A retrospective study of factors associated with the development of oral candidiasis in patients receiving radiotherapy for head and neck cancer

Abstract

The aims of this study were to investigate the incidence and risk factors for oral candidiasis in patients receiving radiotherapy for head and neck cancer, and to determine the influence of topical steroid therapy on the development of oral candidiasis.We conducted a retrospective study of 300 patients receiving radiotherapy to the head and neck region. The primary endpoint was the incidence of oral candidiasis during radiotherapy. Associations between the incidence of oral candidiasis and various clinical factors were investigated. The cumulative incidence rate of oral candidiasis was calculated using the Kaplan–Meier method and analyzed by the log-rank test and Cox regression. Propensity score-matched analysis was used to assess the influence of topical steroid therapy on the development of oral candidiasis.Oral candidiasis occurred in 75 (25.0%) of the 300 patients. Multivariate analysis identified minimum lymphocyte count and severity of oral mucositis during radiotherapy as independent risk factors for the development of oral candidiasis. Topical steroid therapy for oral mucositis was not associated with the incidence of oral candidiasis according to multivariate and propensity score matching analyses.Oral candidiasis was associated with the suppression of the host's immunity and severe oral mucositis, but not topical steroid therapy. Proper oral health care during radiotherapy and the prevention of severe oral mucositis may reduce the incidence of oral candidiasis.

Oral microbiota versus oral mucositis during cancer treatment: a review

“…3 Furthermore, five studies are from countries of the European continent, among them Sweden, 11,12 Croatia, 13 Spain and Italy. 3,14 Three studies are from Asian countries, among them India, 15 China and Japan. 1,2,16 In addition, one study is from the American continent, more specifically Brazil.…”

“…The studies selected had used different methodologies, both those of conventional culture with the microorganisms being analyzed by cultures in selective media, 3,5,[12][13][14][15] as microbial analysis by 16S sequencing. 1,2,11 Six studies have analyzed bacteria and two studies analyzed mainly fungi.…”

“…1,2,11 Six studies have analyzed bacteria and two studies analyzed mainly fungi. [1][2][3][11][12][13][14][15] One study analyzed both microbiological groups. 5 The kind of sample of OM articles From the nine manuscript selected, three studies collected the sample with oropharyngeal swab before and after RT.…”

“…5 The kind of sample of OM articles From the nine manuscript selected, three studies collected the sample with oropharyngeal swab before and after RT. 2,13,15 One study collected the supragingival plaque before and after CT. 14 One study collected the supra and subgingival plaque before and after RT. 5 One study performed the injury swab before and during RT.…”

“…The inflammatory characteristics of OM and the immune defense suppression are important for the microbial ecosystem imbalance of the mouth and this dysbiosis may exacerbate the severity of this inflammation. 5,1,2,11,15 These factors, together with the ulcerations generated in OM, serve as gateways for a greater number of pathogenic microorganisms, 12 as the periodontopathogens that are strongly found in the mouth cancer and are associated with OM. 27,2 Considering fungal colonization, it begins to increase during the second week of CT and its apogee takes place during the sixth week.…”