***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: Severe oral mucositis is a major cause of morbidity following  allogeneic hematopoietic stem cell transplantation ( AHSCT ) . Cryotherapy , that is , the application of ice chips on the mucosa of the oral cavity during the administration of antineoplastic agents , may reduce the incidence and severity of chemotherapy-related oral mucositis . In this multicenter r and omized study , we addressed whether cryotherapy during MTX administration is effective in the prevention of severe oral mucositis in patients undergoing myeloablative AHSCT . One hundred and thirty patients undergoing myeloablative AHSCT and MTX-containing GVHD prophylaxis were enrolled and r and omized to receive or not receive cryotherapy during MTX administration . The incidence of severe ( grade 3–4 ) oral mucositis , the primary end point of the study , was comparable in patients receiving or not cryotherapy . Moreover , no difference was observed in the incidence of oral mucositis grade 2–4 and the duration of oral mucositis grade 3–4 or 2–4 , or in the kinetics of mucositis over time . In univariate and multivariate analysis , severe oral mucositis correlated with TBI in the conditioning regimen and lack of folinic acid rescue following MTX administration . Thus , cryotherapy during MTX administration does not reduce severe oral mucositis in patients undergoing myeloablative allogeneic HSCT . Future studies will assess cryotherapy before allogeneic HSCT BACKGROUND The aim of this study was to evaluate the effectiveness of granulocyte-macrophage colony-stimulating factor ( GM-CSF ) mouthwashes in the prevention of severe mucositis induced by high doses of chemotherapy . PATIENTS AND METHODS Ninety consecutive patients affected by solid tumors and undergoing high-dose chemotherapy with autologous peripheral blood stem cell transplantation rescue were r and omized to receive placebo versus GM-CSF mouthwash 150 micro g/day . Patients were stratified on the basis of the conditioning treatment and the consequent different risk of severe oral mucositis . Treatment was administered from the day after the end of chemotherapy until the resolution of stomatitis and /or neutrophil recovery . RESULTS The statistical analyses were intention-to-treat and involved all patients who entered the study . The severity of stomatitis was evaluated daily by the physicians according to National Cancer Institute Common Toxicity Criteria . Both study and control groups were compared with respect to the frequency [ 30 % versus 36 % , chi(2 ) exact test , not significant ( NS ) ] and mean duration ( 4.8 + /- 4.7 versus 4.4 + /- 2.7 days , t-test , NS ) of severe stomatitis ( grade > or = 3 ) . Oral pain was evaluated daily by patients themselves by means of a 10 cm analog visual scale : the mean ( + /- st and ard error of the mean ) maximum mucositis scores were 4.8 + /- 3.5 versus 4.2 + /- 3.5 cm ( t-test , NS ) . Furthermore , 15/46 patients in the study group ( 33 % ) and 19/44 patients in the control group experienced pain requiring opioids ( chi(2 ) exact test , NS ) . CONCLUSION We did not find any evidence to indicate that prophylaxis with GM-CSF mouthwash can help to reduce the severity of mucositis in the setting of the patients we studied During anticancer treatment , oral lesions considerably aggravate the child 's clinical condition and increase the risk of infection . This prospect i ve study evaluated the incidence , nature and chronology of oral complications arising during the first 6 weeks of chemotherapy .  131 children were included in this study , and their oral and dental health evaluated on enrolment . Each child was observed once a week , for 6 weeks . Fifty-two per cent ( 68/131 ) of the children presented with at least one oral lesion . Two oral healthcare regimens ( with or without tooth brushing ) were evaluated . Tooth brushing significantly reduced the number of children affected . St and ardised multicentre studies should permit the definition of oral care regimens which would eliminate pain and reduce the risk of infection in children hospitalised for cancer This prospect i ve r and omized 2-period crossover study aim ed at comparing the efficacy of 2 oral care protocol s differing in the type of mouthwashes : chlorhexidine versus benzydamine in alleviating oral mucositis symptoms for children undergoing chemotherapy . Forty subjects were r and omly allocated to receive either chlorhexidine first then benzydamine protocol s or benzydamine first then chlorhexidine protocol s. Each protocol was started on the first day of chemotherapy and continued for 21 days . Subjects were evaluated in intervals of 3 to 4 days using the World Health Organization ( WHO ) grading for mucositis and 10-cm visual analogue scale for oral symptoms evaluations . Among 34 evaluable subjects , 26 % and 48 % of them using chlorhexidine and benzydamine had WHO grade II mucositis , respectively ( P < .05 ) . The results revealed a significant difference in mean area under the curve ( AUC ) of mouth pain ( 1.35 ± 2.26 versus 3.09 ± 3.21 ) ( P = .05 ) , and a trend of a lessening of mean AUC of difficulty in eating/chewing ( 2.49 ± 3.74 versus 2.71 ± 4.1 ) ( P = .82 ) and swallowing ( 1.34 ± 3.31 versus 1.91 ± 4.03 ) ( P = .53 ) for subjects receiving chlorhexidine compared to those receiving benzydamine . In conclusion , chlorhexidine may be helpful in palliating mucositis symptoms for children in chemotherapy . The beneficial effect , however , is small and needs to be confirmed in a larger trial PURPOSE To prospect ively evaluate performance and quality of life ( QOL ) in advanced-stage head and neck cancer ( HNC ) patients on a curative-intent , concomitant-chemoradiotherapy ( CT/XRT ) ( twice-daily radiation , fluorouracil , hydroxyurea , and cisplatin ) regimen aim ed at improving locoregional control , survival , and QOL . PATIENTS AND METHODS Sixty-four patients were assessed before , during , and at 3-month intervals after treatment . St and ardized measures of QOL ( Functional Assessment of Cancer Therapy-Head and Neck ) , performance ( Performance Status Scale for Head and Neck Cancer Patients and Karnofsky Performance Status Rating Scale ) , and patient-reported symptoms ( McMaster University Head and Neck Radiotherapy Question naire ) were administered . RESULTS Acute treatment toxicities were severe , with declines in virtually all QOL and functional domains . Marked improvement was seen by 12 months ; general functional and physical measures returned to baseline levels of good to excellent . Although up to a third of the patients continued to report problems with swallowing , hoarseness , and mouth pain , these difficulties were present in similar magnitudes before treatment . The following symptoms were more frequent at 12 months : dry mouth ( 58 % v 17 % ) , difficulties tasting ( 32 % v 8 % ) , and soft food diet ( 82 % v 42 % ) . Twelve-month diet was not related to pretreatment functioning , disease , treatment , or patient characteristics . Twelve-month QOL was best predicted by pretreatment QOL , with very little relationship to residual side effects or functional impairments . Small numbers of patients in four of the five disease sites precluded examination of outcome by site . CONCLUSION These data support the feasibility of intense CT/XRT as primary treatment for advanced HNC . Results confirm acute toxicity but indicate that many of the treatment-related performance and QOL declines resolve by 12 months . The persistent inability to eat a full range of foods warrants further attention and monitoring BACKGROUND The aim of this study was to describe prospect ively quality of life and mood before and after radiotherapy for laryngeal cancer . METHODS Sixty-five patients with Tis-T3 laryngeal cancer treated with radiotherapy completed the European Organization for Research and Treatment of Cancer ( EORTC ) Core Question naire , the EORTC Head and Neck Cancer module , and the Center for Epidemiologic Studies Depression Scale before treatment and 6 and 12 months later . RESULTS There was a significant but temporary deterioration of physical functioning , fatigue and most head and neck symptoms . Speech was the only symptom which improved . Patients with T2 tumors had significantly worse physical symptoms compared with patients with T1 tumors . There was a high level of depressive symptomatology at baseline , followed by an improvement after treatment . CONCLUSIONS After radiotherapy for laryngeal cancer , a temporary deterioration of physical functioning and symptoms occurs , mostly caused by side effects of treatment . Despite physical deterioration , there is an improvement of emotional functioning and mood after treatment , probably as a result of psychological adaptation and coping processes Mouth sores and /or difficulty swallowing are common and painful consequences of cytotoxic chemotherapy for cancer . In previous studies oral glutamine was found to protect animals from the effects of whole abdominal radiation and methotrexate‐induced enteritis . Glutamine also was found to reduce oral mucositis in a nonr and omized pilot study in humans . Therefore , the authors attempted to determine the efficacy of oral glutamine in a r and omized , double blind , crossover trial in cancer patients receiving chemotherapy Disruption of the oral mucosal lining and the lack of normal defense mechanisms predispose bone marrow transplant ( BMT ) patients to life-threatening infections , often caused by oral flora . Chlorhexidine , used as an oral antiseptic , appears promising in limiting oral bacteria and fungi , and therefore , may decrease oral complications associated with BMT . The purpose of this study was to determine in pediatric BMT recipients if a 0.12 % chlorhexidine mouthrinse , used as an adjunct to normal in-hospital oral care regimens , would decrease the severity of oral mucositis as measured by oral ulcerations , bacteremia , and length of hospital stay .  Forty-seven pediatric BMT subjects were included in this double-blind study . Subjects were instructed to use 15 ml of a mouthrinse 3 times daily to be swished and gargled for 30 sec. Each subject had 7 oral sites scored for the percentage of ulcerated mucosa twice weekly until day + 35 or hospital discharge or death . Blood was cultured daily during neutropenia . Additionally , the number of days from onset of cytoreduction to hospital discharge or death was recorded for each subject . Alpha was set at .05 . There was no significant difference in the severity of oral ulceration between the chlorhexidine and placebo groups ( P = .18 ) . Chlorhexidine did not reduce the development of bacteremia ( P greater than .5 ) , nor did it significantly decrease the length of hospital stay ( P = .68 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Patients receiving cytotoxic antineoplastic therapy often have treatment-associated stomatitis . A 0.12 % chlorhexidine digluconate mouthrinse was evaluated ( 15 ml , three times a day ) in a prospect i ve , double-blind r and omized trial as prophylaxis against cytotoxic therapy-induced damage to oral soft tissues . Seventy subjects , forty in patients receiving high-dose chemotherapy and thirty out patients receiving high-dose head and neck radiation therapy , were evaluated .  Chlorhexidine mouthrinse significantly reduced the incidence of oral mucositis in the chemotherapy group on day 14 ( p less than 0.02 ) and at 1 week follow-up on day 28 ( p less than 0.002 ) . Mucositis in the patients undergoing chemotherapy who received chlorhexidine also resolved more rapidly . Mucositis severity was significantly less compared to the control chemotherapy group on day 14 ( p less than 0.03 ) , day 21 ( p less than 0.04 ) , and on 1 week follow-up ( p less than 0.02 ) . Concomitant trends in the reduction in oral streptococci and yeast were noted in the chemotherapy group receiving chlorhexidine mouthrinse . Although no differences were observed in oral mucositis between the control and chlorhexidine groups of patients undergoing high-dose radiotherapy , similar reductions of oral microflora to those seen in the chemotherapy population were also noted for patients undergoing radiation therapy who received chlorhexidine . Although generally not significant , some increase in gram-negative bacilli was noted in the chlorhexidine-treated patients in both the chemotherapy and radiotherapy groups , but there was no correlation with increased systemic infection . Prophylactic chlorhexidine mouthrinse reduces oral mucositis and microbial burden in patients with cancer undergoing intensive chemotherapy Background / Objective : The study was conducted to determine if enteral glutamine , 0.65 g kg−1 daily for 7 days , is effective in reducing the incidence and severity of mucositis in paediatric oncology patients when given alongside chemotherapy . The study was carried out at St James 's University Hospital , Leeds , UK.Subjects/ Methods : This was a r and omized study using the patients as their own controls . Seventy-six patients undergoing treatment for paediatric malignancy having at least two identical courses of chemotherapy and at risk of developing mucositis participated in the study . Patients received one course of chemotherapy with glutamine and an identical course 
    Output:
    
In conclusion , this review suggests the use of oral care protocol s to prevent oral mucositis in children because of their strength of evidence ( fair to good ) .