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. 2019 Oct 31:20:13-18.
doi: 10.1016/j.ctro.2019.10.006. eCollection 2020 Jan.

The association between oral candidiasis and severity of chemoradiotherapy-induced dysphagia in head and neck cancer patients: A retrospective cohort study

Hirotake Saito  1 , Ryusuke Shodo  2 , Keisuke Yamazaki  3 , Kouji Katsura  4 , Yushi Ueki  2 , Toshimichi Nakano  5 , Tomoya Oshikane  5 , Nobuko Yamana  1 , Satoshi Tanabe  1 , Satoru Utsunomiya  6 , Atsushi Ohta  5 , Eisuke Abe  5 , Motoki Kaidu  5 , Ryuta Sasamoto  6 , Hidefumi Aoyama  5
Affiliations

The association between oral candidiasis and severity of chemoradiotherapy-induced dysphagia in head and neck cancer patients: A retrospective cohort study

Hirotake Saito et al. Clin Transl Radiat Oncol. .

Abstract

Background and purpose: Concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC) is a risk factor for oral candidiasis (OC). As Candida spp. are highly virulent, we conducted a retrospective study to determine whether OC increases the severity of dysphagia related to mucositis in HNC patients.

Patients and methods: We retrospectively analyzed the cases of consecutive patients with carcinomas of the oral cavity, pharynx, and larynx who underwent CCRT containing cisplatin (CDDP) at our hospital. The diagnosis of OC was based on gross mucosal appearance. We performed a multivariate analysis to determine whether OC was associated with the development of grade 3 dysphagia in the Radiation Therapy Oncology Group (RTOG) Acute Toxicity Criteria. The maximum of the daily opioid doses was compared between the patients with and without OC.

Results: We identified 138 HNC patients. OC was observed in 51 patients (37%). By the time of their OC diagnosis, 19 (37%) had already developed grade 3 dysphagia. Among the 30 patients receiving antifungal therapy, 12 (40%) showed clinical deterioration. In the multivariate analysis, OC was independently associated with grade 3 dysphagia (OR 2.75; 95%CI 1.22-6.23; p = 0.015). The patients with OC required significantly higher morphine-equivalent doses of opioids (45 vs. 30 mg/day; p = 0.029).

Conclusion: Candida infection causes refractory dysphagia. It is worth investigating whether antifungal prophylaxis reduces severe dysphagia related to candidiasis.

Keywords: Candidiasis; Dysphagia; Head and neck cancer.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Histogram of morphine-equivalent of the maximum of daily opioid doses in the OC and non-OC groups.
Fig. A1
Fig. A1
CONSORT diagram. Abbreviations; RT = radiotherapy, CDDP = cisplatin, 5FU = 5-fluorouracil.
See this image and copyright information in PMC

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