Skip to main content

Advertisement

SpringerLink
Log in

Epidemiology and prevalence of oropharyngeal candidiasis in Spanish patients with head and neck tumors undergoing radiotherapy treatment alone or in combination with chemotherapy

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Objective

To describe the oropharyngeal candidiasis (OPC) prevalence in Spanish patients with head and neck cancer undergoing radiotherapy, alone or combined with chemotherapy. Secondary objectives were to determine the prevalence of Candida species colonization, and to explore whether different Candida species colonizing the oral cavity and the treatment were associated with a higher prevalence of OPC.

Methods

This is an observational, cross-sectional, multicentre study, conducted in Spanish radiation oncology units. Patients were diagnosed with head and neck cancer and started a radiotherapy treatment alone or combined with chemotherapy at the moment of their inclusion (N = 92).

Results

The OPC prevalence was 26 %. The identification of colonizing pathogens was performed in 49 patients, and Candida albicans was the dominant yeast (69 %), while non-albicans Candida was only found in 15 patients (31 %). Patients with C. albicans colonization had a significant higher prevalence of OPC compared to patients colonized by non-albicans Candida (p = 0.0273), but no difference was found regarding the OPC prevalence in patients receiving only radiotherapy compared to patients with both radiotherapy and chemotherapy treatments.

Conclusions

Our data represent a step further in the knowledge of Candida species present in Spanish patients with head and neck tumors under radiation therapy. This is an essential step to manage the prophylaxis and treatment of OPC, since it might lead to severe clinical complications causing treatment interruption and, thus, representing a reduction in anti-tumor efficacy.

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

Similar content being viewed by others

References

  1. Fotos PG, Hellstein W (1992) Candida and candidosis. Dent Clin N Am 36:857–878

    PubMed  CAS  Google Scholar 

  2. Ramírez V, Silverman S, Mayer P et al (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

    Article  Google Scholar 

  3. Silverman S, Luangjarmekorn L, Greenspan D (1984) Occurrence of oral Candida in irradiated head and neck cancer patients. J Oral Med 39:194–196

    PubMed  Google Scholar 

  4. Redding SW, Zellars RC, Kirkpatrick WR et al (1999) Epidemiology of oropharyngeal Candida colonization and infection in patients receiving radiation for head and neck cancer. J Clin Microbiol 37:3896–3900

    PubMed  CAS  Google Scholar 

  5. Dahiya MC, Redding SW, Dahiya RS et al (2003) Oropharyngeal candidiasis caused by non-albicans yeast in patients receiving external beam radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 57(1):79–83

    Article  PubMed  Google Scholar 

  6. Davies AN, Brailsford SR, Beighton D (2006) Oral candidosis in patients with advanced cancer. Oral Oncol 42:698–702

    Article  PubMed  Google Scholar 

  7. Lalla RV, Latortue MC, Hong CH et al (2010) A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 18:985–992

    Article  PubMed  Google Scholar 

  8. Deng Z, Kiyuna A, Hasegawa M et al (2010) Oral candidiasis in patients receiving radiation therapy for head and neck cancer. Otolaryngol Head Neck Surg 143:242–247

    Article  PubMed  Google Scholar 

  9. Gligorov J, Bastit L, Gervais H et al (2011) Prevalence and treatment management of oropharyngeal candidiasis in cancer patients: results of the French Candidoscope study. Int J Radiat Oncol Biol Phys 80:532–539

    Article  PubMed  Google Scholar 

  10. Schelenz S, Abdallah S, Gray G et al (2011) Epidemiology of oral yeast colonization and infection in patients with hematological malignancies, head neck and solid tumors. J Oral Pathol Med 40:83–89

    Article  PubMed  Google Scholar 

  11. Jham BC, da Silva Freire AR (2006) Oral complications of radiotherapy in the head and neck. Braz J Otorhinolaryngol 72:704–708

    PubMed  Google Scholar 

  12. Specht L (2002) Oral complications in the head and neck radiation patient. Introduction and scope of the problem. Support Care Cancer 10:36–39

    Article  PubMed  Google Scholar 

  13. Jensen SB, Pedersen AM, Reibel J et al (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:207–225

    PubMed  Google Scholar 

  14. Redding SW, Bailey CW, Lopez-Ribot JL et al (2001) Candida dubliniensis in radiation-induced oropharyngeal candidiasis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:659–662

    Article  PubMed  CAS  Google Scholar 

  15. Redding SW, Kirkpatrick WR, Coco BJ et al (2002) Candida glabrata oropharyngeal candidiasis in patients receiving radiation treatment for head and neck cancer. J Clin Microbiol 40:1879–1881

    Article  PubMed  Google Scholar 

  16. Redding SW, Dahiya MC, Kirkpatrick WR et al (2004) Candida glabrata is an emerging cause of oropharyngeal candidiasis in patients receiving radiation for head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:47–52

    Article  PubMed  Google Scholar 

  17. Paz M, Kahl S, Escovich L et al (2007) Presence of yeast fungi in the oral cavity of patients under oncologic treatment for neck and head cancer. Phenotypic characterization. A pilot study. Anuario Fundación Dr JR Villavicencio 15:141–146

    Google Scholar 

  18. Jham BC, França EC, Oliveira RR et al (2006) Candida oral colonization and infection in Brazilian patients undergoing head and neck radiotherapy: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:355–358

    PubMed  Google Scholar 

  19. Oude Lashof AM, De Bock R, Herbrecht R et al (2004) An open multicentre comparative study of the efficacy, safety and tolerance of fluconazole and itraconazole in the treatment of cancer patients with oropharyngeal candidiasis. Eur J Cancer 40:1314–1319

    Article  PubMed  CAS  Google Scholar 

  20. Price MF, LaRocco MT, Gentry LO (1994) Fluconazole susceptibilities of Candida species and distribution of species recovered from blood cultures over a 5-year period. Antimicrob Agents Chemother 38:1422–1424

    Article  PubMed  CAS  Google Scholar 

  21. Rex JH, Pfaller MA, Barry AL et al (1995) Antifungal susceptibility testing of isolates from a randomized, multicenter trial of fluconazole versus amphotericin B for treatment of non-neutropenic patients with candidemia. Antimicrob Agents Chemother 39:40–44

    Article  PubMed  CAS  Google Scholar 

  22. Andrews EA, Avorn J, Bortnichak EA et al (1996) Guidelines for good epidemiology practices for drug, device, and vaccine research in the United States. Pharmacoepidemiol Drug Saf 5:333–338

    Article  PubMed  CAS  Google Scholar 

  23. International Epidemiological Association. Good epidemiological practice (GEP). IEA guidelines for paper conduct in epidemiologic research. IEA European Federation; November 2007. http://www.ieaweb.org

  24. Bensadoun RJ, Patton LL, Lalla RV et al (2011) Oropharyngeal candidiasis in head and neck cancer patients treated with radiation: update 2011. Support Care Cancer 19:737–744

    Article  PubMed  Google Scholar 

  25. Mann PA, McNicholas PM, Chau AS et al (2009) Impact of antifungal prophylaxis on colonization and azole susceptibility of Candida species. Antimicrob Agents Chemother 53:5026–5534

    Article  PubMed  CAS  Google Scholar 

  26. Pappas PG, Kauffman CA, Andes D et al (2009) Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 48:503–535

    Article  PubMed  CAS  Google Scholar 

  27. Johnson EM, Davey KG, Szekely A et al (1995) Itraconazole susceptibilities of fluconazole susceptible and resistant isolates of five Candida species. J Antimicrob Chemother 36:787–793

    Article  PubMed  CAS  Google Scholar 

  28. Vazquez JA, Skiest DJ, Nieto L, Northland R, Sanne I, Gogate J, Greaves W, Isaacs R (2006) A multicenter randomized trial evaluating posaconazole versus fluconazole for the treatment of oropharyngeal candidiasis in subjects with HIV/AIDS. Clin Infect Dis 42(8):1179–1186

    Article  PubMed  CAS  Google Scholar 

  29. Vazquez JA, Skiest DJ, Tissot-Dupont H, Lennox JL, Boparai N, Isaacs R (2007) Safety and efficacy of posaconazole in the long-term treatment of azole-refractory oropharyngeal and esophageal candidiasis in patients with HIV infection. HIV Clin Trials 8(2):86–97

    Article  PubMed  CAS  Google Scholar 

  30. Skiest DJ, Vazquez JA, Anstead GM, Graybill JR, Reynes J, Ward D, Hare R, Boparai N, Isaacs R (2007) Posaconazole for the treatment of azole-refractory oropharyngeal and esophageal candidiasis in subjects with HIV infection. Clin Infect Dis 44(4):607–614 (Epub 2007 Jan 17)

    Article  PubMed  CAS  Google Scholar 

  31. Corvò R, Amichetti M, Ascarelli A et al (2008) Effects of fluconazole in the prophylaxis of oropharyngeal candidiasis in patients undergoing radiotherapy for head and neck tumour: results from a double-blind placebo-controlled trial. Eur J Cancer Care (Engl) 17:270–277

    Article  Google Scholar 

  32. Clarkson JE, Worthington HV, Eden OB (2007) Interventions for preventing oral candidiasis for patients with cancer receiving treatment. Cochrane Database Syst Rev 24:CD003807

    Google Scholar 

  33. 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

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank the GICOR research group, the ÍCARO patients and researchers for their participation in the study, Patricia Yuste and MSD for their interest and their support during all the study, and Esther Prats (Serini3) for coordinating the study. We also thank Lídia Armengol (RPS) and Marta Roldán (RPS) for assisting with the clinical study development and Ester Saus (RPS) for assisting with the writing and editing of the manuscript. This study was promoted by the main investigators and funded by a restricted grant by Merck Sharp & Dohme of Spain.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Pº de la Castellana, 261, 28046, Madrid, Spain

    Ana Mañas, Ana Escribano, Aurea Manso & Luis Alberto Glaria

  2. Servicio de Oncología Radioterápica, Hospital La Princesa, Madrid, Spain

    Laura Cerezo

  3. Servicio de Oncología Radioterápica, Hospital Universitario Puerta de Hierro, Madrid, Spain

    Alejandro de la Torre

  4. Servicio de Oncología Radioterápica, Hospital Universitario Madrid Sanchinarro, Madrid, Spain

    Mariola García

  5. Servicio de Oncología Radioterápica, Hospital General Universitario Gregorio Marañon, Madrid, Spain

    Héctor Alburquerque

  6. Servicio de Oncología Radioterápica, Hospital Universitario Fuenlabrada, Madrid, Spain

    Blanca Ludeña

  7. Servicio de Oncología Radioterápica, Hospital Universitario 12 de Octubre, Madrid, Spain

    Ana Ruiz

  8. Servicio de Oncología Radioterápica, Fundación Jiménez Díaz, Madrid, Spain

    Ana Pérez

Authors
  1. Ana Mañas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Cerezo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alejandro de la Torre
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mariola García
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Héctor Alburquerque
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Blanca Ludeña
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ana Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ana Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ana Escribano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Aurea Manso
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Luis Alberto Glaria
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Grupo de Investigación Clínica en Oncología Radioterápica (GICOR)

Corresponding author

Correspondence to Ana Mañas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mañas, A., Cerezo, L., de la Torre, A. et al. Epidemiology and prevalence of oropharyngeal candidiasis in Spanish patients with head and neck tumors undergoing radiotherapy treatment alone or in combination with chemotherapy. Clin Transl Oncol 14, 740–746 (2012). https://doi.org/10.1007/s12094-012-0861-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-012-0861-8

Keywords

Search

Navigation