Nicolatou-Galitis, O., Dardoufas, K., Markoulatos, P., Sotiropoulou-Lontou, A., Kyprianou, K., Kolitsi, G., … Velegraki, A. (2001). Oral pseudomembranous candidiasis, herpes simplex virus-1 infection, and oral mucositis in head and neck cancer patients receiving radiotherapy and granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash. Journal of Oral Pathology and Medicine, 30, 471–480.

Patients were given a mouthwash of 400 mcg granulocyte-macrophage colony-stimulating factor (GM-CSF) dissolved in 1 mL sterile water, added to 200 mL drinking water, to treat grade II–IV mucositis. Patients were instructed to use the mouthwash once a day after the end of the second week of therapy. They were instructed to use as a mouthwash and then swallow in fragments within one hour.

• GM-CSF was given to 46 patients with radiation-induced ulcers.
• All patients were receiving radiation therapy (RT) for head and neck cancer. Some patients also received chemotherapy.

Physicians used the following grading system.

• 0 - None
• I - Diffuse erythema
• II - Erythema, small foci of ulcers
• III - Ulcers covered by pseudomembranes in more than half of mucosa
• IV - Necrotic ulcers and hemorrhage

Patients used the following grading system.

• 0 - none
• I - Mild soreness, solid diet
• II - Mild to moderate pain, soft diet
• III - Severe pain and dysphagia, liquids only
• IV - Severe pain, liquids only, and/or parenteral support

The authors stated that because 20 out of 46 patients with initial mucositis of grade II and III completed RT with grade I mucositis, the mouthwash was beneficial. However, additional research is needed.

• Mucositis grade 1 was NOT treated.
• The article did not include statistical evidence.
• The article assumes that the oral mucositis resolved as a result of the mouthwash and not spontaneously; however, no control group was included to validate that conclusion.
• The article focused on infection.