An underestimated pitfall of oral candidiasis in head and neck cancer patients undergoing radiotherapy: an observation study

Abstract

Background Oral candidiasis is a common problem associated with head and neck radiation therapy (RT) consequences being pain, burning sensation, taste change, and systemic infection. There are difficulties in differentiating between oral candidiasis and radiation induced oral mucositis. We conducted a prospective study to explore the incidence of clinical oral candidiasis and evaluate the accuracy of diagnosis among head and neck cancer (HNC) patients receiving RT or concurrent chemoradiotherapy (CCRT). Methods This study included 86 HNC patients who had no clinical signs or symptoms of oral candidiasis. Oral mucosa and tongue swabs were carried out and analyzed three times by fungal cultures at the following time points: (1) before RT, (2) at the time of clinically diagnosed candidiasis or during RT at between the 15th–17th fraction (whichever occurred first), and (3) at the end of RT. The accuracy of clinical oral candidiasis was explored and confirmed by fungal colonization techniques. The incidence and risk factors associated with fungal colonization before and throughout the treatment were analyzed. Results The overall incidence of clinical oral candidiasis was 53.5% throughout the course of RT. Confirmation of fungal colonization was found in 39.5%, 65.9%, and 57.7% of cases before RT, during RT, and end of RT, respectively. The accuracy of the diagnosis using only clinical presentation was demonstrated in 60%, 50%, and 52% before RT, during RT, and end of RT, respectively. Logistic regression analysis showed that age, CCRT, and using 2% viscous lidocaine solution were independent risk factors for fungal colonization. Conclusions The results of this study demonstrated an underestimation of clinical oral candidiasis before and throughout the course of radiotherapy from using only clinical sign and symptoms. Crucial attention to detail and testing in the oral examination could improve decision making for detection of oral candidiasis in HNC patients receiving RT or CCRT.

Evaluation of oral mucositis, candidiasis, and quality of life in patients with head and neck cancer treated with a hypofractionated or conventional radiotherapy protocol: a longitudinal, prospective, observational study

“…Lower rates of pseudomembranous candidiasis were found in our study population compared to those reported in other longitudinal studies evaluating the onset of candidiasis during RT treatment of HNC, such as that of Jham et al [30]. A previous study by Chitapanarux et al showed that the clinical and symptom-based analysis of oral candidiasis in irradiated patients with HNC might underestimate the diagnosis and that microbiological analysis may contribute to a higher number of positive diagnoses of this condition [31]. Our study only performed a clinical evaluation of oral candidiasis and not a microbiological analysis, which could explain the differences found since studies showing a high prevalence of this condition in irradiated patients used microbiological analysis to establish the diagnosis.…”

Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello

“…la candidiasis oral debido a factores predisponentes locales como la disminución en la cantidad y calidad de saliva y los daños en la mucosa oral y/o factores predisponentes sistémicos como la inmunosupresión [62][63][64][65] . Es la infección oportunista más frecuente en pacientes que reciben radioterapia por CCC, reportándose en un 25-53% 62,[66][67][68] .…”

The microbiota and radiotherapy for head and neck cancer: What should clinical oncologists know?

“…A study of 60 patients with suspected candidiasis reported a 77 % incidence of detection of yeasts, with the most commonly detected species including Candida albicans (48 %), Candida tropicalis (28 %), and Candida parapsilosis (13 %) [83]. Using culture methods, a recent study in 86 patients with HN-SCC undergoing definitive or postoperative radiotherapy where the field included the oral cavity and/or oropharynx also detected a 54 % incidence of oral candidiasis, with the accuracy of clinical diagnosis unaided by microbiological sampling ranging 52-60 % [84]. Although it is tempting to assume that candidiasis is underdiagnosed by about 40 %, it is important to note that Candida is a common commensal of the oral cavity, so detection does not necessarily represent disease.…”