A retrospective study of 606 cases of nasopharyngeal carcinoma with or without oropharyngeal candidiasis during radiotherapy.

Wen-Ze Qiu,Xing Lv,Xin-Jun Huang,Liang-Ru Ke,Hu Liang,Xiang Guo,Wei-Xiong Xia,Jing Yang,Guo-Ying Liu,Ya-Hui Yu,Yan-Qun Xiang,Wang-Zhong Li,Qingyi Wei

doi:10.1371/journal.pone.0182963

Wen-Ze Qiu, Xing Lv + Show 11 more

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https://doi.org/10.1371/journal.pone.0182963

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Abstract

BackgroundTo evaluate the clinical characteristics, treatment-related toxicities and survival in patients with nasopharyngeal carcinoma (NPC) with or without oropharyngealcandidiasis (OPC) during radiotherapy.MethodsThe current study was conducted with NPC patients undergoing radiotherapy at Sun Yat-Sen University Cancer Center between June 2011 and May 2012. A clinical diagnosis of candidiasis was determined on the basis of a positive potassium hydroxide (KOH) test and the presence of pseudomembranous (white) form of candidal overgrowth. The Cox proportional hazard regression model was used to test the association of OPC and related survival rates.ResultsCompared with the non-OPC group, the OPC group had significantly increased occurrence rates of grade 3–4 mucositis (14.5% vs. 7.4%, P = 0.049), anaemia (11.3% vs. 4.4%, P = 0.020), hepatotoxicity (4.8% vs. 1.1%, P = 0.021) and critical weight loss (85.5% vs. 56.6%, P<0.001) during radiotherapy. The OPC group had a significantly lower disease-free survival (DFS) (70.9% vs. 82.6%, P = 0.012), mainly as a result of a reduction in locoregional relapse-free survival (LRFS) (87.0%vs. 94.9%, P = 0.025). After stratification by T stage, the 5-year DFS in T3-4 patients were 82.0% and 68.8% in non-OPC and OPC groups, respectively (P = 0.022). Multivariate analyses indicated that OPC was a prognostic factor for LRFS and DFS.ConclusionsOPC during radiotherapy may worsen the nutritional status of NPC patients according to weight loss and anaemia, leading to a negative impact on 5-year locoregional relapse-free survival and disease-specific survival. Further investigations are needed to explore whether prevention and treatment of OPC during radiotherapy will be useful.

Highlights

Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus-associated cancer commonly reported in China and occurs at a high frequency in the southern area [1, 2]
Compared with the non-OPC group, the OPC group had significantly increased occurrence rates of grade 3–4 mucositis (14.5% vs. 7.4%, P = 0.049), anaemia (11.3% vs. 4.4%, P = 0.020), hepatotoxicity (4.8% vs. 1.1%, P = 0.021) and critical weight loss (85.5% vs. 56.6%, P
Multivariate analyses indicated that OPC was a prognostic factor for locoregional relapse-free survival (LRFS) and disease-free survival (DFS)

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus-associated cancer commonly reported in China and occurs at a high frequency in the southern area [1, 2]. For early stages of the disease, radiotherapy (RT) has long been the standard treatment, with a 5-year overall survival of 75%-90% [1, 3]. For locally advanced NPC, 5-year overall survival can be increased by 4% in combination with chemotherapy and RT [4,5,6]. Due to complex anatomical localization of the tumor and the surrounding critical structures, RT-related acute toxicities, such as xerostomia, mucositis, dysphagia, dermatitis, are inevitable. To evaluate the clinical characteristics, treatment-related toxicities and survival in patients with nasopharyngeal carcinoma (NPC) with or without oropharyngealcandidiasis (OPC) during radiotherapy

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Conclusion