Supervisors info:
Ουρανία Νικολάτου-Γαλίτη, Καθηγήτρια, Κλινική Νοσοκομειακής Οδοντιατρικής, Τμήμα Οδοντιατρικής, ΕΚΠΑ
Κωνσταντίνος Τσιχλάκης, Καθηγητής, Τμήμα Οδοντιατρικής, ΕΚΠΑ
Δήμος Καλύβας, Αναπληρωτής Καθηγητής,Τμήμα Οδοντιατρικής, ΕΚΠΑ
Summary:
Introduction. The application of modern antineoplastic therapy in patients with cancer, has improved the prognosis, but is still linked to complications in normal tissues. The oral cavity is a display position of significant direct and indirect complications of antineoplastic therapy. In particular, almost all patients undergoing head and neck radiotherapy will experience complications such as mucositis, pain, xerostomia and infections, bacterial, fungal and herpes. The complications that develop significantly reduce the quality of life of patients. The candidiasis developed in patients with Candida carriage increases occurring mucositis and pain and risk associated with candidemia patients with myelotoxicity. Oral Candida carriage in patients receiving head and neck radiotherapy (RT), reported between 43% to 73%, is significant complication, with adverse effects on quality of life. Furthermore, the change of Candida species in non-albicans, is very important, due to the resistance of non-albicans species to fluconazole.
Objectives. The main objective was to assess the prevalence of oral Candida carriage, in the oral cavity of head and neck patients during conformal radiotherapy, with or without chemotherapy. Secondary objectives were to assess oral mucositis, pain, xerostomia and quality of life, in the same group of patients
Methods. The patients included should start conformal radiotherapy with or without chemotherapy for head and neck cancer (primary site, or relapse). Also in the irradiation field the oral cavity must have been included, and the patients should be aged over 18 years. Patients under 18 years, under prophylactic antifungal therapy prior to initiation of treatment or pregnant, were not included.
In the first visit of patients in the Clinic of Hospital Dentistry, Athens, we received a full medical and a dental history, followed by a physical examination of the oral cavity , and a panoramic radiograph. Patients who fulfilled the selection criteria, were informed in detail about the study, signing the Consent Memorandum and were incorporated into the study with a number. All patients were given detailed oral hygiene instructions. Then smear was taken from the dorsum of the tongue with a cotton swab, and the sample was sent to the Mycology Laboratory of the Medical School. The mucosal examination at all visits was done by the same examiner. Moreover, all patients received the questionnaire QLQ-C30 and QLQ-H & N35 (EORTC), in order to assess quality of life in patients undergoing radiation therapy for head and neck cancer, with or without chemotherapy.
During the radiotherapy, the patients were re-examined once a week. All the data concerning the pain and xerostomia were recorded with the visual analogue scale VAS, 0-10, and mucositis was recorded in grade 1-4, (EORTC / RTOG criteria). As severe mucositis was recorded from grade 2 to grade 4 and as severe dry mouth or pain from grade 7 to grade 10.
A last examination took place immediately after the end of radiotherapy, with a physical examination of the oral cavity and swabbing the back of the tongue, for laboratory testing. Also pain scale, xerostomia (VAS), mucositis (Grade 1-4) and QLQ-C30 and QLQ-H & N35 questionnaires (EORTC) were assessed again.
Thirty-two patients (mean age 61) were included. Seventeen patients (53%) received concomitant chemotherapy. Mean daily dose was 2Gray and total dose 63.2Gray. Smear for Candida carriage was taken in all patients before RT and in fourteen (14/32, 43%) after RT. Sixteen patients (16/32, 50%) completed the EORTC Quality of Life C30 and H&N35 questionnaires before and after radiotherapy.
Results. Candida carriage was 50% (16/32) before RT; C. albicans was isolated in 14/16 patients (87.5%). After RT, Candida carriage was 5/18 (29%); all species were C. albicans (5/5). Antifungal and antiviral treatment were administered in 9/32 (28,13%) and 2/32 (6,25%) patients, respectively. Thirteen patients 13/32 (40.63%) used pain medications. Severe oral mucositis was observed in 20/32 (62.5%), severe pain in 13/32 (40%) and severe xerostomia in 18/32 (56.25%) patients. Candida was not isolated in patients treated with antifungal therapy (p <0.05). Fatigue, sore throat, discomfort in swallowing solid food, anorexia, loss or change of taste, difficulty in eating liquid or solid form of food and weight loss, were evaluated as important factors reducing the quality of life (p <0.05).
Conclusions. In contrast to the studies so far, a decrease of oral Candida carriage was observed. This result seems to be related to the antifungal administration during RT and to the effective supportive care of the oral cavity of the patient. Weakness of the study is the small number of patients (18/32) who were re-tested and re-examined for Candida carriage.
