Advertisement

Factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas: a retrospective multicenter study of 326 patients

  • Mika Nishii
  • Sakiko SoutomeEmail author
  • Akiko Kawakita
  • Hirokazu Yutori
  • Eiji Iwata
  • Masaya Akashi
  • Takumi Hasegawa
  • Yuka Kojima
  • Madoka Funahara
  • Masahiro Umeda
  • Takahide Komori
Original Article
  • 62 Downloads

Abstract

Purpose

The present retrospective multicenter study intended to investigate the factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas.

Methods

A total of 326 patients who underwent radiotherapy for oral and oropharyngeal cancers were enrolled in the study. The patients’ age, sex, body mass index, primary site, diabetes, serum albumin, creatinine, hemoglobin, leukocyte and lymphocyte, concurrent cisplatin or cetuximab, method of radiation, total radiation dose, feeding route, use of spacers, pilocarpine hydrochloride, and corticosteroid ointment were examined, and the associations of each variable with oral mucositis and candidiasis were analyzed by multivariate Cox regression analysis.

Results

Grade 3 oral mucositis occurred in 136 (41.7%) patients. Male sex, oropharyngeal cancer, low hemoglobin levels, low leukocytes or lymphocytes, concurrent cisplatin or cetuximab, and oral feeding were found to be significantly associated with a higher incidence of severe oral mucositis. Oral candidiasis occurred in 101 (31.0%) patients. Oropharyngeal cancer, low leukocyte count, and oral mucositis of grade 2 or higher were found to be significantly associated with a higher incidence of oral candidiasis. The use of a topical steroid ointment was not found to be a risk factor for oral candidiasis.

Conclusions

The present retrospective study demonstrated that certain factors may predispose patients with oral and oropharyngeal cancers receiving radiotherapy to develop severe oral mucositis and oral candidiasis. A preventive strategy for severe oral mucositis needs to be established in the future for high-risk cases.

Keywords

Oral mucositis Oral candidiasis Radiotherapy Head and neck cancer Risk factors 

Notes

Acknowledgments

We thank Editage (www.editage.jp) for their English-language editing services.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval and informed consent

This study was performed in accordance with the 1964 Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Boards (IRB) of Kobe University Hospital (No. 180250), Nagasaki University Hospital (No. 18091008), and Kansai University Hospital (2018164). As this was a retrospective study, the research plan was published on the homepage of the participating hospitals according to the instructions of the IRB in accordance with the guaranteed opt-out opportunity.

References

  1. 1.
    Moslemi D, Nokhandani AM, Otaghsaraei MT, Moghadamnia Y, Kazemi S, Moghadamnia AA (2016) Management of chemo/radiation-induced oral mucositis in patients with head and neck cancer: a review of the current literature. Radiother Oncol 120:13–20CrossRefGoogle Scholar
  2. 2.
    Clarkson JE, Worthington HV, Furness S, McCabe M, Khalid T, Meyer S (2010) Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev CD001973Google Scholar
  3. 3.
    Jensen SB, Jarvis V, Zadik Y, Barasch A, Ariyawardana A, Hovan A et al (2013) Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients. Support Care Cancer 21:3223–3232CrossRefGoogle Scholar
  4. 4.
    Rodriguez-Caballero A, Torres-Lagares D, Robles-Garcia M, Pachon-Ibanez J, Gonzalez-Padilla D, Gutierrez-Perez JL (2012) Cancer treatment-induced oral mucositis: a critical review. Int J Oral Maxillofac Surg 41:225–238CrossRefGoogle Scholar
  5. 5.
    Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire DB, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S, Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) (2014) MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 120:1453–1461CrossRefGoogle Scholar
  6. 6.
    Sonis ST (2009) Mucositis: the impact, biology and therapeutic opportunities of oral mucositis. Oral Oncol 45:1015–1020CrossRefGoogle Scholar
  7. 7.
    Common terminology criteria for adverse events (CTCAE) version 5.0 2019 https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf. Available on April 29, 2019
  8. 8.
    Kawashita Y, Hayashida S, Funahara M, Umeda M, Saito T (2014) Prophylactic bundle for radiation-induced oral mucositis in oral or oropharyneal cancer patients. J Cancer Res Ther 2:9–13CrossRefGoogle Scholar
  9. 9.
    Kawashita Y, Koyama Y, Kurita H, Otsuru M, Ota Y, Okura M, Horie A, Sekiya H, Umeda M. (2019) Effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients receiving radiotherapy with or without chemotherapy for oral cancer: a multicentre, phase II, randomized controlled trial. Int J Oral Maxillofac Surg in pressGoogle Scholar
  10. 10.
    Rugo HS, Seneviratne L, Beck JT, Glaspy JA, Peguero JA, Pluard TJ, Dhillon N, Hwang LC, Nangia C, Mayer IA, Meiller TF, Chambers MS, Sweetman RW, Sabo JR, Litton JK (2017) Prevention of everolimus-related stomatitis in women with hormone receptor-positive, HER2-negative metastatic breast cancer using dexamethasone mouthwash (SWISH): a single-arm, phase 2 trial. Lancet Oncol 18:654–662CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mika Nishii
    • 1
  • Sakiko Soutome
    • 2
    Email author
  • Akiko Kawakita
    • 3
  • Hirokazu Yutori
    • 3
  • Eiji Iwata
    • 4
  • Masaya Akashi
    • 4
  • Takumi Hasegawa
    • 4
  • Yuka Kojima
    • 5
  • Madoka Funahara
    • 6
  • Masahiro Umeda
    • 3
  • Takahide Komori
    • 4
  1. 1.Department of Oral and Maxillofacial SurgeryKobe University HospitalKobeJapan
  2. 2.Perioperative Oral Management CenterNagasaki University HospitalNagasakiJapan
  3. 3.Department of Clinical Oral OncologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  4. 4.Department of Oral and Maxillofacial SurgeryKobe University Graduate School of MedicineKobeJapan
  5. 5.Department of Dentistry and Oral SurgeryKansai Medical UniversityOsakaJapan
  6. 6.School of Oral Health SciencesKyushu Dental UniversityKitakyushuJapan

Personalised recommendations