***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: BACKGROUND Total parenteral nutrition ( TPN ) supplemented with glutamine ( GLN ) has been reported to be effective for patients with bone marrow transplantation ( BMT ) . Our aim was to evaluate enteral and parenteral glutamine in patients undergoing BMT . METHODS For evaluation of GLN in BMT , 66 patients with 43 hematologic and 23 solid malignancies ( 21 breast carcinomas ) , were r and omized , double-blinded , to either oral GLN ( n = 35 ) or glycine-control ( GLY ) ( n = 31 ) , 10 g three times daily . When TPN became necessary , patients who received GLN orally were given TPN with GLN ( 0.57 g/kg ) . Those who received GLY received st and ard TPN , isocaloric and isonitrogenous . Patients with hematologic malignancies received high-dose chemotherapy , total body irradiation , and either allogeneic ( ALLO ) BMT ( n = 18 ) or autologous ( AUTO ) stem cell transplantation ( n = 25 ) . Patients with solid malignancies ( n = 23 ) received AUTO . RESULTS There were 14 in-hospital deaths without relationship to GLN administration . For respective comparisons of ALLO and AUTO transplants in the GLN and GLY hematologic groups and AUTO in the solid tumor groups , there were no significant differences in hospital stay , duration of stay after BMT , TPN days , neutrophil recovery > 500/mm3 , incidence of positive blood cultures , sepsis , mucositis , and diarrhea . Acute graft us host disease occurred in 1 of 10 hematologic patients receiving GLN and in 3 of 8 patients receiving GLY placebo ( p > .05 ) . Possible reduction in need for TPN and a suggestion of improved long-term survival were associated with GLN . CONCLUSIONS Oral and parenteral GLN seemed to be of limited benefit for patients having AUTO or ALLO BMT for hematologic or solid malignancies . Further study of long-term effects of GLN in BMT seems warranted 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 Background The aim of this study was to evaluate the effect of pure natural honey on  radiation-induced mucositis .  Patients and methods Forty patients diagnosed with head and neck cancer requiring radiation to the oropharyngeal mucosal area were divided in to two groups to receive either radiation alone or radiation plus topical application of pure natural honey . Patients were treated using a 6-MV linear accelerator at a dose rate of 2 Gy per day five times a week up to a dose of 60–70 Gy . In the study arm , patients were advised to take 20 ml of pure honey 15 min before , 15 min after and 6 h post-radiation therapy . Patients were evaluated every week for the development of radiation mucositis using the Radiation Therapy Oncology Group ( RTOG ) grading system . Main results There was significant reduction in the symptomatic grade 3/4 mucositis among honey-treated patients compared to controls ; i.e. 20 % versus 75 % ( p 0.00058 ) . The compliance of honey-treated group of patients was better than controls . Fifty-five percent of patients treated with topical honey showed no change or a positive gain in body weight compared to 25 % in the control arm ( p 0.053 ) , the majority of whom lost weight . Conclusions Topical application of natural honey is a simple and cost-effective treatment in radiation mucositis , which warrants further multi-centre r and omised trials to vali date our finding The purpose of this study was to monitor the dose modifying effect of supplemental dietry beta-carotene on the progression of the oral mucosal reaction and treatment outcome during an intensive course of synchronous radiation and chemotherapy .  Tumour response and long term normal tissue changes have been carefully recorded . Twenty patients with advanced squamous carcinoma of the mouth , who received 60 Gy telecobalt therapy given in 30 daily fractions with synchronous chemotherapy comprising vincristine , methotrexate and bleomycin , were r and omised to receive st and ard diet with supplemental beta carotene ( study patients ) or st and ard diet only with no placebo ( control patients ) . Patients were matched for performance status ( > H2 ( AJC ) ) and age ( av . 57 years ) . All patients gave informed consent , were hospitalised , on routine mouth care and restrained from smoking during treatment . There OBJECTIVE : To determine the effect of glutamine suspension on mucositis associated with the administration of high-dose preparative regimens for bone marrow transplantation . METHODS : We performed a retrospective analysis of 21 consecutive patients receiving high-dose paclitaxel and melphalan as the preparative regimen for autologous peripheral blood stem-cell transplantation for metastatic breast cancer between January 1997 and December 1997 .  Glutamine suspension was given as swish- and -swallow administration every four hours around the clock starting day −7 , for a total dose of 24 g/d . RESULTS : The group given oral glutamine suspension demonstrated significantly fewer days of mucositis and a lower maximum grade of mucositis . The treatment group also had fewer days of parenteral morphine for pain relief . The group that did not receive glutamine required an average of 5.22 days of patient-controlled analgesia ( PCA ) morphine  ; the glutamine group did not require PCA morphine . The total days of narcotic pain relief were decreased in the glutamine group ; however , this did not reach statistical significance . Qualitatively , the patients in the glutamine group had less oral ulceration and bleeding , and were able to tolerate liquids sooner than those in the nonglutamine group . Patients tolerated the glutamine suspension well . CONCLUSIONS : This study showed that around-the-clock administration of oral glutamine may decrease both the severity and duration of mucositis associated with high-dose bone marrow transplant preparative regimens . The decrease in severity and duration of mucositis translated into reduced parenteral narcotic use . A prospect i ve , r and omized , controlled trial is needed to determine future applications of glutamine in the support of patients undergoing high-dose chemotherapy Oral mucositis ( OM ) is a frequent complication of mucotoxic cancer therapy , causing significant oral pain , increased infection risk , and impaired functioning . The efficacy and safety of Saforis ( glutamine ) powder in UpTec for oral suspension was evaluated for the prevention and treatment of OM Background Few treatments have the potential to reduce the severity of radiation-induced mucositis in head and neck cancer patients . Some small studies have suggested that organic honey may be a useful preventive treatment . Methods This investigator-initiated double-blind r and omized placebo-controlled trial investigated whether honey reduced the severity of radiation-induced oral mucositis ( ROM ) .  One hundred six head and neck cancer patients from the Vancouver and Sudbury Cancer Centers in Canada were r and omized to swish , hold , and swallow either 5 ml of irradiated organic manuka honey or a placebo gel , four times a day throughout radiation treatment , plus seven more days . Severity of oral mucositis according to the Radiation Therapy Oncology Group ( RTOG ) , World Health Organization ( WHO ) , and Oral Mucositis Assessment Scale scales , weight , and subjects ' symptom severity and quality of life were assessed weekly . Sialometry was performed at baseline and at the last study visit . Results One hundred six patients were recruited . Twenty-four did not attend any mucositis assessment s. One was removed from the study because of off- study consumption of store-bought manuka honey . The remaining 81 patients had at least one mucositis assessment and were included in the analysis . Sixty-two percent of subjects received concurrent chemotherapy ; 81 % were male . The groups were well-matched , and blinding was excellent . Dropouts were mostly due to nausea and were similar in both arms , with 78 % being able to tolerate the study products for more than 1 week . The dropout rate was 57 % in those who received honey and 52 % in those who received placebo gel . The dropout rate in those who had concurrent chemotherapy was 59 % and in those who only received radiation was 47 % . There was no statistically significant difference between the honey and placebo arms in any of the outcome indicators . Those who completed the study in both treatment arms had low rates of RTOG greater than or equal to grade 3 mucositis ; 35 % in the honey group and 43 % in the placebo group . Conclusion Despite promising earlier reports , manuka honey was not tolerated well by our patients and , even when used as directed , did not have a significant impact on the severity of ROM This study evaluated the effects of an essential oil mouthwash on  radiation induced mucositis of the oropharyngeal area during treatment for head and neck cancers . Nineteen adult patients completed the r and omized placebo controlled trial which involved the use of a gargle containing 2 drops of a 1:1 mix of the essential oils of manuka ( Leptospermum scoparium ) and kanuka ( Kunzea ericoides ) in water . Those in the essential oil gargle group were observed to have a delayed onset of mucositis and reduced pain and oral symptoms relative to placebo ( gargling with water ) and the control ( ' usual care ' ) groups . In addition those in the essential oil group were seen to have less weight loss ( 1 % loss ) than the other two groups ( control 2.5 % , placebo 4.5 % ) . However a significant limitation in this study was the small sample size . Although the results from this feasibility study support the hypothesis that very small volumes of manuka and kanuka used in a gargle can provide a positive effect on the development of radiation induced mucositis , further research is required to confirm this finding . R and omization was applied according to the timing of the patient 's entering the trial as well as their physical ability to gargle . Confirmation of these findings would pave the way for introduction of a simple , yet effective treatment for a condition which causes considerable discomfort and for which there is currently no definitive treatment PURPOSE To determine the effect of oral zinc sulphate supplementation on radiation-induced oropharyngeal mucositis in patients with head- and -neck cancer . MATERIAL S AND METHODS Thirty patients with head- and -neck cancer were r and omly assigned to receive either zinc sulfate or placebo .  Primary tumors were localized in the larynx in 14 patients , in the nasopharynx in 4 , in the oral cavity in 4 , in a salivary gl and in 1 , in the maxillary sinus in 1 , in neck nodes ( lymphoma presenting primarily ) in 3 and in neck metastases from an unknown primary in 3 . In the placebo group , 3 patients were excluded ; 1 patient died during treatment , 1 left the study , and 1 did not come to the 6 week control visit . The patients were treated with telecobalt radiotherapy at conventional fractionation ( 2 Gy/fraction , five fractions weekly , for 20 - 35 fractions within 4 - 7 weeks ) . The median radiation dose was 6400 cGy ( 4000 - 7000 cGy ) . Oral mucositis was assessed by two independent physicians , experts in radiation oncology , using the Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring criteria . RESULTS In the zinc sulfate group , Grade 3 - 4 mucositis was not detected in any patient ; Grade 0 mucositis was detected in 2 , and Grade 1 in 8 , and Grade 2 in 5 patients . In the placebo group , Grade 2 mucositis was detected in 4 and Grade 3 in 8 patients . We observed that the degree of mucositis in the patients in the zinc sulfate group was significantly lower than that in the placebo group ( p < 
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No guideline was possible for any other agent , due to inadequate and /or conflicting evidence .
Conclusions Of the various natural agents review ed here , the available evidence supported a guideline only for two agents : a suggestion in favor of zinc and a recommendation against glutamine , in the treatment setting s listed above .