Yarom, Noam, Hovan, Allan, Bossi, Paolo, Ariyawardana, Anura, Jensen, Siri Beier, Gobbo, Margherita, Saca-Hazboun, Hanan, Kandwal, Abhishek, Majorana, Alessandra, Ottaviani, Giulia, Pentenero, Monica, Nasr, Narmin Mohammed, Rouleau, Tanya, Lucas, Anna Skripnik, Treister, Nathaniel Simon, Zur, Eyal, Ranna, Vinisha, Vaddi, Anusha, Cheng, Karis Kin Fong, Barasch, Andrei, Lalla, Rajesh V., Elad, Sharon, and MASCC/ISOO (2019) Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements. Supportive Care in Cancer, 27 (10). pp. 3997-4010.

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Abstract

Purpose: To update the clinical practice guidelines for the use of natural and miscellaneous agents for the prevention and/or treatment of oral mucositis (OM).

Methods: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible.

Results: A total of 78 papers were identified within the scope of this section, out of which 29 were included in this part, and wereanalyzed with 27 previously reviewed studies. A new Suggestion was made for oral glutamine for the prevention of OM in head and neck (H&N) cancer patients receiving radiotherapy with concomitant chemotherapy. The previous Recommendation against the use of parenteral glutamine for the prevention of OM in hematopoietic stem cell transplantation (HSCT) patients was reestablished. A previous Suggestion for zinc to prevent OM in H&N cancer patients treated with radiotherapy or chemoradiotherapy was reversed to No Guideline Possible. No guideline was possible for other interventions.

Conclusions: Of the vitamins, minerals, and nutritional supplements studied for the management of OM, the evidence supports a Recommendation against parenteral glutamine in HSCT patients and a Suggestion in favor of oral glutamine in H&N cancer patients for the management of OM.

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