***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: Painful oral mucositis is a common complication after  bone marrow transplantation ( BMT ) . Glutamine is a nutrient for rapidly dividing cells and the major energy source for intestinal epithelium . This study tested whether an oral glutamine preparation could decrease the severity of oral mucositis in patients undergoing BMT . Glutamine or a placebo ( glycine ) were administered from admission until day + 28 in 193 BMT patients in a r and omized , double-blind , placebo-controlled study at a dose of 1.0 g amino acid/m2/dose swish and swallow four times a day . In  autologous BMT patients ( n = 87 ) glutamine was associated with significantly less mouth pain by self report and by opiate use ( 5.0 ± 6.2 days of morphine for glutamine vs 10.3 ± 9.8 days for placebo ; P = 0.005 ) . Matched sibling BMT patients had no effect by self report and an increased duration of opiate use ( 23.2 ± 5.7 days for glutamine vs 16.3 ± 8.3 days for placebo ) ( P = 0.002 ) . However , day 28 survival of allogeneic patients was improved by glutamine . No significant differences in TPN use , rate of relapse or progression of malignancy , parenteral antibiotic use , acute or chronic GVHD , or days of hospitalization were observed in either autologous or allogeneic recipients . No toxicity of glutamine was observed . We conclude that oral glutamine can decrease the severity and duration of oropharyngeal mucositis in autologous BMT patients but not in allogeneic BMT patients , possibly due to interaction with methotrexate Based on the assumption that an accelerated proliferation process prevails in tumour cell residues after surgery , the possibility that treatment acceleration would offer a therapeutic advantage in postoperative radiotherapy of locally advanced head and neck cancer was investigated . The value of Tpot in predicting the treatment outcome and in selecting patients for accelerated fractionation was tested . Seventy patients with ( T2/N1–N2 ) or ( T3 - 4/any N ) squamous cell carcinoma of the oral cavity , larynx and hypopharynx who underwent radical surgery , were r and omized to either ( a ) accelerated hyperfractionation : 46.2 Gy per 12 days , 1.4 Gy per fraction , three fractions per day with 6 h interfraction interval , treating 6 days per week or ( b ) Conventional fractionation : 60 Gy per 6 weeks , 2 Gy per fraction , treating 5 days per week . The 3-year locoregional control rate was significantly better in the accelerated hyperfractionation ( 88±4 % ) than in the CF ( 57±9 % ) group , P=0.01 ( and this was confirmed by multivariate analysis ) , but the difference in survival ( 60±10 % vs 46±9 % ) was not significant ( P=0.29 ) . The favourable influence of a short treatment time was further substantiated by demonstrating the importance of the gap between surgery and radiotherapy and the overall treatment time between surgery and end of radiotherapy . Early mucositis progressed more rapidly and was more severe in the accelerated hyperfractionation group ; reflecting a faster rate of dose accumulation . Xerostomia was experienced by all patients with a tendency to be more severe after accelerated hyperfractionation . Fibrosis and oedema also tended to be more frequent after accelerated hyperfractionation and probably represent consequential reactions . Tpot showed a correlation with disease-free survival in a univariate analysis but did not prove to be an independent factor . Moreover , the use of the minimum and corrected P-values did not identify a significant cut-off . Compared to conventional fractionation , accelerated hyperfractionation did not seem to offer a survival advantage in fast tumours though a better local control rate was noted . This limits the use of Tpot as a guide for selecting patients for accelerated hyperfractionation . For slowly growing tumours , tumour control and survival probabilities were not significantly different in the conventional fractionation and accelerated hyperfractionation groups . A rapid tumour growth was associated with a higher risk of distant metastases ( P=0.01 ) . In conclusion , tumour cell re population seems to be an important determinant of postoperative radiotherapy of locally advanced head and neck cancer despite lack of a definite association between Tpot and treatment outcome . In fast growing tumours accelerated hyperfractionation provided an improved local control but without a survival advantage . To gain a full benefit from treatment acceleration , the surgery-radiotherapy gap and the overall treatment time should not exceed 6 and 10 weeks respectively The aim of this study was to see if antibiotic pastilles could reduce radiation mucositis , pain , dysphagia and weight loss in patients undergoing radical radiotherapy for head and neck cancer . A total of 275 patients with T1-T4 tumours entered the study ; 136 were allocated to suck four times daily a pastille containing amphotericin , polymyxin and tobramycin . The remaining 139 patients received an identical placebo . In all , 54 patients were unevaluable ( 24 active , 30 placebo )  .  Bacteriological monitoring was carried out before and twice weekly during treatment . Both arms of the study were well balanced for T and N stage , age , sex and radiation dose ( 60 Gy ) . There was a slight imbalance in the site of disease which had no substantive effect on the results . The primary study end point was the percentage of patients who developed intermediate or thick pseudomembranes . No statistically significant difference was found in this end point , with 36 % of patients in the active arm developing this type of membrane compared with 48 % in the placebo arm ( P = 0.118 ) . The estimated odds ratio ( placebo/active ) of developing an intermediate or thick pseudomembrane was 1.59 ( 95 % CI 0.89 - 2.82 ) . However a more sensitive test comparing the worst recorded mucositis grade between the two arms was statistically significant ( P = 0.009 ) . This indicated that the active pastilles had a beneficial effect , but the magnitude was probably smaller than the trial was design ed to detect . There was a reduction in mucositis distribution ( P = 0.002 ) , mucositis area ( P = 0.028 ) , dysphagia ( P = 0.006 ) and weight loss ( P = 0.009 ) in the active arm . There was a clear tendency for patients with positive cultures for aerobic Gram-negative bacteria ( AGNB ) ( P = 0.003 ) and yeasts ( P = 0.026 ) during treatment to have more severe mucositis . The active pastilles reduced the percentage of patients with yeast cultures ( P = 0.003 ) but had less effect on AGNB . The benefit derived from the pastilles should material ly increase patient tolerance to radical radiotherapy for head and neck cancer Background . Oral mucositis is a common complication of bone marrow transplantation ( BMT ) conditioning therapy . Sequelae consist of increased risk for infection , moderate to severe pain , compromised oral function , and bleeding . This study investigated helium‐neon laser treatment for prevention of conditioning‐induced oral mucositis in  BMT patients .  Patterns and severity of mucositis for specific conditioning drug regimens also were analyzed PURPOSE In a single-institution , double-blind , prospect i ve , r and omized trial , we determined whether oral aloe vera gel can reduce radiation-induced mucositis in head- and -neck cancer patients . METHODS AND MATERIAL S We r and omized 58 head- and -neck cancer patients between oral aloe vera and placebo .  To be included in this Phase II protocol , patients had to be treated with radiotherapy with curative intent at Stanford University between February 1999 and March 2002 . We examined patients biweekly for mucositis at 15 head- and -neck subsites and administered quality -of-life question naires . RESULTS Patients in the aloe and placebo groups were statistically identical in baseline characteristics . By the end of treatment , the two groups were also statistically identical in maximal grade of toxicity , duration of Grade 2 or worse mucositis , quality -of-life scores , percentage of weight loss , use of pain medications , hydration requirement , oral infections , and prolonged radiation breaks . CONCLUSION In our r and omized study , oral aloe vera was not a beneficial adjunct to head- and -neck radiotherapy . The mean quality -of-life scores were greater in the aloe vera group , but the differences were not statistically significant . Oral aloe vera did not improve tolerance to head- and -neck radiotherapy , decrease mucositis , reduce soreness , or otherwise improve patient well-being BACKGROUND Oral mucositis is a complication of intensive chemotherapy and radiotherapy with no effective treatment . We tested the ability of palifermin ( recombinant human keratinocyte growth factor ) to decrease oral mucosal injury induced by cytotoxic therapy . METHODS This double-blind study compared the effect of palifermin with that of a placebo on the development of oral mucositis in 212 patients with hematologic cancers ; 106 patients received palifermin ( 60 microg per kilogram of body weight per day ) and 106 received a placebo intravenously for three consecutive days immediately before the initiation of conditioning therapy ( fractionated total-body irradiation plus high-dose chemotherapy ) and after autologous hematopoietic stem-cell transplantation . Oral mucositis was evaluated daily for 28 days after transplantation . RESULTS The incidence of oral mucositis of World Health Organization ( WHO ) grade 3 or 4 was 63 percent in the palifermin group and 98 percent in the placebo group ( P<0.001 ) . Among patients with this degree of mucositis , the median duration of mucositis was 6 days ( range , 1 to 22 ) in the palifermin group and 9 days ( range , 1 to 27 ) in the placebo group . Among all patients , regardless of the occurrence of mucositis , the median duration of oral mucositis of WHO grade 3 or 4 was 3 days ( range , 0 to 22 ) in the palifermin group and 9 days ( range , 0 to 27 ) in the placebo group ( P<0.001 ) . As compared with placebo , palifermin was associated with significant reductions in the incidence of grade 4 oral mucositis ( 20 percent vs. 62 percent , P<0.001 ) , patient-reported soreness of the mouth and throat ( area-under-the-curve score , 29.0 [ range , 0 to 98 ] vs. 46.8 [ range , 0 to 110 ] ; P<0.001 ) , the use of opioid analgesics ( median , 212 mg of morphine equivalents [ range , 0 to 9418 ] vs. 535 mg of morphine equivalents [ range , 0 to 9418 ] , P<0.001 ) , and the incidence of use of total parenteral nutrition ( 31 percent vs. 55 percent , P<0.001 ) . Adverse events , mainly rash , pruritus , erythema , mouth and tongue disorders , and taste alteration , were mild to moderate in severity and were transient . CONCLUSIONS Palifermin reduced the duration and severity of oral mucositis after intensive chemotherapy and radiotherapy for hematologic cancers PURPOSE Experimental and clinical data suggest a reduction of radiation-induced acute toxicity by amifostine . We investigated this issue in a r and omized trial comparing radiochemotherapy ( RCT ) versus radiochemotherapy and amifostine ( RCT + A ) in patients with head and neck cancer . PATIENTS AND METHODS Forty-seven patients with pharyngeal or laryngeal cancer ( T1 - 2 N1 - 2 G3 , T3 - 4 N0 - 2 G1 - 3 ) were r and omized to receive RCT alone ( 21 patients ) or RCT + A ( 21 patients ) . Patients were irradiated up to 60 Gy ( R0 ) or 70 Gy ( R1/2 ) . Chemotherapy consisted of 70 mg/m2 carboplatin and was administered over 5 days in the 1st and 5th week of the radiotherapy course . 250 mg amifostine were applied daily just before each radiotherapy session . Acute toxicity was evaluated according to the Common Toxicity Criteria ( CTC ) . As for xerostomia no patients with laryngeal cancer were assessed because in these cases only small volumes of the salivary gl and s were within the treatment volume . To evaluate the overall toxicity a summarized CTC score of all observed side effects was calculated . RESULTS Forty-two patients were evaluable . Clinical characteristics ( age , sex , Karnofsky index , tumor-staging ) were well balanced in both treatment groups ( Tables 2 and 3 ) . Amifostine provided reduction in xerostomia and mucositis ( Figures 5 and 6 ) but had no obvious influence on Karnofsky index , body weight , cutaneous side effects and alopecia ( Figures 1 to 4 ) . CONCLUSIONS According to our preliminary results amifostine has a radioprotective effect on salivary gl and s. Mucositis can be reduced during radiochemotherapy . At this point of patient accrual the difference between both groups are statistically not significant . To improve the radioprotective effects of amifostine in clinical practice the application of a 
    Output:
    
Ten interventions were found to have some benefit with regard to preventing or reducing the severity of mucositis associated with cancer treatment .