What do systematic reviews say?

Amifostine vs no treatment/placebo

Amifostine may leads to higher allergic response (adverse effect) compared with no treatment/placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 7.51 [1.40, 40.39]
  3 studies · 524 participants
  Low

G‐CSF vs placebo or no treatment

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  Limited evidence of adverse events for G-CSF; 2 of 6 studies did not report; low rates of mild to moderate events, most commonly bone pain (SoF comments cell, not GRADE-rated)
  6 studies
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No evidence of a difference in reported adverse events across the three trials (nausea, fever, constipation, diarrhoea, headache, fatigue and others)
  3 studies
  GRADE not reported

Granulocyte-macrophage colony-stimulating factor (GM-CSF), mouthwash vs Sucralfate mouthwash

Granulocyte-macrophage colony-stimulating factor (GM-CSF), mouthwash showed no clear difference in normalcy of diet (percutaneous endoscopic gastrostomy) compared with sucralfate mouthwash; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck
  RR 0.18 [0.01, 3.56]
  1 study · 40 participants
  GRADE not reported

Chinese medicine vs no treatment/placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  Difference in favour of Chinese medicine on VAS xerostomia (P < 0.05); standard deviations not available (Wang 1998)
  1 study · 50 participants
  GRADE not reported

G‐CSF vs placebo or no treatment

Granulocyte-colony stimulating factor (G-CSF) led to lower oral mucositis (any severity) compared with placebo or no treatment; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Chemotherapy alone for lung cancer
  RR 0.59 [0.40, 0.87]
  1 study · 195 participants
  GRADE not reported
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck
  RR 1.02 [0.86, 1.22]
  2 studies · 54 participants
  GRADE not reported

Antimicrobial lozenge vs placebo

Antimicrobial lozenge showed no clear difference in xerostomia compared with placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Up to and including 3 months postRT
  RR 1.16 [0.97, 1.40]
  1 study · 133 participants
  GRADE not reported

Antiseptic mouthrinse vs placebo

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No quality of life data were reported.
  0 studies
  No studies found

Selenium vs no intervention

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No survival data were reported.
  0 studies
  No studies found

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Keratinocyte growth factor (KGF; palifermin or repifermin),… may leads to lower oral mucositis (moderate to severe) compared with placebo (low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  BMT/SCT after conditioning for haematological cancers
  RR 0.89 [0.80, 0.99]
  6 studies · 852 participants
  Low
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck with cisplatin/fluorouracil
  RR 0.91 [0.83, 1.00]
  3 studies · 471 participants
  Moderate
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Chemotherapy alone for mixed cancers
  RR 0.56 [0.45, 0.70]
  4 studies · 344 participants
  Moderate

Chinese medicine vs no treatment/placebo

Chinese medicine led to lower xerostomia (dichotomous, Shenqi Fanghou recipe) compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  RR 0.39 [0.28, 0.55]
  1 study · 140 participants
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Keratinocyte growth factor (KGF; palifermin or repifermin),… showed no clear difference in oral pain (mean worst pain, 0 to 10 scale) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  BMT/SCT after conditioning for haematological cancers
  MD -0.85 [-3.00, 1.30]
  1 study · 42 participants
  GRADE not reported
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck with cisplatin/fluorouracil
  MD -0.12 [-0.27, 0.02]
  2 studies · 374 participants
  GRADE not reported

Amifostine (intravenous) vs Amifostine (subcutaneous)

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  Increased hypotension with intravenous delivery (20% vs 8%; P = 0.007); skin rash (10% vs 22%; P = 0.012) and local pain at injection site (0% vs 8%; P = 0.001) worse with subcutaneous; inconclusive for…
  1 study
  GRADE not reported

Bethanechol vs placebo

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on either quality of life or other oral related symptoms were reported.
  0 studies
  No studies found

Amifostine vs no treatment/placebo

Amifostine may leads to higher vomiting (adverse effect) compared with no treatment/placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 4.90 [2.87, 8.38]
  5 studies · 601 participants
  Low

Selenium vs no intervention

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  6 weeks after end of RT
  Insufficient evidence of differences for loss of taste or dysphagia; data largely unusable (no standard deviations). Ageusia milder in selenium group (not significant); dysphagia significant only at week 7 (P = 0.05)…
  1 study
  GRADE not reported

Erythropoietin mouthwash vs placebo

Erythropoietin mouthwash showed no clear difference in oral mucositis (severe) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  RR 0.40 [0.14, 1.17]
  1 study · 80 participants
  GRADE not reported

Granulocyte-macrophage colony-stimulating factor (GM-CSF), mouthwash vs Sucralfate mouthwash

Granulocyte-macrophage colony-stimulating factor (GM-CSF), mouthwash showed no clear difference in oral mucositis (severe) compared with sucralfate mouthwash; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck
  RR 0.54 [0.24, 1.21]
  1 study · 40 participants
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Keratinocyte growth factor (KGF; palifermin or repifermin),… showed no clear difference in normalcy of diet (supplemental nutrition: TPN, PEG, nasogastric tube… compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck with cisplatin/fluorouracil
  RR 1.03 [0.77, 1.37]
  3 studies · 473 participants
  GRADE not reported

Transforming growth factor-beta(2) (TGF-beta2) vs placebo

Transforming growth factor-beta(2) (TGF-beta2) showed no clear difference in oral mucositis (any severity) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  RR 0.10 [0.01, 1.71]
  1 study · 13 participants
  GRADE not reported