CANDIDAL COLONIZATION AND ORAL CANDIDIASIS IN PATIENTS UNDERGOING ORAL AND PHARYNGEAL RADIATION-THERAPY

Objectives. Radiotherapy-induced hyposalivation encourages oral candid al colonization that often leads to oral/pharyngeal candidiasis. The p urpose of this study was to quantitate oral candidal colonization; ass ess signs, symptoms, and response to antifungal management, speciate C andida, and evaluate the influence of smoking and dentures. Study desi gn. Forty-six patients undergoing radiation therapy for oral/pharyngea l squamous cell carcinoma were evaluated clinically and by Candidal cu ltures before, during, and after irradiation. Results. All patients co mplained of progressive xerostomia. There was a significant increase i n the prevalence of positive candidal cultures (p = < 0.0001): baselin e 43%, completion of radiotherapy 62%, and follow-up timepoint 75%. Sm oking and denture wearing were not statistically significant risk fact ors for increased candidal colonization (p = 0.085 and p = 0.420, resp ectively). Eight patients developed clinical candidiasis. Although fiv e responded clinically to systemic antifungal medication, all follow-u p cultures remained positive. Candida albicans was the predominant spe cies at baseline and completion of radiation (85% and 68%, respectivel y). Conclusions. When salivary glands are included in the field of rad iation, xerostomia occurs, causing progressive increases in oral Candi da colonization. Because 17.4% developed clinical candidiasis during r adiotherapy and the question of fungal resistance remains speculative, a recommendation for the prophylactic use of antifungal medication is unresolved.