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Management of oropharyngeal mycosis in head and neck cancer occurring during (chemo) radiotherapy: an Italian radio-oncologist survey

Abstract

Aims and Background

Oropharyngeal candidiasis is a common disorder in head and neck cancer patients (HNCPs) who underwent (chemo)-radiotherapy. An Italian survey was conducted in order to investigate radiation oncologists’ behavior in regard to diagnosis, prevention, and treatment of oral candidiasis.

Methods and Study design

Between April and May 2013, a national online 18-question survey was sent to major Italian radiotherapy centers.

Results

All Italian regions were represented and 86 radiation oncologists were involved. Eighty-three percent of responders estimated that oropharyngeal candidiasis occurred in 30%-40% of their HNCPs. The majority of responders were able to recognize oral mycosis when it occurred in a localized pseudomembranous form and all responders agreed with the fact that oral candidiasis was always associated with mucositis. A prophylactic therapy was prescribed occasionally by 35% and routinely by 20% of responders. Forty percent prescribed an antifungal drug in the case of suspected mycotic infection and 20% waited for symptomatic clinical evidence before prescribing a therapy. In the presence of candidiasis, mainly topical fluconazole (59%) and itraconazole (36%) were prescribed. Concomitant chemo-radiotherapy was first identified as a risk factor for mycosis occurrence and development. Ninety-nine percent of responders believed that oral mycosis was associated with increased toxicity and 44% of them interrupted treatment due to candidiasis.

Conclusions

A variety of approaches to oropharyngeal candidiasis emerges from this survey; further clinical trials are necessary to identify the best approach for oral mycosis prevention and treatment and to establish specific international guidelines for HNCPs.

Tumori 2015; 101(3): 312 - 317

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/tj.5000284

Authors

Liliana Belgioia, Almalina Bacigalupo, Daniela Alterio, Elvio Russi, Renzo Corvò

Article History

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

Affiliations

  • Department of Radiation Oncology, AOU IRCCS San Martino-IST, Genoa - Italy
  • Department of Radiation Oncology, European Institute of Oncology, Milan - Italy
  • Department of Radiation Oncology, AOS Croce e Carle, Cuneo - Italy

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