Bensadoun, R.J., Schubert, M.M., Lalla, R.V., & Keefe, D. (2006). Amifostine in the management of radiation-induced and chemo-induced mucositis. Supportive Care in Cancer, 14, 566–572.

DATABASES USED: MEDLINE (May 2002–May 2005), selected studies related to amifostine

KEYWORDS: stomatitis, mucous membrane, mucositis (text in titles and abstracts)

INCLUSION CRITERIA: Limited to \"neoplasm\" and English language

FINAL NUMBER STUDIES INCLUDED = 29 trials included, 6 covered in detail; pilot studies and randomized, controlled studies included

SAMPLE RANGE ACROSS STUDIES: Sample sizes range from small to more than 200

KEY SAMPLE CHARACTERISTICS: Patients with head and neck cancer receiving radiation alone; patients with cancers of various origin receiving combination chemoradiation or radiation alone; patients receiving intensity-modulated radiation therapy; and studies examining routes of administration in patients with head and neck cancer, patients with prostate cancer, and patients receiving epirubicin

The study did not provide sufficient evidence for recommendations related to amifostine and prevention or management of oral mucositis. The authors recommended maintaining the original guideline from the Multinational Association of Supportive Care in Cancer—chemoradiation for non-small cell lung cancer for prevention of esophagitis (level of evidence III, grade of recommendation C). Several small studies demonstrated prevention of proctitis in patients with only rectal carcinoma. No effect was shown for other pelvic cancers. Therefore, the authors suggested that the guideline be revised to include the recommendation of amifostine at least 340 mg/m² IV daily prior to radiation (level of evidence III, grade of recommendation B) for rectal carcinoma to prevent proctitis. For patients with hematologic disorders, no significant data could reinforce any recommendations. Possible future uses and routes of amifostine also were discussed.