Alteration in Oral Flora and Effect of Mucositis in Head and Neck Cancer Patients Undergoing Chemo-radiotherapy

Reeta Maurya,Manodeep Sen,Somali Sanyal,Madhup Rastogi

doi:10.22207/jpam.14.3.53

Abstract

The main aim of this study is to determine the various types of oral bacteria and yeast. Present in oral flora of head and neck cancer patients at different stages of chemo-radiotherapy, and compare it with the control group (patients with contralateral healthy mucosa). Seventy seven patients with proven history of squamous cell carcinoma were included in the study. The oral mucosa profile was assessed for bacterial manifestations in swab samples from both the sites of the patients. The grade of mucositis was charted out for all patients during the second and third week of radiotherapy. The study revealed that all isolated oral flora showed a non-significant increase during radiotherapy, while there was a decrease in oral flora in post RT. However, E. faecalis showed a non- significant decrease during RT, while Citrobacter showed an increase. Candida albicans showed 83% non- significant decrease post- radiotherapy. When these floras were correlated with grade of mucositis, an insignificant increase in flora was found in G2 and G3 stage of mucositis. In this study, the effect of radiation was evaluated on oral flora of head and neck cancer patients and compared with contralateral healthy mucosa of the patients. Various changes were observed during and after radiation therapy. In patients with head and neck cancer the normal oral flora are replaced by pathogenic flora during radiotherapy, and the latter is responsible for infections in post- radiation phase.

Highlights

Head and neck cancer is one of the highly common cancers in India with higher incidence in men than in women
In patients with head and neck cancer the normal oral flora are replaced by pathogenic flora during radiotherapy, and the latter is responsible for infections in post- radiation phase
Muthu K et al.[11] have demonstrated a statistically significant decrease in Alpha Hemolytic Streptococci and Neisseria species post-radiotherapy which resulted in possible recovery from mucositis in head and neck cancer patients they reported a statistically significant increase in Proteus species and Candida albicans in the patients with head and neck cancer post–radiotherapy, while in our study we found an insignificant increase in Candida albicans during RT

Summary

Introduction

Head and neck cancer is one of the highly common cancers in India with higher incidence in men than in women. According to Globocon report published in 2018, head and neck cancer accounts for 16.1% of all the cases of cancer in men, and when these patients are treated with radiotherapy (RT) or chemotherapy, oral mucositis may develop. It is reported in literature that about 40% of patients undergoing chemo-radiotherapy develop oral mucositis[2]. This is referred to as oral erythematous and ulcerative lesions of various gradings. The degree of mucositis is graded according to guidelines provided by Radiation Therapy Oncology Group (RTOG) and WHO3. It onsets after 5-10 days of commencement of radiotherapy. The grading of mucositis (grade – 0, I, II, III, IV) increases with the increase in dose delivered and lasts for 7-14 days after the course of radiotherapy

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