Evaluation of efficacy of antifungal treatment during radiotherapy of patients with oropharynx cancer

The radiotherapy of head and neck cancer is connected with many side effects. Acute mucositis is the most important one and occurs in each case of irradiation. Moreover, fungal infection additionally increases the acute effects, which might even lead to the occurrence of gaps during the course of radiotherapy.
The aim of this paper is to evaluate the effectiveness of anti-fungal treatment of fungal infection in oral cavity and pharynx in the group of patients irradiated due to the head and neck cancer. The surgery was performed in ENT at the University School of Medical Sciences and Maxilla-Facial Department of the University School of Medical Sciences in Poznań. Between January 2000 and December 2001 the postoperative radiotherapy was performed at the Department of Radiotherapy of Greatpoland Cancer Centre in Poznań. One hundred twenty patients with confirmed diagnosis of squamous cell carcinoma were entered into analysis. The mean age of patients was 56.4 years. All patients were in a good performance status evaluated according to Karnofsky scale as 70 or more. Radiotherapy in a conventional way was administered to the tumor bed to the median total dose of 62 Gy and the neck to the total dose of 50 Gy. In each case of a clinical suspicion of fungal infection the smear from inflammatoon area was taken. An anti-fungal treatment in the case of confirmation of fungal inflammation was introduced. Also the prophylactic anti-fungal treatment was administered, in the case of severe acute irradiation side effects (grade 3 according to the RTOG) with concomitant clinical symptoms of candidosis. The analysed group of 120 patients was divided into two subgroups according to the applied treatment: fluconazole versus nystatin. Fluconazole was given in average dose of 50-mg/day po. Nystatin was administered in the dose of 100.000-mj/day. No patients had gaps due to the acute side effects of treatment. The anti-fungal treatment allowed for the decreasing or maintaining of the level of intensity of acute side effects. The decreasing in acute side effects was observed as a result of anti-fungal treatment. More pronounced an anti-fungal outcome was achieved in the group of patients treated by fluconazole.