Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Supportive care - Health Professional Information [NCI] - Head / Neck Radiation Patients
A systematic review indicated that the weighted mean prevalence of clinical oral candidiasis during head and neck radiation therapy is 37.4% and may be significantly higher in patients who receive concurrent chemotherapy. Factors promoting clinical fungal infection in this population include the following:
- Hyposalivation resulting from radiation damage to the salivary glands.
- Tissue damage caused by radiation-induced oral mucositis.
- Resulting dietary impairment.
- Inability to maintain oral hygiene.
Because these patients are usually not significantly neutropenic, topical antifungal agents such as nystatin rinse/pastilles and clotrimazole troches can be effective. The use of a troche may be limited by significant xerostomia. Patients who receive topical antifungals should be asked to avoid eating, drinking, or rinsing for at least 30 minutes after use. Patients with removable dentures should remove the dentures before using the topical antifungals and should also treat the dentures to avoid repeat colonization of the oral tissues by fungal organisms that are colonizing the dentures.
For persistent lesions, systemic agents such as fluconazole are very effective.
As oral and pharyngeal mucosa are exposed to radiation, taste receptors become damaged, and taste discrimination becomes increasingly compromised.[13,14] After several weeks of radiation therapy, patients commonly complain that they have no sense of taste. It will generally take 6 to 8 weeks after the end of radiation therapy for taste receptors to recover and become functional. Zinc sulfate supplements (220 mg 2 or 3 times a day) have been reported to help with recovery of the sense of taste.[15,16][Level of evidence: I]
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- Wong PC, Dodd MJ, Miaskowski C, et al.: Mucositis pain induced by radiation therapy: prevalence, severity, and use of self-care behaviors. J Pain Symptom Manage 32 (1): 27-37, 2006.
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- Lalla RV, Latortue MC, Hong CH, et al.: A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 18 (8): 985-92, 2010.
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- Zheng WK, Inokuchi A, Yamamoto T, et al.: Taste dysfunction in irradiated patients with head and neck cancer. Fukuoka Igaku Zasshi 93 (4): 64-76, 2002.
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- Ripamonti C, Zecca E, Brunelli C, et al.: A randomized, controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation. Cancer 82 (10): 1938-45, 1998.