Composition spectrum of oral microbiota diversity in patients with radiotherapy of head and neck neoplasms: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WU Haokun ¹ , ZENG Yujiao ² , WEI Hao ³ ,  SUN Yu ¹

1. West China Hospital, Sichuan University, Radiotherapy Physics & Technology Center, Cancer Center, Chengdu 610041, P. R. China;
2. West China Medical School, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, P. R. China;
3. West China Medical School, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

SUN Yu, Email: 55880810@qq.com

Keywords：

Head and neck tumors; Radiation therapy; Oral microbiota; Microbial abundance; Meta-analysis

DOI：

10.7507/1672-2531.202508011

Video：

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Objective To systematically evaluate the composition spectrum of oral microbiota diversity in patients with head and neck tumors undergoing radiotherapy. Methods Computer searches were conducted on CNKI, CBM, WanFang Data, PubMed, Embase, and Web of Science databases to collect cohort and control studies on changes in oral microbiota in patients with head and neck tumors after radiotherapy. The search period was from January 1, 2015 to June 1, 2025. Two researchers screened and evaluated literature, extracted data, and conducted meta-analysis using RevMan 5.4 software. Results A total of 25 studies were included, including 731 patients with head and neck tumors and 275 healthy controls. The meta-analysis results indicated that compared with the control group not exposed to radiotherapy, the detection rates of major oral opportunistic pathogens such as Candida albicans and Streptococcus mutans had significantly increased (OR=3.62, 95%CI 2.23 to 5.89, P<0.01). The Shannon index and Chao1 index for oral alpha diversity had decreased after radiotherapy (SMD=?0.78, 95%CI ?1.23 to 0.34, P<0.01; SMD=?0.64, 95%CI ?1.14 to ?0.15, P<0.001), and the differences were statistically significant. Qualitative analysis showed that after radiotherapy, the relative abundance of Firmicutes, Streptococcus, Lactobacillus, etc. in patients increased, while the relative abundance of Clostridium, Neisseria, etc. decreased. Conclusion There are changes in the oral microbiota of patients with head and neck tumors after radiotherapy, mainly manifested as an increase in the detection rate of opportunistic pathogens, a decrease in alpha diversity, and an imbalance in the relative abundance of some bacterial phyla. This suggests that oral care should be taken seriously for radiotherapy patients.

Citation： WU Haokun, ZENG Yujiao, WEI Hao, SUN Yu. Composition spectrum of oral microbiota diversity in patients with radiotherapy of head and neck neoplasms: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2026, 26(4): 430-438. doi: 10.7507/1672-2531.202508011 Copy

1.	胡陽, 魏豪, 何垠波, 等. 頭頸部放療對口腔菌群的影響. 現代腫瘤醫學, 2022, 30(3): 499-504.
2.	Elad S, Cheng K, Lalla R. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy (vol 126, pg 4423, 2020). Cancer, 2021, 127(19): 3700-3700.
3.	Lee C, Galloway T. Pathogenesis and amelioration of radiation-induced oral mucositis. Curr treat options oncol, 2022, 23(3): 311-324.
4.	Reyes-Gibby C, Wang J, Zhang L, et al. Oral microbiome and onset of oral mucositis in patients with squamous cell carcinoma of the head and neck. Cancer, 2020, 126(23): 5124-5136.
5.	盧志遠, 許益敏, 周夢緣, 等. 口腔微生物影響放射性口炎: 一項單臂前瞻性研究. 口腔醫學, 2024, 44(8): 596-601.
6.	Naito M, Hirakawa H, Yamashita A, et al. Determination of the genome sequence of porphyromonas gingivalis strain ATCC 33277 and genomic comparison with strain W83 revealed extensive genome rearrangements in P-gingivalis. DNA res, 2008, 15(4): 215-225.
7.	周典蓉, 張澤, 趙曉航. 應用二代測序方法研究長遠航作業人員口腔細菌變化. 中國衛生檢驗雜志, 2016, 26(10): 1369-1372,1376.
8.	Jensen K, Vogelius I, Moser C, et al. Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database. Br J cancer, 2021, 125(3): 458-464.
9.	毛得斌, 陶建萍. 鼻咽癌患者放療期間口咽細菌動態變化及耐藥分析. 臨床合理用藥雜志, 2015, 8(27): 29-30.
10.	范遙. 放射性口腔黏膜炎、免疫水平與口腔菌群關系的初步探索. 廣州: 南方醫科大學, 2019.
11.	舒澤凱, 王佰魁, 王磊, 等. 頭頸部放療期間口腔細菌菌群變化及其與放射性口腔黏膜炎相關性研究. 中華放射腫瘤學雜志, 2021, 30(7): 665-670.
12.	錢祥, 甄宏德, 傅曉璇, 等. 鼻咽癌放療后陰虛證患者口腔微生態與舌象變化研究. 中國中西醫結合雜志, 2020, 40(11): 1322-1327.
13.	李亞楠. 口腔鱗癌不同治療階段口腔菌群的動態變化規律研究. 成都: 電子科技大學, 2021.
14.	匡麗, 黨惠兵, 孫杰, 等. 鼻咽癌放療患者口腔菌群的改變及復方黃芩含漱液的作用. 中國微生態學雜志, 2024, 36(9): 1060-1065.
15.	曹志誠. 口腔鱗癌術后放療口腔菌群多樣性變化與放射性口腔炎相關性研究. 南京: 南京中醫藥大學, 2024.
16.	de Freitas Neiva Lessa A, da Silva Amancio AMT, de Oliveira ACR, et al. Assessing the oral microbiome of head and neck cancer patients before and during radiotherapy. Support Care Cancer, 2024, 32(11): 752.
17.	Wang Z, Yang G, Zhou X, et al. Heavy ion radiation directly induced the shift of oral microbiota and increased the cariogenicity of streptococcus mutans. Microbiol Spectr, 2023, 11(4): e0132223.
18.	Medeiros MC, The S, Bellile E, et al. Salivary microbiome changes distinguish response to chemoradiotherapy in patients with oral cancer. Microbiome, 2023, 11(1): 268-277.
19.	Gaetti-Jardim E, Jardim ECG, Schweitzer CM, et al. Supragingival and subgingival microbiota from patients with poor oral hygiene submitted to radiotherapy for head and neck cancer treatment. Arch Oral Biol, 2018, 90: 45-52.
20.	Hao Y, Zeng Z, Peng X, et al. The human oral - nasopharynx microbiome as a risk screening tool for nasopharyngeal carcinoma. Front Cell Infect Microbiol, 2022, 12: 101-120.
21.	Kumpitsch. C, Moissl-Eichinger C, Pock J, et al. Preliminary insights into the impact of primary radiochemotherapy on the salivary microbiome in head and neck squamous cell carcinoma. Sci Rep, 2020, 10(1): 165-182.
22.	Lim Y, Tang K, Karpe A, et al. Chemoradiation therapy changes oral microbiome and metabolomic profiles in patients with oral cavity cancer and oropharyngeal cancer. Head neck-j sci spec head neck, 2021, 43(5): 1521-1534.
23.	Mojdami ZD, Barbour A, Oveisi M, et al. The effect of intensity-modulated radiotherapy to the head and neck region on the oral innate immune response and oral microbiome: a prospective cohort study of head and neck tumour patients. Int J Mol Sci, 2022, 23(17): 9594.
24.	Zhang J, Liu H, Liang X, et al. Investigation of salivary function and oral microbiota of radiation caries-free people with nasopharyngeal carcinoma. PLoS One, 2015, 10(4): e0123137.
25.	Müller VJ, Belibasakis GN, Bosshard PP, et al. Change of saliva composition with radiotherapy. Arch Oral Biol, 2019, 106: 104480.
26.	Pandey D, Szczesniak M, Maclean J, et al. Dysbiosis in head and neck cancer: determining optimal sampling site for oral microbiome collection. Pathogens, 2022, 11(12): 1550.
27.	Gao L, Hu Y, Wang Y, et al. Exploring the variation of oral microbiota in supragingival plaque during and after head-and-neck radiotherapy using pyrosequencing. Arch oral biol, 2015, 60(9): 1222-1230.
28.	Mougeot JC, Stevens CB, Almon KG, et al. Caries-associated oral microbiome in head and neck cancer radiation patients: a longitudinal study. J Oral Microbiol, 2019, 11(1): 1586421.
29.	Anjali K, Manzoor M, Suryavanshi MV, et al. Dysbiosis of the oral microbiota composition is associated with oral squamous cell carcinoma and the impact of radiotherapy: a pilot study. FEMS Microbiol Lett, 2023, 370: fnad111.
30.	Rai A, Panda M, Das A, et al. Dysbiosis of salivary microbiome and cytokines influence oral squamous cell carcinoma through inflammation. Arch microbiol, 2021, 203(1): 137-152.
31.	Hou J, Zheng H, Li P, et al. Distinct shifts in the oral microbiota are associated with the progression and aggravation of mucositis during radiotherapy. Radiother oncol, 2018, 129(1): 44-51.
32.	劉坤, 王冀川, 王捷, 等. 鼻咽癌放療后咽部菌群的變化. 腫瘤預防與治療, 2008, 21(4): 415-417.
33.	牙祖科, 黃光武, 陶人川, 等. 鼻咽癌放療期患者的口腔反應及口腔念珠菌負荷狀況和生物分型. 廣西醫科大學學報, 2005, 22(3): 329-331.
34.	Pei J, Li F, Xie Y, et al. Microbial and metabolomic analysis of gingival crevicular fluid in general chronic periodontitis patients: lessons for a predictive, preventive, and personalized medical approach. EPMA J, 2020, 11(2): 197-215.
35.	張琳, 唐雅文, 王建濤, 等. 益生菌防治口腔和胃腸道放化療黏膜炎的研究進展. 口腔疾病防治, 2021, 29(8): 567-571.
36.	Liu G, Tang CM, Exley RM. Non-pathogenic Neisseria: members of an abundant, multi-habitat, diverse genus. Microbiology (Reading), 2015, 161(7): 1297-1312.
37.	Joyce LR, Guan Z, Palmer KL. Streptococcus pneumoniae, S. pyogenes and S. agalactiae membrane phospholipid remodelling in response to human serum. Microbiology (Reading), 2021, 167(5): 001048.

1. 胡陽, 魏豪, 何垠波, 等. 頭頸部放療對口腔菌群的影響. 現代腫瘤醫學, 2022, 30(3): 499-504.
2. Elad S, Cheng K, Lalla R. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy (vol 126, pg 4423, 2020). Cancer, 2021, 127(19): 3700-3700.
3. Lee C, Galloway T. Pathogenesis and amelioration of radiation-induced oral mucositis. Curr treat options oncol, 2022, 23(3): 311-324.
4. Reyes-Gibby C, Wang J, Zhang L, et al. Oral microbiome and onset of oral mucositis in patients with squamous cell carcinoma of the head and neck. Cancer, 2020, 126(23): 5124-5136.
5. 盧志遠, 許益敏, 周夢緣, 等. 口腔微生物影響放射性口炎: 一項單臂前瞻性研究. 口腔醫學, 2024, 44(8): 596-601.
6. Naito M, Hirakawa H, Yamashita A, et al. Determination of the genome sequence of porphyromonas gingivalis strain ATCC 33277 and genomic comparison with strain W83 revealed extensive genome rearrangements in P-gingivalis. DNA res, 2008, 15(4): 215-225.
7. 周典蓉, 張澤, 趙曉航. 應用二代測序方法研究長遠航作業人員口腔細菌變化. 中國衛生檢驗雜志, 2016, 26(10): 1369-1372,1376.
8. Jensen K, Vogelius I, Moser C, et al. Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database. Br J cancer, 2021, 125(3): 458-464.
9. 毛得斌, 陶建萍. 鼻咽癌患者放療期間口咽細菌動態變化及耐藥分析. 臨床合理用藥雜志, 2015, 8(27): 29-30.
10. 范遙. 放射性口腔黏膜炎、免疫水平與口腔菌群關系的初步探索. 廣州: 南方醫科大學, 2019.
11. 舒澤凱, 王佰魁, 王磊, 等. 頭頸部放療期間口腔細菌菌群變化及其與放射性口腔黏膜炎相關性研究. 中華放射腫瘤學雜志, 2021, 30(7): 665-670.
12. 錢祥, 甄宏德, 傅曉璇, 等. 鼻咽癌放療后陰虛證患者口腔微生態與舌象變化研究. 中國中西醫結合雜志, 2020, 40(11): 1322-1327.
13. 李亞楠. 口腔鱗癌不同治療階段口腔菌群的動態變化規律研究. 成都: 電子科技大學, 2021.
14. 匡麗, 黨惠兵, 孫杰, 等. 鼻咽癌放療患者口腔菌群的改變及復方黃芩含漱液的作用. 中國微生態學雜志, 2024, 36(9): 1060-1065.
15. 曹志誠. 口腔鱗癌術后放療口腔菌群多樣性變化與放射性口腔炎相關性研究. 南京: 南京中醫藥大學, 2024.
16. de Freitas Neiva Lessa A, da Silva Amancio AMT, de Oliveira ACR, et al. Assessing the oral microbiome of head and neck cancer patients before and during radiotherapy. Support Care Cancer, 2024, 32(11): 752.
17. Wang Z, Yang G, Zhou X, et al. Heavy ion radiation directly induced the shift of oral microbiota and increased the cariogenicity of streptococcus mutans. Microbiol Spectr, 2023, 11(4): e0132223.
18. Medeiros MC, The S, Bellile E, et al. Salivary microbiome changes distinguish response to chemoradiotherapy in patients with oral cancer. Microbiome, 2023, 11(1): 268-277.
19. Gaetti-Jardim E, Jardim ECG, Schweitzer CM, et al. Supragingival and subgingival microbiota from patients with poor oral hygiene submitted to radiotherapy for head and neck cancer treatment. Arch Oral Biol, 2018, 90: 45-52.
20. Hao Y, Zeng Z, Peng X, et al. The human oral - nasopharynx microbiome as a risk screening tool for nasopharyngeal carcinoma. Front Cell Infect Microbiol, 2022, 12: 101-120.
21. Kumpitsch. C, Moissl-Eichinger C, Pock J, et al. Preliminary insights into the impact of primary radiochemotherapy on the salivary microbiome in head and neck squamous cell carcinoma. Sci Rep, 2020, 10(1): 165-182.
22. Lim Y, Tang K, Karpe A, et al. Chemoradiation therapy changes oral microbiome and metabolomic profiles in patients with oral cavity cancer and oropharyngeal cancer. Head neck-j sci spec head neck, 2021, 43(5): 1521-1534.
23. Mojdami ZD, Barbour A, Oveisi M, et al. The effect of intensity-modulated radiotherapy to the head and neck region on the oral innate immune response and oral microbiome: a prospective cohort study of head and neck tumour patients. Int J Mol Sci, 2022, 23(17): 9594.
24. Zhang J, Liu H, Liang X, et al. Investigation of salivary function and oral microbiota of radiation caries-free people with nasopharyngeal carcinoma. PLoS One, 2015, 10(4): e0123137.
25. Müller VJ, Belibasakis GN, Bosshard PP, et al. Change of saliva composition with radiotherapy. Arch Oral Biol, 2019, 106: 104480.
26. Pandey D, Szczesniak M, Maclean J, et al. Dysbiosis in head and neck cancer: determining optimal sampling site for oral microbiome collection. Pathogens, 2022, 11(12): 1550.
27. Gao L, Hu Y, Wang Y, et al. Exploring the variation of oral microbiota in supragingival plaque during and after head-and-neck radiotherapy using pyrosequencing. Arch oral biol, 2015, 60(9): 1222-1230.
28. Mougeot JC, Stevens CB, Almon KG, et al. Caries-associated oral microbiome in head and neck cancer radiation patients: a longitudinal study. J Oral Microbiol, 2019, 11(1): 1586421.
29. Anjali K, Manzoor M, Suryavanshi MV, et al. Dysbiosis of the oral microbiota composition is associated with oral squamous cell carcinoma and the impact of radiotherapy: a pilot study. FEMS Microbiol Lett, 2023, 370: fnad111.
30. Rai A, Panda M, Das A, et al. Dysbiosis of salivary microbiome and cytokines influence oral squamous cell carcinoma through inflammation. Arch microbiol, 2021, 203(1): 137-152.
31. Hou J, Zheng H, Li P, et al. Distinct shifts in the oral microbiota are associated with the progression and aggravation of mucositis during radiotherapy. Radiother oncol, 2018, 129(1): 44-51.
32. 劉坤, 王冀川, 王捷, 等. 鼻咽癌放療后咽部菌群的變化. 腫瘤預防與治療, 2008, 21(4): 415-417.
33. 牙祖科, 黃光武, 陶人川, 等. 鼻咽癌放療期患者的口腔反應及口腔念珠菌負荷狀況和生物分型. 廣西醫科大學學報, 2005, 22(3): 329-331.
34. Pei J, Li F, Xie Y, et al. Microbial and metabolomic analysis of gingival crevicular fluid in general chronic periodontitis patients: lessons for a predictive, preventive, and personalized medical approach. EPMA J, 2020, 11(2): 197-215.
35. 張琳, 唐雅文, 王建濤, 等. 益生菌防治口腔和胃腸道放化療黏膜炎的研究進展. 口腔疾病防治, 2021, 29(8): 567-571.
36. Liu G, Tang CM, Exley RM. Non-pathogenic Neisseria: members of an abundant, multi-habitat, diverse genus. Microbiology (Reading), 2015, 161(7): 1297-1312.
37. Joyce LR, Guan Z, Palmer KL. Streptococcus pneumoniae, S. pyogenes and S. agalactiae membrane phospholipid remodelling in response to human serum. Microbiology (Reading), 2021, 167(5): 001048.

Chinese Journal of Evidence-Based Medicine

Composition spectrum of oral microbiota diversity in patients with radiotherapy of head and neck neoplasms: a meta-analysis

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