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A systematic review of viral infections associated with oral involvement in cancer patients: a spotlight on Herpesviridea

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Abstract

Purpose

Our aim was to evaluate the literature for the prevalence of and interventions for oral viral infections and, based on scientific evidence, point to effective treatment protocols. Quality of life (QOL) and economic impact were assessed if available in the articles reviewed.

Methods

Our search of the English literature focused on oral viral infections in cancer patients within the timeframe of 1989–2007. Review methods were standardized. Cohort studies were used to determine the weighted prevalence of oral viral infection in cancer patients. The quality of selected articles were assessed and scored with respect to sources of bias, representativeness, scale validity, and sample size. Interventional studies were utilized to determine management guidelines. Literature search included measures of QOL and economic variables.

Results

Prevalence of oral herpes simplex virus (HSV) infection in neutropenic patients was higher than in patients treated with radiotherapy for head and neck cancer (49.8% vs. 0%, respectively). In patients treated with radiochemotherapy for head and neck cancer, the prevalence of oral HSV infection increases up to 43.2% (CI, 0–100%). Prevalence of HSV infection was higher when oral ulcers existed. Information about other oral viral infections is sparse. There was a significant benefit of using acyclovir to prevent HSV oral infection (at 800 mg/day). Various dosing protocols of valacyclovir achieved prevention of HSV reactivation (500 or 1,000 mg/day). The prevalence of HSV reactivation was similar for acyclovir and valacyclovir. No information about impact on QOL and economic burden was available.

Conclusions

Acyclovir and valacyclovir are equally effective in preventing oral HSV infection. Neutropenic patients, who were primarily treated for hematological malignancies in the studies reviewed, are at a greater risk for viral infection.

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Conflict of interest

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Authors and Affiliations

  1. Department of Oral Medicine, Hebrew University, Hadassah School of Dental Medicine, P.O. Box 12272, Jerusalem, 91120, Israel

    Sharon Elad & Yehuda Zadik

  2. Dental Unit, Royal Melbourne Hospital, Grattan Street, Parkville, 3050, Australia

    Ian Hewson

  3. Program in Oral Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada

    Allan Hovan

  4. Ambulatory of Oral Medicine, Hematology and Blood Transfusion Center, University of Campinas, Rua Carlos Chagas 490, Campinas, Brazil

    M. Elvira P. Correa

  5. Oral Pathology, School of Dentistry, Faculty of Health Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia

    Richard Logan

  6. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Linda S. Elting

  7. Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    Fred K. L. Spijkervet

  8. Department of Oral Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC, 28232, USA

    Michael T. Brennan

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  1. Sharon Elad
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  2. Yehuda Zadik
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  3. Ian Hewson
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  4. Allan Hovan
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  5. M. Elvira P. Correa
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  6. Richard Logan
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  7. Linda S. Elting
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  8. Fred K. L. Spijkervet
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  9. Michael T. Brennan
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Viral Infections Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)

Corresponding author

Correspondence to Sharon Elad.

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Elad, S., Zadik, Y., Hewson, I. et al. A systematic review of viral infections associated with oral involvement in cancer patients: a spotlight on Herpesviridea. Support Care Cancer 18, 993–1006 (2010). https://doi.org/10.1007/s00520-010-0900-3

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  • DOI: https://doi.org/10.1007/s00520-010-0900-3

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