Head and neck intensity modulated radiation therapy leads to an increase of opportunistic oral pathogens.
The introduction of intensity modulated radiation therapy (IMRT) has led to new possibilities in the treatment of head and neck cancer (HNC). Limited information is available on how this more advanced radiation technique affects the oral microflora. In a prospective study we assessed the effects of various advanced treatments for HNC on the oral microflora, as well as the effects of elimination of oral foci of infection.



All consecutive dentate patients >18years, diagnosed with a primary oral or oropharynx carcinoma and seen for a pre-treatment dental screening (May 2011-May 2013) were included. Patients were grouped by oncologic treatment: surgery (SURG), IMRT (IMRT) or IMRT+chemotherapy (CHIMRT). Dental screening data, demographic data, subgingival biofilm samples, oral lavages and whole saliva samples were obtained to microbiologically analyze the effects of cancer treatments (1-year follow-up).



This study included 82 patients (29 SURG, 26 IMRT and 27 CHIMRT). The trends in changes in prevalence and proportions of microorganisms were comparable in the IMRT and CHIMRT group. However, relative to the SURG group, increased prevalence of enteric rods, staphylococci and Candida species was observed in the IMRT and CHIMRT groups. In these groups, elimination of oral foci decreased the frequency of detection of pathogens such as Porphyromonas gingivalis, Tannerella forsythia and Streptococcus mutans.



Different treatments in HNC patients result in different changes in the oral microflora. Opportunistic pathogens such as staphylococci, enteric rods and Candida sp. tend to increase in prevalence after IMRT with or without chemotherapy, but not after surgical intervention.
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands.
Jennifer M
JM
Schuurhuis
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands; Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands.
Monique A
MA
Stokman
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands.
Max J H
MJ
Witjes
Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands.
Johannes A
JA
Langendijk
Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands; Department of Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands.
Arie J
AJ
van Winkelhoff
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands.
Arjan
A
Vissink
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands. Electronic address: f.k.l.spijkervet@umcg.nl.
Frederik K L
FK
Spijkervet
D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000382:microbiology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*
Chemoradiotherapy; Head and neck neoplasms; Intensity modulated radiotherapy; Microbiota; Periodontitis