17. PTA antibiotic pastille or paste versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

17.1 Mucositis (any) Show forest plot

2

298

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.78, 0.96]

17.2 Mucositis (severe) Show forest plot

2

135

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.66, 1.09]

Figuras y tablas -
Comparison 17. PTA antibiotic pastille or paste versus placebo/no treatment
Comparison 18. Radiotherapy: am versus pm

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

18.1 Mucositis (severe) Show forest plot

2

382

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.85, 1.36]

Figuras y tablas -
Comparison 18. Radiotherapy: am versus pm
Comparison 19. Sucralfate versus placebo/usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

19.1 Mucositis (any) Show forest plot

3

222

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.88, 1.10]

19.2 Mucositis (moderate plus severe) Show forest plot

4

164

Risk Ratio (M‐H, Random, 95% CI)

0.75 [0.54, 1.04]

19.3 Mucositis (severe) Show forest plot

7

Risk Ratio (IV, Random, 95% CI)

0.67 [0.48, 0.92]

Figuras y tablas -
Comparison 19. Sucralfate versus placebo/usual care