title: Management of oropharyngeal mycosis in head and neck cancer occurring during (chemo) radiotherapy: an Italian radio-oncologist survey.
abstract: OBJECTIVE
  Oropharyngeal candidiasis is a common disorder in head and neck cancer patients (HNCPs) who underwent (chemo)-radiotherapy. An Italian survey was conducted in order to investigate radiation oncologists' behavior in regard to diagnosis, prevention, and treatment of oral candidiasis.
  
  
  METHODS
  Between April and May 2013, a national online 18-question survey was sent to major Italian radiotherapy centers.
  
  
  RESULTS
  All Italian regions were represented and 86 radiation oncologists were involved. Eighty-three percent of responders estimated that oropharyngeal candidiasis occurred in 30%-40% of their HNCPs. The majority of responders were able to recognize oral mycosis when it occurred in a localized pseudomembranous form and all responders agreed with the fact that oral candidiasis was always associated with mucositis. A prophylactic therapy was prescribed occasionally by 35% and routinely by 20% of responders. Forty percent prescribed an antifungal drug in the case of suspected mycotic infection and 20% waited for symptomatic clinical evidence before prescribing a therapy. In the presence of candidiasis, mainly topical fluconazole (59%) and itraconazole (36%) were prescribed. Concomitant chemo-radiotherapy was first identified as a risk factor for mycosis occurrence and development. Ninety-nine percent of responders believed that oral mycosis was associated with increased toxicity and 44% of them interrupted treatment due to candidiasis.
  
  
  CONCLUSIONS
  A variety of approaches to oropharyngeal candidiasis emerges from this survey; further clinical trials are necessary to identify the best approach for oral mycosis prevention and treatment and to establish specific international guidelines for HNCPs.
authors.affiliation: 1 Department of Radiation Oncology, AOU IRCCS San Martino-IST, Genoa - Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Belgioia
authors.forename: Almalina
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Daniela
authors.initials: D
authors.lastname: Alterio
authors.forename: Elvio
authors.initials: E
authors.lastname: Russi
authors.forename: Renzo
authors.initials: R
authors.lastname: Corvò
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002613:Cheilitis / Q000188:drug therapy / Q000517:prevention & control; D059248:Chemoradiotherapy / Q000009:adverse effects; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D019538:Health Care Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D017964:Itraconazole / Q000008:administration & dosage; D007654:Ketoconazole / Q000008:administration & dosage; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009761:Nystatin / Q000008:administration & dosage; D009960:Oropharynx / Q000382:microbiology*; D011322:Primary Prevention / Q000379:methods; D018787:Radiation Oncology / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000935:Antifungal Agents; D009761:Nystatin; D017964:Itraconazole; D015725:Fluconazole; D007654:Ketoconazole