***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Summary : We initiated a r and omized study of amifostine ( the organic thiophosphate formerly known as WR-2721 ) given to patients during myeloablative conditioning therapy for allogeneic bone marrow transplantation .  Amifostine was given at a dose of 1000 mg/day of conditioning and was well tolerated if attention was given to serum calcium levels , blood pressure and antiemetics . Since August 1998 , 60 patients ( 30 on each arm ) have completed the study . There was no significant difference in the days to neutrophil or platelet engraftment in either arm of the study . Significantly , the duration of grade I – IV mucositis was decreased in the group that received amifostine ( P=0.02 ) . Also grade III or IV infections ( P=0.008 ) , duration of antibiotic therapy ( P=0.03 ) and duration of fever ( P=0.04 ) were significantly reduced with amifostine . However , there were no differences in the incidence of grade III or IV mucositis , liver toxicity or renal toxicity . There were also no differences in early mortality , relapse and long-term survival . We conclude that amifostine , while reducing the duration of mucositis and infections ( possibly through some preservation of gut mucosal integrity ) , has a modest effect in allogeneic bone marrow transplants given the multiplicity of factors influencing organ toxicity and survival in this setting PURPOSE To evaluate chronic xerostomia and tumor control 18 and 24 months after initial treatment with amifostine in a r and omized controlled trial of patients with head- and -neck cancer ; at 12 months after radiotherapy ( RT ) , amifostine had been shown to reduce xerostomia without changing tumor control . METHODS AND MATERIAL S Adults with head- and -neck cancer who underwent once-daily RT for 5 - 7 weeks ( total dose , 50 - 70 Gy ) received either  open-label amifostine ( 200 mg/m2 i.v . ) 15 - 30 min before each fraction of radiation ( n = 150 ) or RT alone ( control ; n = 153 ) . RESULTS Amifostine administration was associated with a reduced incidence of Grade > or = 2 xerostomia over 2 years of follow-up ( p = 0.002 ) , an increase in the proportion of patients with meaningful ( > 0.1 g ) unstimulated saliva production at 24 months ( p = 0.011 ) , and reduced mouth dryness scores on a patient benefit question naire at 24 months ( p < 0.001 ) . Locoregional control rate , progression-free survival , and overall survival were not significantly different between the amifostine group and the control group . CONCLUSIONS Amifostine administration during head- and -neck RT reduces the severity and duration of xerostomia 2 years after treatment and does not seem to compromise locoregional control rates , progression-free survival , or overall survival A r and omized phase 2 study was performed to investigate the efficacy/toxicity of combining concomitant boost radiation and weekly carboplatin/paclitaxel with or without amifostine in patients with locally advanced squamous cell carcinoma of the head and neck ( SCCHN ) Concurrent chemotherapy and radiation has improved the outcome for patients presenting with locally advanced squamous cell carcinomas of the head and neck ( SCCHN ) . These improvements have come at a cost of increased treatment-related toxicities . We previously reported the results of a phase II trial examining the role of concurrent carboplatin , paclitaxel , and daily radiotherapy ( RT ) in SCCHN . In an attempt to decrease these side effects , we conducted a prospect i ve phase II trial evaluating the role of amifostine ( Ethyol , MedImmune Oncology , Inc , Gaithersburg , MD ) in patients treated with this concurrent chemoRT scheme . From April 2002 to September 2004 , 19 patients with stage III-IV SCCHN were enrolled on a prospect i ve phase II trial . Treatment consisted of daily RT delivered to 70.2 Gy ( 1.8 Gy/fx ) with amifostine 500 mg IV ( < 1 hour before RT ) , and concurrent weekly carboplatin ( 100 mg/m2 ) and paclitaxel ( 40 mg/m2 ) . Median age was 58.5 years ( range , 48 to 70 years ) ; male to female ratio was , 83%:17 % ; Caucasian versus other was , 61%/39 % . Tumor characteristics based on histology were : primary cancers of the oropharynx ( 55.6 % ) ; supraglottic larynx ( 16.7 % ) ; hypopharynx ( 16.7 % ) ; oral cavity ( 5.6 % ) ; and unknown primaries ( 5.6 % ) . All patients presented with locally advanced , unresectable disease T4 ( 50 % ) , T3 ( 27.8 % ) , and advanced nodal disease ( N2b-N3 ) ( 78 % ) . Toxicities were measured weekly during treatment and at each follow-up visit . Disease response to therapy was determined 2 months after completion of therapy . Seventeen patients are evaluable for response and survival at 2 months following completion of RT . Eighty-four percent completed the prescribed radiation treatment , and 84 % of patients received more than six cycles of chemotherapy . The median number of missed chemotherapy cycles was 1.5 ( range , 0 to 5 cycles ) . Fifty-six percent of patients received more than 90 % of prescribed amifostine doses , with chemoRT-related toxicity being the most common reason for withholding the dose ( 77 % ) . Median doses of missed amifostine were three ( range , 0 to 30 doses ) . Grade 3 toxicities associated with therapy were : mucositis and dysphagia ( 40 % of patients each ) , dehydration ( 27 % ) , xerostomia ( 20 % ) , and dermatitis ( 20 % ) ; 53 % of patients experienced grade 3 leukopenia , while grade 3/4 neutropenia developed in 20%/13 % . No grade 4/5 nonhematologic toxicities were encountered . Forty percent of patients completed RT without unscheduled treatment breaks secondary to treatment-related toxicity . Median treatment-break time was 5 days ( range , 0 to 20 days ) . Clinical complete response at both the primary site of disease and neck was achieved in 75 % of patients 2 months following completion of RT . Weekly carboplatin and paclitaxel administered concurrently with definitive RT and daily amifostine is well tolerated , with over 85 % of patients completing therapy with acceptable toxicity . The addition of amifostine appears to decrease treatment-related toxicity without impacting efficacy This pilot study evaluates the degree of side effects during high-dose chemotherapy ( HD-VIC ) plus autologous bone marrow transplant ( HDCT ) and its possible prevention by the cytoprotective thiol-derivate amifostine . Additionally , the in-patient medical costs of both treatment arms were compared . 40 patients with solid tumours were r and omized to receive HD-VIC chemotherapy with or without amifostine ( 910 mg/m2at day 1–3 ) given as a short infusion prior to carboplatin and ifosfamide . Patients were stratified according to pretreatment . HDCT consisted of an 18 h infusion of carboplatin ( 500 mg/m2/d over 18 h ) , ifosfamide ( 4 g/m2/d over 4 h ) and etoposide ( 500 mg/m2/d ) all given for 3 consecutive days . All patients received prophylactic application of G-CSF ( 5 μg kg−1subcutaneously ) to ameliorate neutropenia after treatment . Patients were monitored for nephrotoxicity , gastrointestinal side effects , haematopoietic recovery , as well as frequency of fever and infections . The median fall of the glomerular filtration rate ( GFR ) was 10 % from baseline in the amifostine group ( 105 to 95 ml min−1 ) and 37 % in the control patient group ( 107 to 67 ml min−1 ) ( P < 0.01 ) . Amifostine-treated patients revealed a less pronounced increase in albumine and low molecular weight protein urinary excretion . Stomatitis grade III/IV occurred in 25 % without versus 0 % of patients with amifostine ( P = 0.01 ) . Acute nausea/vomiting was frequently observed immediately during or after the application of amifostine despite intensive antiemetic prophylaxis consisting of 5-HT3-receptor antagonists/dexamethasone/trifluorpromazine . However , delayed emesis occurred more often in the control patients . Engraftment of neutrophil ( > 500 μl−1 ) and thrombocytes ( > 25 000 μl−1)were observed at days 9 versus 10 and 10 versus 12 , respectively , both slightly in favour of the amifostine arm . In addition , a lower number of days with fever and a shortened duration of hospital stay were observed in the amifostine arm . The reduction of acute toxicity observed in the amifostine arm result ed in 30 % savings in costs for supportive care ( Euro 4396 versus Euro 3153 per patient ) . Taking into account the drug costs of amifostine , calculation of in-patient treatment costs from the start of chemotherapy to discharge revealed additional costs of Euro 540 per patient in the amifostine arm . This r and omized pilot study indicates that both organ and haematotoxicity of HD-VIC chemotherapy can be ameliorated by the use of amifostine . Additionally , a nearly complete preservation of GFR was observed in amifostine-treated patients which may be advantageous if repetitive cycles of HDCT are planned . Larger r and omized trials evaluating amifostine  cytoprotection during high-dose chemotherapy are warranted . © 2001 Cancer Research Campaign PURPOSE To evaluate the cytoprotective impact of the interval between amifostine administration and  radiotherapy ( RT ) . METHODS AND MATERIAL S In a nonr and omized study , we review ed the records of 177 patients with tumors localized in the pelvis ( prostate , bladder , or gynecologic cancer ) , upper abdomen ( pancreas , stomach , kidney ) , thorax ( lung and breast cancer ) , head and neck ( nasopharynx ) , soft tissue ( sarcomas ) , and central nervous system . The patient records were stratified according to whether the patients had undergone  RT  either 25 - 40 min ( Group 1 , 96 subjects ) or 10 - 15 min ( Group 2 , 81 subjects ) after i.v . amifostine administration . The mean toxicity score was the mean value of recorded acute radiation toxicity . The mean interruption time was the mean value of the recorded interruption time due to radiation toxicity . RESULTS A significantly reduced severity of symptoms related to oral ( p = 0.023 ) , esophageal ( p = 0.05 ) and rectal ( p = 0.015 ) mucosa was noted in Group 2 . A statistically significant reduction in the mean toxicity score ( p < 0.001 ) and mean interruption time ( p = 0.001 ) was observed in Group 2 vs. Group 1 . In terms of the incidence of radiation-induced dermatitis and alopecia , multivariate logistic analysis revealed only the total dose ( p = 0.018 ) and the amifostine-RT interval ( p = 0.002 ) as independent factors . CONCLUSION A significantly better cytoprotective effect of amifostine against radiation-induced mucositis , dermatitis , and alopecia was noted if RT was administered no later than 15 min after i.v . amifostine infusion . The results presented here need additional investigation with r and omized prospect i ve trials PURPOSE To determine the prophylactic properties of amifostine against acute and late toxicities from radiochemotherapy in patients with head- and -neck cancer . METHODS AND MATERIAL S Fifty patients were r and omized to receive conventional radiotherapy ( RT ) ( 2-Gy fractions , 5 days weekly , to a total of 60 - 74 Gy , depending on the tumor localization and TNM classification ) and carboplatin ( 90 mg/m(2 ) infusion once per week before RT ) . Amifostine ( 300 mg/m(2 ) ) was administered in the study group only 15 - 30 min before RT for 6 - 7.5 weeks . The primary study end point was the grading of acute and late nonhematologic toxicities ( mucositis , dysphagia , xerostomia ) induced by radiochemotherapy . Secondary end points included treatment duration , hematologic toxicity , and clinical outcome . RESULTS The treatment duration was significantly shorter in the amifostine-treated group ( p = 0.013 ) , because treatment interruptions were more frequent in the control group . Acute toxicities ( mucositis and dysphagia ) were less severe in the amifostine-treated group . By Week 3 , all in the control group experienced Grade 2 mucositis compared with only 9 % in the amifostine-treated group 
    Output:
    
No guideline was possible for amifostine in any cancer treatment setting due to inadequate and conflicting evidence .
Conclusion Review of the amifostine studies for the prevention and treatment of oral mucositis has found insufficient evidence to support its use in any cancer treatment setting for this purpose .