***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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    ***EXAMPLES*** 
    Input: PURPOSE To compare granulocyte-macrophage colony-stimulating factor ( GM-CSF ) mouthwashes with sucralfate mouthwashes in the prevention of radiation-induced mucositis . METHODS AND MATERIAL S Forty patients with radically operated head- and -neck cancer were r and omly allocated to use either GM-CSF ( n = 21 ) or sucralfate ( n = 19 ) mouthwashes during postoperative radiotherapy ( RT ) . All patients received conventionally fractionated RT to a total dose of 50 - 60 Gy in 2-Gy daily fractions during 5 - 6 weeks to the primary site and regional lymphatics . A minimum of 50 % of the oral cavity and oropharyngeal mucosa was included in the clinical target volume . GM-CSF mouthwashes consisted of 37.5 microg GM-CSF and sucralfate mouthwashes of 1.0 g of sucralfate distilled in water . Both washes were used 4 times daily , beginning after the first week of RT and continued to the end of the RT course . Symptoms related to radiation mucositis and body weight , serum prealbumin level , and blood cell counts were monitored weekly . RESULTS Oral mucositis tended to be less severe in the GM-CSF group ( p = 0.072 ) . Complete ( n = 1 ) or partial ( n = 4 ) healing of mucositis occurred during the RT course in 5 patients ( 24 % ) in the GM-CSF group and in none of the patients in the sucralfate group ( p = 0.049 ) . Patients who received GM-CSF had less mucosal pain ( p = 0.058 ) and were less often prescribed opioids for pain ( p = 0.042 ) . Three patients in the sucralfate group needed hospitalization for mucositis during RT compared with none in the GM-CSF group . Four patients ( 21 % ) in the sucralfate group and none in the GM-CSF group required an interruption in the RT course ( p = 0.042 ) . No significant differences in weight , prealbumin level , or blood cell count were found between the groups , and both mouthwashes were well tolerated . CONCLUSION GM-CSF mouthwashes may be moderately more effective than sucralfate mouthwashes in preventing radiation-induced mucositis and mucositis-related pain , and their use may lead to less frequent RT course interruptions from mucositis . The present findings need to be confirmed before adopting GM-CSF mouthwashes in routine clinical use Benzydamine hydrochloride rinse was shown to prevent oral mucositis in radiation therapy . Prevention of mucositis allows reduction in morbidity of one of the therapy limiting complications of radiotherapy for cancer therapy Oral mucositis is a frequent side effect of myeloablative chemo- and radiotherapy preceding stem cell transplantation . It causes pain , poor food intake , and is a port of entry for infection . We studied whether GM-CSF applied topically in the oral cavity can prevent or ameliorate this mucositis . In 36 consecutive patients undergoing a stem cell transplantation , we performed a double-blind placebo-controlled study of 300 µg GM-CSF in a 2 % methylcellulose gel daily versus a 2 % methylcellulose gel alone . Both were locally applied in the oral cavity . The primary end-point was mucositis as measured by the WHO toxicity scale for mucositis , oral assessment scale , and a subjective pain scale , all scored daily . The secondary end-points were need to give parenteral nutrition and morphine , incidence of fever and infections , and duration of neutropenia and hospitalization . No differences were found in the median subjective pain scores , WHO scores , and oral assessment scores between the placebo and the GM-CSF groups . In both groups , nine patients required morphine for pain control . Ten patients in the placebo group and 11 in the GM-CSF group received parenteral nutrition . Documented infections , use of broad-spectrum antibiotics , and number of days with fever were similar in the placebo and the GM-CSF groups . The duration of neutropenia below 0.5 × 109/l ( median 14.5 days in the placebo group versus 17 days in the GM-CSF group ) and the duration of hospitalization ( 28.5 versus 29 days ) was also not significantly different . We found no beneficial effect of 300 µg GM-CSF dissolved in a 2 % methylcellulose gel applied locally for chemo- and radiotherapy-induced mucositis in patients undergoing a stem cell transplantation BACKGROUND AND PURPOSE We evaluated sucralfate , well-known in the treatment of gastric ulcers , in relation to its possible reduction of radiation-induced acute complications in the treatment of head and neck cancers . MATERIAL S AND METHODS One hundred two patients were r and omized in a double-blind placebo-controlled prospect i ve setting . All patients were treated to a minimum dose of 55 Gy in 5 weeks . Oral intake of sucralfate was started at the beginning of radiotherapy and continued during the whole treatment at a dose of 1 g six times a day . All patients were scored according to a scoring system developed in our department . Weight was checked once a week . RESULTS Comparing the time course of the mean scores for subjective intolerance , mucositis , dysphagia , dermatitis and nausea , no statistically significant differences between the two treatment arms ( sucralfate , n = 38 ; placebo , n = 45 ) were observed . The mean weight loss in the sucralfate arm was 1.6 + /- 3.4 kg while it was 1.3 + /- 2.0 kg in the placebo arm . Apart from gastrointestinal upset , the administration of sucralfate did not cause any side-effects . CONCLUSION This trial produced no clinical evidence indicating that the oral intake of sucralfate reduces the acute radiation-induced side-effects . Therefore , we do not recommend the prophylactic use of sucralfate in patients with head and neck cancer treated by radiotherapy Mucositis significantly affects quality of life and tolerance of treatment in oral irradiation . Effective management of this complication is therefore very important . However , there is a scarcity of up-to- date oral care protocol s , with most centres using ritualized regimens . The literature on oral rinses in radiation mucositis is at best inconclusive and at worst confusing . In this study , patients undergoing radical radiotherapy treatment ( 55 - 60 Gy in 4 weeks ) to more than 50 % of the oral cavity and oropharynx were r and omized to a research based oral care protocol with either saline 0.9 % or hydrogen peroxide 3.5 volumes ( HP ) as rinses . The results of this study show that , on average , the group receiving saline rinses appeared to do better on some outcomes than the group receiving HP . This suggests that frequent mechanical cleansing of the mouth may be more important than the antiseptic properties of a mouthwash . Antiseptic mouthwashes may be contra-indicated in radiation mucositis . In order to determine best practice in mucositis management , multi-centre , multidisciplinary trials should be conducted The invasion and colonization of oral cavity mucosal tissues by microflora may contribute to the pathophysiology of ulcerative oral mucositis ( UOM ) . Iseganan is an analog of protegrin-1 , a naturally occurring peptide with broad-spectrum microbicidal activity . A r and omized , double-blind , placebo-controlled study was conducted to evaluate the efficacy and safety of iseganan in preventing UOM after stomatotoxic therapy . Patients received an oral rinse , consisting of iseganan 9 mg or placebo , to be swished/swallowed six times daily , starting with stomatotoxic therapy and continuing up to 21 days . Patients were assessed for stomatitis and UOM , and administered a question naire evaluating mouth pain and difficulty swallowing thrice weekly . The primary study efficacy endpoint was the proportion of patients who did not have peak stomatitis NCI-CTC grade > or=2 . Between November 2001 and June 2002 , 502 patients were r and omized to receive iseganan  ( 251 ) or placebo ( 251 ) . Equivalent numbers of patients in both cohorts received bone marrow or peripheral blood allogeneic or autologous stem cell transplantation ( SCT ) . Forty-three percent and 37 % of iseganan and placebo patients , respectively , did not have peak stomatitis grade = 2 ( P = 0.182 ) . There was no significant difference between the cohorts in stomatitis severity , incidence of UOM , peak mouth pain , peak difficulty swallowing , amount of opiate analgesics used , or adverse event type or incidence . A major impact of Iseganan on reducing stomatitis , UOM , or its clinical sequelae in patients receiving stomatotoxic therapy was not detected on this study Benzydamine HCl is a new nonsteroidal analgesic and anti-inflammatory compound which is not chemically related to local anesthetics such as procaine and xylocaine . A double-blind , r and omized clinical investigation was carried out to determine the analgesic and anti-inflammatory effectiveness of benzydamine HCl in patients with radiation-induced mucositis of the oropharynx . Of the 67 patients in the study , 37 were on benzydamine and 30 on placebo .  Patients developed radiation mucositis , hyperemia , and throat pain when the total radiation dose reached above 2,000 rad over 2 weeks ( 200 rad per fraction , five treatments per week ) . Analysis of the data showed that benzydamine HC1 used as a rinse/gargle provided a statistically significant and clinical ly meaningful alleviation of the symptoms of oropharyngeal mucositis . There was also significant improvement in terms of reduction in hyperemia and mucositis in benzydamine group . No systemic side effects associated with benzydamine medication were noted . In view of the relative ineffectiveness of systemic analgesics and topical anesthetics for these conditions , benzydamine HCl promises to be a useful addition to the therapeutic armamentarium 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 Oral mucositis is a common symptomatic complication associated with hematopoietic stem cell transplantation ( HCT ) . We use simple strategies aim ed to reduce oral mucositis by keeping the oral cavity clean and moist . Here , we report on the progress of oral care and the changes in the degree of oral mucositis . The purpose of this pilot study is to evaluate the effects of our strategies on the prevalence and the severity of oral mucositis . Methods Fifty-three consecutive patients from 2003 to 2006 administered with conventional allogeneic HCT were enrolled in this study . The degree of oral mucositis was evaluated daily in all patients . Our oral care program was divided into two periods : “ examination and trial period ( 2003 and 2004 ) ” and “ intensive oral care period ( 2005 and 2006 ) . ” In the latter , an oral care regimen was carried out systematic ally by a multidisciplinary team . Results Using our oral care strategies , the prevalence of ulcerative oral mucositis was decreased significantly . The rate was reduced from 76 % ( 10 of 13 ) of patients with ulcerative oral mucositis in 2003 to only 20 % ( 3 of 15 ) in 2006 . Conclusions Our pilot study suggests that oral mucositis in HCT patients can be alleviated by simple strategies aim ed at keeping the oral cavity clean and moist Patients receiving cytotoxic antineoplastic therapy often have 
    Output:
    
Conclusion Among these , chlorhexidine , normal saline , sodium bicarbonate , iseganan , benzydamine , sucralfate and Granulocyte macrophage colony-stimulating factor have been used in the form of mouth-rinse for prevention of chemotherapy induced mucositis .
However , none of these mouthrinses have been shown to be definitely effective in preventing chemotherapy induced oral mucositis