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Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 15-18

Fungal flora changes in head-and-neck cancer patients receiving radiotherapy

Department of Radiation Oncology, Father Muller Medical College, Mangalore, Karnataka, India

Correspondence Address:
Dr. B Sandesh Rao
Department of Radiation Oncology, Father Muller Medical College, Mangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrcr.jrcr_70_20

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Background: Oral mucositis is one of the primary toxicities of radiation in head-and-neck radiotherapy (RT). Oral fungal microflora changes have been studied to aggravate the inflammatory process leading to mucositis. The study evaluated the changes in oral fungal microflora during RT in head-and-neck cancer (HNC) using a single-institutional, prospective research and its correlation with oral mucositis. Subjects and Methods: A prospective single-institutional study was conducted on 68 biopsy-proven HNC patients on RT with or without chemotherapy treated in the Department of Radiation Oncology at Father Muller Medical College, Mangalore, between 2015 and 2017. Three samples of saliva were collected before RT, the end of the 3rd week of RT, and 4 weeks after the completion of RT and assessed for developing fungal flora changes by Sabouraud's dextrose agar growth media and CHROMagar in the number of patients. Mucositis grades are correlated with fungal pathogens. Statistical analysis was on fungal changes and mucositis using mean, percentage, standard deviation, and Chi-square test. Results: An increase in fungal microflora was found in patients receiving radiation or chemoradiation in head-and-neck malignancy. Among them, a significant increase was there in Candida albicans (1.5% of patients before RT to 44.1% of patients during RT) and Candida krusei (1.5% of patients before RT to 10.5% of patients during RT) during RT (P < 0.05). Aspergillus fumigatus was found during radiation and absent before and after radiation. Mucositis during radiation had a nonsignificant increasing trend for A. fumigatus and Candida species. Conclusion: There was a significant increase in C. albicans and C. krusei during RT when compared to before RT. A better understanding of the oral microflora's role in developing oral mucositis is needed to mitigate symptoms and improve treatment tolerance.

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