title: NUTRITIONAL, MICROBIOLOGICAL, AND THERAPEUTIC FACTORS RELATED TO MUCOSITIS IN HEAD AND NECK CANCER PATIENTS: A COHORT STUDY.
abstract: OBJECTIVE
  the objective was to demonstrate if treatment modality, nutritional status and oropharyngeal flora contribute to the development of mucositis in radiotherapy- treated head and neck cancer.
  
  
  METHODS
  single-cohort study of patients with head and neck cancer (H&N) in which radiotherapy was indicated. Nutritional status was evaluated using SGA, BMI, and FFMI. A buccal smear was performed before radiotherapy for cultivation of bacteria and yeasts. Mucositis was evaluated using the WHO grades. Relative risk (RR) and its 95% CI were calculated.
  
  
  RESULTS
  the study included 35 patients, 74.3% males, 63.8 (9.9) years of age, and 34.3% malnourished. The diagnoses included larynx (40.0%), oral (25.7%), and pharynx cancer (11.4%). Treatment comprised 66.0 Gy of radiation, chemotherapy (60.0%), and surgery (57.1%). Bacteria were found in 28.6%, including Staphylococcus aureus (8.6%) and Escherichia coli (8.6%). Yeasts (Candida spp.) were found in 35.3%. Mucositis was more frequent in patients with definitive radiotherapy [100% vs. 65%, p = 0.01; RR = 1.54 (CI95% 1.12 to 2.12)]. Neither SGA nor BMI or FFMI were related to the development or severity of mucositis. Positive cultures for bacteria before radiotherapy were related to severe mucositis [44.4% vs. 12%, p = 0.039; RR = 4.17 (CI95% 1.22 to 14.24)], but there was no relationship with the presence of yeasts. Previous surgery was not associated with the appearance of the studied strains of bacteria.
  
  
  CONCLUSIONS
  bacterial colonization of the oropharynx prior to radiotherapy may be a factor for severe mucositis in H&N patients.
authors: Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León.. avcyo@hotmail.com.
authors: Alfonso
authors: A
authors: Vidal-Casariego
authors: Department of Microbiology, Complejo Asistencial Universitario de León, Spain.. avcyo@hotmail.com.
authors: Isabel
authors: I
authors: Fernández-Natal
authors: Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León.. avcyo@hotmail.com.
authors: Alicia
authors: A
authors: Calleja-Fernández
authors: Department of Microbiology, Complejo Asistencial Universitario de León, Spain.. avcyo@hotmail.com.
authors: Trinidad
authors: T
authors: Parras-Padilla
authors: Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León.. avcyo@hotmail.com.
authors: Isidoro
authors: I
authors: Cano-Rodríguez
authors: Department of Microbiology, Complejo Asistencial Universitario de León, Spain.. avcyo@hotmail.com.
authors: Begoña
authors: B
authors: Prieto-Alonso
authors: Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León.. avcyo@hotmail.com.
authors: María D
authors: MD
authors: Ballesteros-Pomar
mesh_terms: D000368:Aged; D000886:Anthropometry; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D052016:Mucositis / Q000175:diagnosis* / Q000209:etiology*; D009367:Neoplasm Staging; D009752:Nutritional Status; D009960:Oropharynx / Q000382:microbiology