Fluconazole prophylaxis in patients with head and neck tumours undergoing radiation and radiochemotherapy

Abstract

The aim of the present study was to investigate the incidence of Candida stomatitis and resulting interruptions in radiation and radiochemotherapy in 50 patients suffering from squamous cell carcinomas of the head and neck region receiving fluconazole (100 mg d-1) in comparison with a historical control group (n = 50) without specific prophylaxis. Twenty of the control patients (40%) demonstrated Candida stomatitis, with seven of them (14%) requiring interruptions in anticancer therapy. In contrast, none of the patients with fluconazole had evidence of Candida stomatitis (P = 0.0000051) and subsequent interruption of anti-cancer therapy (P = 0.0061). Laboratory monitoring for the presence of Candida species was performed in 30 patients before and after therapy with fluconazole. Candida albicans was identified less frequently after therapy when compared with the pretreatment status. However, C. glabrata and C. krusei were isolated in some of the patients, probably because of drug resistance of these subspecies. The results demonstrate the clinical usefulness of prophylactic fluconazole applications in patients suffering from head and neck tumours with the aim of reducing Candida stomatitis and the resulting interruptions in radiation and radiochemotherapy.

Long-term oral Candida colonization, mucositis and salivary function after head and neck radiotherapy

“…The clinical impact of this observation is highlighted by the persistently elevated mucositis LENT/SOMA scores. From other studies it is well recognized that non-albicans Candida (C. glabrata and C. krusei) are predominant in patients following radiotherapy [22]. Some of these species show intermediate susceptibility to fluconazole and others such as C. krusei are resistant to fluconazole.…”

Effect of fluconazole antifungal prophylaxis on oral mucositis in head and neck cancer patients receiving radiotherapy

“…The high prevalence of candidiasis during head and neck radiotherapy, combined with the difficulties in the differential diagnosis between the infection and mucositis and the potential role of candidiasis on the severity of mucositis, has led several authors to consider the need for antifungal prophylaxis [7,12,17,18].…”

“…The potential role of candidiasis in the initiation, severity, and duration of oral mucositis during radiotherapy has been addressed in only two studies [7,12]. In both studies, a beneficial effect of fluconazole antifungal prophylaxis on RT interruptions was reported.…”

“…In the second study [12], a historical group was used as control for the development of candidiasis. The incidence of severe (grade 3 or 4) ulcerative/pseudomembrane mucositis was not reported in either of the above studies.…”

Complicações bucais da radioterapia em cabeça e pescoço

“…C. glabrata e C. krusei micro-organisms had already been seen in patients submitted to radiotherapy. 21 Recent studies found a relation between oral candidosis and C. dubliniensis species. In this study, the authors suggest that the species C. albicans and C. dubliniensis probably act together in the infections that affect radiated patients.…”