Oral Candidiasis: Complication of Concomitant Chemo-radiotherapy in Patients with Oral Squamous Cell Carcinoma

Objectives: To investigate oral candidiasis clinically and cytologically in patients with oral squamous cell carcinoma cancer before and at the end of concomitant chemo-radiation therapy and to explore its association with clinical oral symptoms and days of Chemo-radiation. Secondary objective was to describe the oral candidiasis incidence in Pakistani patients with oral squamous cell carcinoma undergoing chemo-radiotherapy.

Subjects and Methods: 85 patients who received concomitant chemo-radiotherapy (CCRT) for the treatment of oral squamous cell carcinoma (OSCC) first time were included in this study. Patients were examined for signs and symptoms of oral candidiasis, mucositis and xerostomia before and at the end of CCRT. Oral scrapings were obtained from contralateral normal buccal mucosa and peri-tumoural area on the selected days i.e. before and at the end of CCRT. Cytological examination was carried out using H&E stain and GMS stain. Mucositis, oral hygiene and xerostomia were assessed by self-reporting questionnaires and also subjectively. Associations among oral candidiasis and these symptoms were evaluated. Age, gender and addictive habits of patients were recorded in a specially designed proforma.

Results: The incidence of oral candidiasis, mucositis and xerostomia were significantly higher at the end of CCRT in these patients. Cytological examination reveals an increase in incidence of fungal colonization at the end of therapy smears on both sites (contralateral normal buccal mucosa and peri tumoural area). Significant association was observed at the end of CCRT between candidiasis and radiotherapy dosage (p = 0.000), oral hygiene and candidiasis (p = 0.012) (p =0.001), addictive habits of patients and candidiasis (p = 0.012), xerostomia and candidiasis (p = 0.000). Similarly significant association was observed among days of CCRT and fungal colonization on both sites of smears i.e. contralateral normal buccal mucosa and peri- tumoural area (p = 0.000).

Conclusion: Oral squamous cell carcinoma patients who have received concomitant chmeo-radiotherapy had a high incidence of fungal colonization in the oral cavity. As a result, prophylaxis to decrease candidalinfection in these patients is requisite. This might improve the quality of life of patients who have be given chemo- radiation treatment for malignant oral cancers.