Skip to main content

Advertisement

SpringerLink
Log in

Herpes simplex virus-1 (HSV-1) infection in radiation-induced oral mucositis

  • Original article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goal of work

The aim of the study was to investigate the incidence of herpes simplex virus-1 (HSV-1) infection in mucositis during head and neck cancer radiotherapy.

Patients and methods

Sixty patients with malignant head and neck tumor, eligible to receive radiotherapy, who were referred to the Dental Oncology Unit, entered the study. Sixteen patients (26.6%) received concomitant chemotherapy. Mucositis was recorded weekly. Smears taken from the ulcers of mucositis grade 2, or 3, or 4 were stained with Papanicolaou and alkaline phosphatase/antialkaline phosphatase immunocytochemical method to identify HSV-1.

Main results

Forty-eight of all 60 patients developed ulcerative mucositis. Smear was available from 29 of 48 patients with ulcerations. HSV-1 infection was identified in 14 of 29 smears available (48.2%). Mucositis healed or was reduced after 1 week of antiviral treatment in 11 of those 14 HSV-1-positive patients; 3 patients responded to 1 g/day of valacyclovir, 7–2 g/day, and 1 patient responded to i.v. acyclovir. Ulcerations recurred after quitting antivirals. Three patients did not respond to 1 g/day of valacyclovir. No HSV-1-negative patient responded to acyclovir (P=0.000).

Conclusion

HSV-1 was isolated from 14 of 29 available smears taken from 48 patients with ulcerative mucositis. The incidence of HSV-1 infection during radiotherapy was estimated as being 14 of all 48 patients at risk (29.1%). Healing or reduction in the grade of mucositis after antivirals in HSV-1 positive patients, combined with the negative response to antivirals in HSV-1 negative patients, denoted that HSV-1 infection was a component of ulcerative radiation mucositis in those HSV-1-positive patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Barasch A, Peterson DE (2003) Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol 39:91–100

    Article  PubMed  Google Scholar 

  2. Barrett AP, Buckley DJ, Greenberg ML et al (1986) The value of exfoliative cytology in the diagnosis or oral herpes simplex infection in immunosuppressed patients. Oral Surg Oral Med Oral Pathol 62:175–178

    Article  PubMed  CAS  Google Scholar 

  3. Berger AM, Fall-Dickinson (2005) Oral complications. In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer principles and practice of oncology, 7th edn. Lippincott Williams & Wilkins, Philadelphia, pp 2523–2524

    Google Scholar 

  4. Bergmann OJ, Ellermann-Eriksen S, Mogesen SC, Ellegaard J (1995) Acyclovir given as prophylaxis against oral ulcers in acute myeloid leukemia: randomized, double blind, placebo controlled trial. BMJ 310:1169–1172

    PubMed  CAS  Google Scholar 

  5. Bubley GJ, Chapman B, Chapman SK, Crumpacker CS, Schnipper LE (1989) Effect of acyclovir on radiation- and chemotherapy-induced mouth lesions. Antimicrob Agents Chemother 33:862–865

    PubMed  CAS  Google Scholar 

  6. Buddingh GJ, Schrum DI, Lanier JC et al (1953) Studies of the natural history of herpes simplex infections. Pediatrics 11:595–609

    PubMed  CAS  Google Scholar 

  7. Carrega G, Castagnola E, Canessa A et al (1994) Herpes simplex virus and oral mucositis in children with cancer. Support Care Cancer 2:266–269

    Article  PubMed  CAS  Google Scholar 

  8. Cohen PR (1994) Tests for detecting herpes simplex virus and varicella-zoster virus infections. Dermatol Clin 12:51–68

    PubMed  CAS  Google Scholar 

  9. Cordell JL, Falini B, Erber WN et al (1984) Immuno-enzymatic labeling of monoclonal antibodies using immune complexes of alkaline phosphatase and monoclonal anti-alkaline phosphatase (APAAP complexes). J Histochem Cytochem 32:219–229

    PubMed  CAS  Google Scholar 

  10. Corey L, Spear PG (1986) Infections with herpes simplex viruses. First of two parts. N Engl J Med 314:686–691

    Article  PubMed  CAS  Google Scholar 

  11. Eisen D (1998) The clinical characteristics of intraoral herpes simplex virus infection in 52 immunocompetent patients. Oral Surg Oral Med Oral Pathol 86:432–437

    CAS  Google Scholar 

  12. Epstein JB, Sherlock C, Page JL et al (1990) Clinical study of herpes simplex virus infection in leukemia. Oral Surg Oral Med Oral Pathol 70:38–43

    Article  PubMed  CAS  Google Scholar 

  13. Greenberg M, Cohen S, Boosz B, Friedman H (1987) Oral herpes simplex virus infections in patients with leukemia. J Am Dent Assoc 114:483–486

    PubMed  CAS  Google Scholar 

  14. Neville BW, Damm DD, Allen CM, Bouquot JE (1995) Oral and maxillofacial pathology. Saunders, Philadelphia, p 185

    Google Scholar 

  15. Nicolatou-Galitis O, Dardoufas K, Markoulatos P et al (2001) Oral pseudomembranous candidiasis, herpes simplex virus-1 infection, and oral mucositis in head and neck cancer patients receiving radiotherapy and granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash. J Oral Pathol Med 30:471–480

    Article  PubMed  CAS  Google Scholar 

  16. Nicolatou-Galitis O, Velegraki A, Sotiropoulou-Lontou A et al (2005) Effect of fluconazole antifungal prophylaxis on oral mucositis in head and neck cancer patients receiving radiotherapy. Support Care Cancer (Epub ahead of print)

  17. Oakley C, Epstein JB, Sherlock CH (1997) Reactivation of oral herpes simplex virus. Implications for clinical management of herpes simplex virus recurrence during radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:272–278

    Article  PubMed  CAS  Google Scholar 

  18. Ohrn KEO, Wahlin YB, Sjoden OP (2001) Oral status during radiotherapy and chemotherapy: a descriptive study of patient experiences and the occurrence of oral complications. Support Care Cancer 9:247–257

    Article  PubMed  CAS  Google Scholar 

  19. Pevenstein SR, Williams RK, McChesney D et al (1999) Quantitation of latent varicella-zoster virus and herpes simplex virus genomes in human trigeminal ganglia. J Virol 12:10514–10518

    Google Scholar 

  20. Redding SW, Luce EB, Boren MW (1990) Oral herpes simplex virus infection in patients receiving head and neck radiation. Oral Surg Oral Med Oral Pathol 69:578–580

    Article  PubMed  CAS  Google Scholar 

  21. Riel-Romero RMS, Baumann RJ (2003) Herpes simplex encephalitis and radiotherapy. Pediatr Neurol 29:69–71

    Article  PubMed  Google Scholar 

  22. Rubenstein EB, Peterson DE, Schubert M et al (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100(9 Suppl):2026–2046

    Article  PubMed  Google Scholar 

  23. Saral R, Burns WH, Laskin OL, Santos GW (1981) Acyclovir prophylaxis of herpes-simplex-virus infections. N Engl J Med 305:63–67

    Article  PubMed  CAS  Google Scholar 

  24. Schubert MM, Peterson DE, Flournoy N et al (1990) Oral and pharyngeal herpes simplex virus infection after allogeneic bone marrow transplantation: analysis of factors associated with infection. Oral Surg Oral Med Oral Pathol 70:286–293

    Article  PubMed  CAS  Google Scholar 

  25. Sonis ST (2002) The biologic role for nuclear factor-kappaB in disease and its potential involvement in mucosal injury associated with anti-neoplastic therapy. Crit Rev Oral Biol Med 13:380–389

    Article  PubMed  Google Scholar 

  26. Sonis ST (2004) A biological approach to mucositis. J Support Oncol 2:21–36

    PubMed  Google Scholar 

  27. Trotti A, Bellm LA, Epstein JB et al (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66:253–262

    Article  PubMed  Google Scholar 

  28. Wijers OB, Levendag PC, Harms ERE et al (2001) Mucositis reduction by selective elimination of oral flora in irradiated cancers of the head and neck: a placebo-controlled double-blind randomized study. Int J Radiat Oncol Biol Phys 50:343–352

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We wish to thank Professor Aristea Velegraki for the laboratory verification of mycology smears. The reagents for the mycology laboratory investigation were kindly donated by Pfizer Hellas. GlaxoSmithKline kindly supported part of the costs of the investigation.

Author information

Authors and Affiliations

  1. Dental Oncology Unit, Department of Oral Pathology and Surgery, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece

    Ourania Nicolatou-Galitis

  2. School of Dentistry, University of Athens, Bouboulinas 41, N. Psyhico, 154 51, Athens, Greece

    Ourania Nicolatou-Galitis

  3. Department of Pathologic Anatomy, School of Medicine, University of Athens, Mikras Asias 75, Goudi, 115 28, Athens, Greece

    Pavlina Athanassiadou & Maria Gonidi

  4. Department of Radiotherapy, “Aretaieion” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas Sofias 76, 115 28, Athens, Greece

    Vassilis Kouloulias, Konstantinos Dardoufas & John Kouvaris

  5. 2nd Radiotherapy Department, “O Aghios Savvas” Hospital, Alexandras Avenue 171, 115 22, Athens, Greece

    Anastasia Sotiropoulou-Lontou & George Pissakas

  6. Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, Goudi, 115 27, Athens, Greece

    Argy Polychronopoulou

  7. Radiation Department, Euromedica, “Athinaion” Hospital, Euromedica, Kononos 123, Vironas, Athens, Greece

    Konstantinos Kyprianou & Christos Skarleas

  8. Radiation Oncology Department, “Hygeia” Hospital, Kifisias Avenue and Erythrou Stavrou 4, Maroussi, 151 23, Athens, Greece

    Georgia Kolitsi

  9. Department of Gastroenterology, “NIMTS” Hospital, Vas Sofias Avenue, Athens, Greece

    Ioannis S. Papanikolaou

Authors
  1. Ourania Nicolatou-Galitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pavlina Athanassiadou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vassilis Kouloulias
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anastasia Sotiropoulou-Lontou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Konstantinos Dardoufas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Argy Polychronopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Gonidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Konstantinos Kyprianou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Georgia Kolitsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Christos Skarleas
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. George Pissakas
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ioannis S. Papanikolaou
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. John Kouvaris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ourania Nicolatou-Galitis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nicolatou-Galitis, O., Athanassiadou, P., Kouloulias, V. et al. Herpes simplex virus-1 (HSV-1) infection in radiation-induced oral mucositis. Support Care Cancer 14, 753–762 (2006). https://doi.org/10.1007/s00520-005-0006-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-005-0006-5

Keywords

Search

Navigation