Abstract
The aim of this study was to follow the long-term effects of radiation therapy of head and neck malignancies on oral yeast colonization, mucositis and salivary function. Included in this prospective study were 32 patients with intended radiation therapy of a malignancy of the head and neck. In all patients the salivary glands lay within the radiation field and the patients had at least five teeth. The first examination was performed after oral hygiene instruction and removal of questionable teeth before the start of radiotherapy. The following examinations were conducted after 3, 6, 9 and 12 months. Together with the quantitative determination of Candida colonization, three "mucositis" variables were assessed: (1) examiner-rated mucositis score (LENT/SOMA), (2) patient-rated mucositis symptoms, and (3) scintigraphic salivary excretion fraction. The maximum Candida colonization was found 6 months after radiation therapy and this declined to above normal values after 12 months. Salivary flow was at a minimum 6 months after radiation therapy and had slightly recovered by 12 months. Examiner-rated mucositis and patient-rated xerostomia showed no significant recovery after 6 or 12 months. The results of this study show slight recovery of the oral ecological system. Although the causal role of a single parameter is not clear, persistently elevated Candida colonization should be taken into account therapeutically.
Similar content being viewed by others
References
Bootz F (2002) Leitlinien der Dt. Ges. f. Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie: Onkologie des Kopf-Hals-Bereiches; Kapitel 2: Maligne Tumoren des oberen Aerodigestivtraktes. http://www.uni-duesseldorf.de/WWW/AWMF/ll/hno-l672.htm#2.2
Bschorer R, Schmelzle R (1995) Der RTOG-Score (Radiation Therapy Oncology Group) als Leitfaden zur Behandlung im vorbestrahlten Gebiet. Fortschr Kiefer Gesichtschir 40:162–166
Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) (editorial). Int J Radiat Oncol Biol Phys 31:1341–1346
Seegenschmiedt MH, Sauer R (1993) Systematik der akuten und chronischen Strahlenfolgen. Strahlenther Onkol 169:83–95
Grötz KA, Al-Nawas B, Kutzner J, Brahm R, Kuffner H-D, Wagner W (2001) Äthiologie der infizierten Osteoradionekrose des Kiefer-Gesichts-Bereiches. Dtsch Zahnarztl Z 56:43–46
Almstahl A, Wikstrom M (1999) Oral microflora in subjects with reduced salivary secretion. J Dent Res 78:1410–1416
Redding SW, Zellars RC, Kirkpatrick WR, McAtee RK, Caceres MA, Fothergill AW, Lopez-Ribot JL, Bailey CW, Rinaldi MG, Patterson TF (1999) Epidemiology of oropharyngeal Candida colonization and infection in patients receiving radiation for head and neck cancer. J Clin Microbiol 37:3896–3900
Dörr W, Dölling-Jochem I, Baumann M, Herrmann T (1997) Therapeutische Beeinflussung der radiogenen oralen Mukositis. Strahlenther Onkol 173:183–192
Ramirez-Amador V, Silverman S Jr, Mayer P, Tyler M, Quivey J (1997) Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:149–153
Epstein JB, Emerton S, Le ND, Stevenson-Moore P (1999) A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. Oral Oncol 35:132–137
Grötz KA, Wüstenberg P, Kohnen R, Al-Nawas B, Henneicke-von Zepelin H-H, Bockisch A, Kutzner J, Naser-Hijazi B, Belz GG, Wagner W (2001) Prophylaxis of radiogenic sialadenitis and mucositis by coumarin/troxerutine in patients with head and neck cancer—a prospective, randomized, placebo-controlled, double blind study. Br J Oral Maxillofac Surg 39:34–39
Eichhorn W, Gehrke G, Bschorer R, Stepke M, Greschniok A (1993) Morphologische Veränderungen von kleinen Kopfspeicheldrüsen durch Strahlentherapie. Dtsch Zahnarztl Z 48:58–65
Grötz KA (2002) Die trockene Mundhöhle: Ätiologie, Klinik, Diagnostik, Therapie. Zahnarztl Mitt 92:46–53
Grötz KA, Wahlmann UW, Krummenauer F, Wegener J, Al-Nawas B, Kuffner HD, Wagner W (1999) Prognose und Prognosefaktoren enossaler Implantate im bestrahlten Kiefer. Mund Kiefer Gesichtschir 3 [Suppl 1]:117–124
Makkonen TA, Nordman E (1987) Estimation of long-term salivary gland damage induced by radiotherapy. Acta Oncol 26:307–312
Cooper JS, Fu K, Marks J, Silverman SJ (1995) Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys 31:1141–1164
Bohuslavizki KH, Brenner W, Lassmann S, Tinnemeyer S, Kalina S, Clausen M, Henze E (1997) Quantitative salivary gland scintigraphy--a recommended examination prior to and after radioiodine therapy (in German). Nuklearmedizin 36:103–109
Huppers K, Al-Nawas B, Kunkel M, Grötz KA (2002) Influence of xerostomia on quality of life following radiotherapy. In: Conference Proceedings, Pan European Federation of the International Association of Dental Research, 25–28 September 2002, Cardiff, UK
Pourel N, Peiffert D, Lartigau E, Desandes E, Luporsi E, Conroy T (2002) Quality of life in long-term survivors of oropharynx carcinoma. Int J Radiat Oncol Biol Phys 54:742–751
Epstein JB, Chin EA, Jacobson JJ, Rishiraj B, Le N (1998) The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:286–292
Epstein JB, Freilich MM, Le ND (1993) Risk factors for oropharyngeal candidiasis in patients who receive radiation therapy for malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol 76:169–174
Mucke R, Kaben U, Libera T, Knauerhase H, Ziegler PG, Hamann D, Strietzel M (1998) Fluconazole prophylaxis in patients with head and neck tumours undergoing radiation and radiochemotherapy. Mycoses 41:421–423
Stokman MA, Spijkervet FK, Burlage FR, Dijkstra PU, Manson WL, de Vries EG, Roodenburg JL (2003) Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: a double-blind randomised clinical trial. Br J Cancer 88:1012–1016
Koc M, Aktas E (2003) Prophylactic treatment of mycotic mucositis in radiotherapy of patients with head and neck cancers. Jpn J Clin Oncol 33:57–60
Ueta E, Osaki T, Yoneda K, Yamamoto T (1993) Prevalence of diabetes mellitus in odontogenic infections and oral candidosis. J Oral Pathol Med 22:168–174
Weischer T, von Reclinghausen G, Dermoumi H, Mohr C, Schettler D (1996) Periimplantäre Mikroflora bestrahlter und nicht bestrahlter Tumorpatienten. Z Zahnarztl Implantol 12:164–168
Epstein JB, Gorsky M, Guglietta A, Le N, Sonis ST (2000) The correlation between epidermal growth factor levels in saliva and the severity of oral mucositis during oropharyngeal radiation therapy. Cancer 89:2258–2265
Dörr W, Noack R, Spekl K, Farrell CL (2001) Modification of oral mucositis by keratinocyte growth factor: single radiation exposure. Int J Radiat Biol 77:341–347
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Grötz, K.A., Genitsariotis, S., Vehling, D. et al. Long-term oral Candida colonization, mucositis and salivary function after head and neck radiotherapy. Support Care Cancer 11, 717–721 (2003). https://doi.org/10.1007/s00520-003-0506-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-003-0506-0