BACKGROUND Pre-clinical evidence suggests reduced efficacy of anticancer treatment in patients exposed to broad-spectrum antibiotics. It is hypothesised that this phenomenon may be explained by the effects of antibiotics on the composition of the microbiota. To assess this in a clinical setting, we analysed the impact of antibiotics in patients with locally advanced head and neck cancer (LAHNC) treated with curative intent with chemotherapy and radiotherapy (RT). MATERIAL AND METHODS Retrospective data for LAHNC patients treated with curative intent (245 induction chemotherapy followed by chemoradiation [CRT], 17 surgery followed by post-operative CRT, six CRT, three RT alone and one RT with concurrent cetuximab) were analysed. We evaluated the impact of antibiotics prescribed during primary anti-cancer treatment on progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) rates by multivariate Kaplan-Meier and Cox proportional hazards regression analysis. RESULTS Among 272 patients, those receiving antibiotics between within 1 week before and 2 weeks after treatment (N = 124) progressed significantly earlier and had lower OS and DSS rates. In the multivariate analysis, administration of antibiotics was independently associated with reduced PFS (hazards ratio [HR] 1.98, P = 0.001), OS (HR 1.85, P = 0.001) and DSS (HR 1.95, P = 0.004). This effect was maintained with independence of reason for prescription, type and time of antibiotic prescription. The negative impact was greater for patients who received two or more courses of antibiotics. Antibiotic treatment was correlated with increased risk of locoregional relapse. CONCLUSIONS Our data suggest a negative impact of antibiotic therapy on treatment outcomes following CRT with curative intent in patients with LAHNC. This potential harm should be considered when prescribing broad-spectrum and prophylactic antibiotics for such patients.

中文翻译：

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化疗和放疗对局部晚期头颈癌的治愈性治疗期间抗生素使用的影响。

背景技术临床前证据表明，在暴露于广谱抗生素的患者中抗癌治疗的功效降低。假设该现象可以通过抗生素对微生物群组成的影响来解释。为了在临床环境中对此进行评估，我们分析了抗生素对通过化学疗法和放射疗法（RT）进行治疗的局部晚期头颈癌（LAHNC）患者的影响。材料与方法分析了治愈性LAHNC患者的回顾性数据（245例诱导化疗后放化疗[CRT]，17例手术后术后CRT，6例CRT，3例单独RT和1例并发西妥昔单抗）。我们通过多元Kaplan-Meier和Cox比例风险回归分析，评估了在初级抗癌治疗期间处方的抗生素对无进展生存期（PFS），总生存期（OS）和疾病特异性生存期（DSS）率的影响。结果在272例患者中，在治疗前1周至治疗后2周内接受抗生素治疗的患者（N = 124）显着进展较早，OS和DSS发生率较低。在多变量分析中，抗生素的使用与PFS降低（危险比[HR] 1.98，P = 0.001），OS（HR 1.85，P = 0.001）和DSS（HR 1.95，P = 0.004）独立相关。保持这种效果与处方理由，抗生素处方的类型和时间无关。对于接受两种或两种以上抗生素疗程的患者，负面影响更大。抗生素治疗与局部复发风险增加相关。结论我们的数据表明抗生素治疗对LAHNC患者CRT后具有治愈意图的治疗结果具有负面影响。在为此类患者开具广谱和预防性抗生素时应考虑这种潜在的危害。