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ABSTRACT Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents.
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O tratamento metronômico consiste na administração regular e contínua de quimioterápicos em baixa dose, preferivelmente via oral, sem pausas prolongadas, com objetivo de bloquear a proliferação tumoral. Este tratamento tem sido utilizado para uma série de tumores e nos últimos anos notou-se aumento da utilização em estudos clínicos, principalmente no cenário paliativo. Objetivo: Realizar uma revisão narrativa acerca do tema quimioterapia metronômica em tumores sólidos, nos seus aspectos de definição, racional biológico, indicação clínica, marcadores preditivos e prognósticos. Metodologia: Foi realizada uma pesquisa na base de dados PUBMED, maior base de dados de conteúdo médico, onde foram encontrados 575 artigos, dos quais 46 artigos se adequavam aos critérios de seleção (artigos em inglês publicados no período compreendido entre 2015 a 2020), dentre eles 32 artigos de revisão, 1 metanálise, 2 retrospectivos, 9 prospectivos e 2 descritivos. E, após análise pormenorizada, 529 artigos foram excluídos devido aos critérios de exclusão: artigos em outras línguas que não inglês e a utilização apenas de anticorpo, imunoterapia ou terapia alvo molecular sem quimioterapia associados. Resultados: A partir da análise dos 46 artigos, foram encontrados descrições acerca dos aspectos conceituais, teorias metronômicas, efeito angiogênico, imunológico e quiescência tumoral, efeito 4 "D" e indicação clínica, avaliação de eficácia, segurança, marcadores, precisão e custo efetividade. Conclusão: Verificou-se que evidências clínicas e pré-clínicas suportam o uso de quimioterapia metronômica como uma alternativa ao tratamento oncológico padrão em cenário de acesso restrito a novas drogas, tais como: terapia alvo ou imunoterapia, sendo a principal característica sua baixa toxicidade, acessibilidade, disponibilidade de drogas para administração oral e alta atividade anti-angiogênica, além de outros efeitos diretos e indiretos, os quais se traduzem em benefício clínico
Metronomic treatment consists of regular and continuous administration of low-dose chemotherapy, preferably orally, without prolonged pauses, with the aim of blocking tumor proliferation. This treatment has been used for a number of tumors and, in recent years, there has been an increase in its use in clinical studies, especially in the palliative setting. Objective: To carry out a narrative review on the topic metronomic chemotherapy in solid tumors, in its aspects of definition, biological rationale, clinical indication, predictive and prognostic markers. Methodology: A search was carried out in the PUBMED database, the largest database of medical content, where 575 articles were found, of which 46 articles fit the selection criteria (articles in English published between 2015 and 2020), among them 32 review articles, 1 meta-analysis, 2 retrospective, 9 prospective and 2 descriptive. And, after a detailed analysis, 529 articles were excluded, due to the exclusion criteria: articles in languages other than English and the use of antibody alone, immunotherapy or molecular targeted therapy without associated chemotherapy. Results: From the analysis of the 46 articles, descriptions were found about the conceptual aspects, metronomic theories, angiogenic, immunological and tumor quiescence effects, 4 "D" effect and clinical indication, evaluation of efficacy, safety, markers, precision and cost effectiveness . Conclusion: It was found that clinical and preclinical evidence support the use of metronomic chemotherapy as an alternative to standard cancer treatment in a scenario of restricted access to new drugs, such as targeted therapy or immunotherapy, the main feature being its low toxicity, accessibility, availability of drugs for oral administration and high anti-angiogenic activity, in addition to other direct and indirect effects, which translate into clinical benefit
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Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Administração Metronômica , Neoplasias/tratamento farmacológico , Antineoplásicos/administração & dosagemRESUMO
Abstract Introduction Coronavirus disease 2019 (COVID-19) is an acute infection caused by the new coronavirus (SARS-CoV-2) and it is highly transmissible, especially through respiratory droplets. To prepare the health system for the care of these patients also led to a restriction in the activity of several medical specialties. Physicians who work with patients affected by diseases of the head and neck region constitute one of the populations most vulnerable to COVID-19 and also most affected by the interruption of their professional activities. Objective The aim of the present study was to assess the impact of the COVID-19 pandemic on the practice of head and neck surgeons and otorhinolaryngologists in Brazil. Methods An anonymous online survey of voluntary participation was applied, containing 30 questions regarding demographic aspects, availability of personal protective equipment (PPE), and impact on the routine of head and neck surgeons and otorhinolaryngologists, as well as clinical oncologists and radiation oncologists who work with head and neck diseases. Results Seven hundred and twenty-nine answers were received in a period of 4 days, ∼ 40 days after the 1st confirmed case in Brazil. With professionals working in public and private services, there was a high level of concerns with the disease and its consequences, limited availability of PPE and a significant decrease in the volume of specialized medical care. Conclusion The study demonstrated a direct impact of the COVID-19 pandemic on the clinical practice of specialties related to the treatment of patients with diseases of the head and neck region already in the beginning of the illness management in Brazil.
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Introdução: O câncer de sítio primário desconhecido caracteriza-se pela presença de doença metastática ao diagnóstico, sem localização do tumor primário. Objetivo: Conhecer o perfil dos pacientes com diagnóstico de câncer de sítio primário desconhecido em um centro de oncologia terciário. Material e método: Estudo retrospectivo e descritivo no qual foram analisados os prontuários dos pacientes com câncer de sítio primário oculto entre 2002 e 2012. Resultados: Entre os 68 prontuários analisados, observou-se que o adenocarcinoma é o tipo histológico mais frequente (39,71%) seguido pelo carcinoma espinocelular (29,41%). Os sítios de metástases mais recorrentes foram a região cervical (38,23%), fígado (20,58%) e peritônio (16,71%). A imuno-histoquímica foi realizada em 44,12%, os pacientes com acometimento cervical não se beneficiaram da elucidação diagnóstica por este meio, devido à falta de marcadores específi cos para este sítio. Em relação ao tratamento, 60,29% dos pacientes foram submetidos a alguma modalidade terapêutica, sendo a quimioterapia a mais comum, onde a cisplatina foi o antineoplásico mais utilizado de forma isolada (11,76%) e o esquema etoposídeo e cisplatina mais realizado em combinação (7,35%). Conclusão: O estudo está em consonância com os dados da literatura sobre o perfil destes pacientes; entretanto, apesar dos avanços nas técnicas diagnósticas, esta síndrome ainda representa um desafio na prática oncológica.
Introduction: Cancer is characterized by the presence of metastatic disease at diagnosis, without location of the primary tumor. Aim: To know the profile of patients diagnosed with cancer of unknown primary site in a tertiary cancer center. Methods: A retrospective study in which the medical records of patients with cancer of unknown primary site were analyzed between 2002 and 2012. Results: From the 68 charts analyzed adenocarcinoma was found to be the most common histological type (39.71 %), followed by squamous-cell carcinoma (29.41%). The most frequent metastasis sites were the cervical region (38.23%), liver (20.58%) and peritoneum (16.71%). Immunohistochemistry was performed on 44.12%, patients with cervical involvement did not benefi t from such diagnostic clarification due to lack of specific markers for this site. Regarding treatment, 60.29% of patients underwent some form of therapy, the most common being chemotherapy, where cisplatin was the most often antineoplastic used alone (11.76%) and etoposide plus cisplatin the most often used regimen used in combination (7.35%). Conclusion: The study is consistent with published data on the profile of these patients. Despite the advances in diagnostic techniques, however, this syndrome is still a challenge in oncology practice.
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Humanos , Epidemiologia Descritiva , Imuno-Histoquímica , Neoplasias Primárias DesconhecidasRESUMO
The Actinomyces sp has been linked to osteoradionecrosis of the jaw. The identification of these bacteria on histopathological findings confers a determining factor of poor prognosis and is related to difficulties of local control of bone necrosis and risk of recurrent infections. The treatment is complicated due to insidious growth pattern of Actinomyces sp. The methods for diagnosis and therapeutic approaches constitute challenges that underscore the need for understanding the risk factors for infection and knowledge about clinical conditions associated with this pathology. The objective of this study is to report two cases of cancer patients suffering from an osteoradionecrosis infection by Actinomyces sp, to describe approaches and discuss therapeutic options in the light of the current literature.
O Actinomyces sp tem sido associado a osteorradionecrose. A identificação desta bactéria confere um fator determinante de mau prognóstico e está relacionado a dificuldades do controle da necrose óssea local e a risco de infecções recorrentes. O tratamento é complicado devido ao padrão de crescimento insidioso do Actinomyces sp. Os métodos de diagnóstico e as abordagens terapêuticas constituem desafios que reforçam a necessidade de compreender os fatores de risco para a infecção e o conhecimento sobre as condições clínicas associadas a esta patologia. O objetivo deste trabalho é relatar dois casos clínicos de pacientes com câncer que sofrem infecção osteorradionecrose por Actinomyces sp, para descrever as abordagens e discutir as opções terapêuticas à luz da literatura atual.
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Osteonecrose , Osteorradionecrose , Actinomyces , Actinomicose , Difosfonatos , Arcada OsseodentáriaRESUMO
O câncer de boca representa um problema de saúde pública devido aos diagnósticos tardios e das taxas de morbimortalidade. Esse estudo avaliou o nível de conhecimento dos odontólogos (23) da atenção primária da rede pública de Divinópolis (MG) sobre o câncer bucal. Empregou-se questionário estruturado e os dados obtidos demonstraram que 39,1% dos entrevistados não sabiam qual o tipo mais comum de câncer de boca; 35% avaliaram seu nível de conhecimento como bom ou ótimo. Fatores de risco apontados: uso do tabaco, antecedentes familiares, uso do álcool e exposição solar. Apenas 13% receberam treinamento para o exame de câncer bucal na graduação. Esses achados reforçam a necessidade de abordagem do tema no período de formação acadêmica e de educação continuada.
Oral cancer represents a major public health problem due to high rates of late diagnoses and significant morbidity and mortality rates. This study assessed the level of knowledge of active dentists (23) in primary care in public health at Divinópolis (MG) on oral cancer. A structured questionnaire was used. The data showed that 39.1% of respondents didn`t know what the most common type of oral cancer, 35% rated their level of knowledge as good or great. Tobacco use, family history, alcohol use and sun exposure were the most likely risk factors mentioned. Only 13% received training for oral cancer exam on graduation. These findings reinforce the need for a greater approach regarding the theme during academic training and continuing education.
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Atenção Primária à Saúde , Neoplasias Bucais , Saúde Pública , Fatores de Risco , Odontólogos , Diagnóstico TardioRESUMO
O presente relato de caso refere-se ao carcinomaneuroendócrino de pequenas células de laringe acometendouma mulher de 52 anos. Este carcinoma é umaneoplasia altamente maligna com metástases frequentese taxa de sobrevida baixa. Depois dos carcinomasespinocelulares, os tumores de laringe mais frequentessão os neuroendócrinos, que podem ser derivados decélulas neurais ou epiteliais. Os tumores neuroendócrinosderivados de epitélio podem ser classificados emquatro grupos patológicos bem definidos: tumor carcinoide,tumor carcinoide atípico, carcinoma neuroendócrinode pequenas células e carcinoma neuroendócrinode células grandes. Os carcinomas neuroendócrinos têmmorfologia distinta, entretanto apresentam perfil imunohistoquímicomarcado por algumas combinações depositividade para citoqueratina, cromogranina, sinaptofisina,CD56, CD57, enolase, serotonina, somatostatinae bombesina. Esses tumores da laringe apresentam umgrande espectro de evolução clínica, dependente dosubtipo histológico, que influencia significativamente oplanejamento de todo o tratamento.
This case report refers to small cell neuroendocrinecarcinoma of the larynx affecting a 52-year-old female.This is a highly malignant neoplasm with frequentmetastases and a lower survival rate. After squamouscarcinomas, the most frequent tumors of the larynx arethe neuroendocrine, these tumors can be derived fromneural or epithelial cells. Neuroendocrine tumors derivedfrom epithelium can be classified into four pathologicalcategories defined: carcinoid tumor, atypical carcinoidtumor, small cell neuroendocrine carcinoma andlarge cell neuroendocrine carcinoma. It is known thatdespite of having distinct morphology, neuroendocrinecarcinomas have immunohistochemical profile markedby some combination of positive for cytokeratin, chromogranin,synaptophysin, CD56, CD57, enolase, serotonin,somatostatin and bombesin. These laryngeal tumorsshow a broad spectrum of clinical, dependent onthe histological subtype, which influences the planningof the whole treatment.