Candida Quantification and Species identification in Patients undergoing Postoperative Head and Neck Radiotherapy and Combination of Chemo-Radio Therapy

Abstract

Introduction: Candidiasis is found to occur frequently in patients undergoing Radiotherapy and Chemotherapy alone or in combination. Mucositis is another common finding post cancer therapy in head and neck region. Hence this study was undertaken to evaluate and compare candidial quantification and species identification in  patients prior to post-operative radiotherapy(PORT)  and  in fourth week of PORT  and among combination of Radiotherapy and Chemotherapy (CTRT) groups in Indian population and gradation of mucositis and also to determine sensitivity profiles of candida species.

Materials and methods- 40 patients who had undergone operative procedure for head and neck cancer were divided into 2 groups - Group 1 radiation therapy (RT) and Group 2 chemotherapy and radiotherapy (CTRT). Microbiological evaluation of candida colonization was carried out prior to radiation and in the fourth week of radiotherapy using the oral rinse method. Species identification helped in determining the sensitivity profiles to various antifungal drugs.

Results- Candida albicans along with non albicans species like C. tropicalis,C. krusie, C.glabrata and C.parapsilosis were identified. Among the non albicans species, C tropicalis was the most common. Mixed species were detected in multiple samples. Grade 2 mucositis was predominant in both treatment modalities. Treatment interruptions occurred due to systemic complications in our patients. When albicans and non albicans group were compared, C albicans was 100% sensitive to all the antifungal drugs tested except fluconazole. All other organisms were 100% sensitive to voriconazole, capsofungin and itraconazole.

Conclusion- Candida albicans was the most common species present and C tropicalis was the most common non albicans fungal organism. Sensitivity revealed that voriconazole, capsofungin and itraconazole can be considered for antifungal prophylaxis during radiotherapy and chemotherapy of head and neck cancers.