Реферат
OBJECTIVE@#To obtain detailed understanding on the gene regulation of natural compounds in altering prognosis of head and neck squamous cell carcinomas (HNSC).@*METHODS@#Gene expression data of HNSC samples and peripheral blood mononuclear cells (PBMCs) of HNSC patients were collected from Gene Expression Omnibus (GEO). Differential gene expression analysis of GEO datasets were achieved by the GEO2R tool. Common differentially expressed gerres (DEGs) were screened by comparing DEGs of HNSC with those of PBMCs. The combination was further analyzed for regulating pathways and biological processes that were affected.@*RESULTS@#Totally 110 DEGs were retrieved and identified to be involved in biological processes related to tumor regulation. Then 102 natural compounds were screened for a combination such that the expression of all 110 commonly DEGs was altered. A combination of salidroside, ginsenoside Rd, oridonin, britanin, and scutellarein was chosen. A multifaceted, multi-dimensional tumor regression was showed by altering autophagy, apoptosis, inhibiting cell proliferation, angiogenesis, metastasis and inflammatory cytokines production.@*CONCLUSIONS@#This study has helped develop a unique combination of natural compounds that will markedly reduce the propensity of development of drug resistance in tumors and immune evasion by tumors. The result is crucial to developing a combinatorial natural therapeutic cocktail with accentuated immunotherapeutic potential.
Тема - темы
Humans , Leukocytes, Mononuclear , Head and Neck Neoplasms/drug therapy , Squamous Cell Carcinoma of Head and Neck/drug therapy , Immunotherapy , PrognosisРеферат
Oral squamous cell carcinoma (OSCC) is a prevalent malignant tumor affecting the head and neck region (Leemans et al., 2018). It is often diagnosed at a later stage, leading to a poor prognosis (Muzaffar et al., 2021; Li et al., 2023). Despite advances in OSCC treatment, the overall 5-year survival rate of OSCC patients remains alarmingly low, falling below 50% (Jehn et al., 2019; Johnson et al., 2020). According to statistics, only 50% of patients with oral cancer can be treated with surgery. Once discovered, it is more frequently at an advanced stage. In addition, owing to the aggressively invasive and metastatic characteristics of OSCC, most patients die within one year of diagnosis. Hence, the pursuit of novel therapeutic drugs and treatments to improve the response of oral cancer to medication, along with a deeper understanding of their effects, remains crucial objectives in oral cancer research (Johnson et al., 2020; Bhat et al., 2021; Chen et al., 2023; Ruffin et al., 2023).
Тема - темы
Humans , Mouth Neoplasms/pathology , Carcinoma, Squamous Cell/metabolism , Luteolin/therapeutic use , Squamous Cell Carcinoma of Head and Neck/drug therapy , Head and Neck Neoplasms/drug therapy , Cell Line, TumorРеферат
Objective: To evaluate the roles of G Protein-Coupled Receptor 68 (GPR68) and tumor infiltrating lymphocytes (TIL) in TPF-(paclitaxel, cisplatin and 5-fluorouracil) induced chemotherapy for middle-advanced hypopharyngeal squamous cell carcinomas. Methods: A total of 31 patients with middle-advanced hypopharyngeal squamous cell carcinoma before TPF-inducted chemotherapy were enrolled from September 2012 to November 2017 in Beijing Tongren Hospital, Capital Medical University, including 28 males and 3 females, aged 43 to 71 years old. The expression of GPR68 and tumor infiltrating CD4+and CD8+T cells before chemotherapy was detected by immunohistochemical staining, and the relationships between GPR68 expression and clinical features, chemotherapy efficacy and overall survival (OS) were analyzed using t-test. Results: After 3 cycles of chemotherapy, there were 4, 14, 10 and 3 patients respectively with complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). The positive rates of GPR68 and CD8 were 25% and 40% respectively in the effective group (CR+PR), while 50% and 15% in the ineffective group (SD+PD), with statistically significant differences between two groups (t=5.17 and 12.86,P<0.001). Linear regression analysis showed that GPR68 was negatively correlated with CD8+T cells (r=-0.64,P<0.001). There was no significant correlation between the CD4 expression and TPF efficacy (P>0.05). The mean OS was 12.5 months in patients with high-expressed GPR68 and 25.0 months in patients with low-expressed GPR68, with a statistically significant difference (P=0.005). And mean OS was 25.0 months in patients with high-expressed CD8 and 14.5 months in low-expressed CD8, with a statistically significant difference (HR=2.58, P=0.019). Cox regression analysis showed that GPR68 and CD8+T cells were significant prognostic factors (OR(95%CI)=3.27(2.46-5.97) and 1.53(0.78-1.82), all P<0.05), while CD4 had no significant effect on prognosis (P>0.05). Conclusion: GPR68 and CD8+T cells are expected to be biomarkers for evaluating the efficacy and prognosis of TPF-induced chemotherapy in patients with middle-advanced hypopharyngeal squamous cell carcinoma.
Тема - темы
Adult , Aged , Female , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cisplatin , Fluorouracil , Head and Neck Neoplasms/drug therapy , Induction Chemotherapy , Lymphocytes, Tumor-Infiltrating , Prognosis , Receptors, G-Protein-Coupled , Squamous Cell Carcinoma of Head and NeckРеферат
INTRODUCCIÓN. Los linfangiomas son una malformación infrecuente a escala mundial y constituye una preocupación para los padres del infante; está asociado a problemas estéticos y a posibles efectos deletéreos debido a la obstrucción o compresión de órganos vitales. Se ha descrito a la escleroterapia como la mejor opción de tratamiento. OBJETIVO. Determinar la eficiencia del tratamiento con bleomicina en linfangiomas en la población pediátrica de 0 a 18 años. MATERIALES Y MÉTODOS. Estudio transversal analítico retrospectivo. Población y muestra conocida de 20 datos de Historias Clínicas electrónicas de pacientes diagnosticados con linfangiomas y tratados con bleomicina en el Hospital de Especialidades Carlos Andrade Marín, desde enero 2015 a enero 2018. Criterios de inclusión: pacientes de 0 a 18 años de edad con diagnóstico de linfangioma mediante ecografía y angiotomografía computarizada. Criterios de exclusión: pacientes mayores de 18 años de edad o sospecha diagnóstica de linfangioma sin estudios de imagen, y/o que no acudieron a la cita de control, pacientes diagnosticados de linfangioma que no recibieron bleomicina para su tratamiento, niños con otras malformaciones vasculares. El análisis de datos se realizó en el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS. La mediana de edad en mujeres fue de 6,25 años y 3,8 años en hombres. 10 pacientes fueron hombres. El promedio de seguimiento fue de 26,86 +/- 16,78 meses. El tamaño promedio de los linfangiomas fue de 5,77 +/- 3,73 cm. La localización más frecuente fue cervical con un 52,38%. La mayoría fueron macronodulares con un 85,71%. La respuesta fue buena o excelente en el 81,00% de los casos con la primera infiltración y subió al 95,00% con la segunda y tercera, según requerimiento. CONCLUSIÓN. El tratamiento de los linfangiomas con bleomicina fue muy efectivo en la población estudiada.
INTRODUCTION. Lymphatic malformation is a rare malformation worldwide and is a concern for the parents of the infant; it is associated with aesthetic problems and possible deleterious effects due to obstruction or compression of vital organs. Sclerotherapy has been described as the best treatment option. OBJECTIVE. To determine the efficiency of bleomycin treatment in lymphangiomas in the pediatric population aged 0 to 18 years. MATERIALS AND METHODS. Retrospective analytical cross-sectional study. Population and known sample of 20 data from Electronic Medical Records of patients diagnosed with lymphangiomas and treated with bleomycin at the Carlos Andrade Marín Specialties Hospital, from January 2015 to January 2018. Inclusion criteria: patients aged 0 to 18 years with diagnosis of lymphangioma by ultrasound and computed angiotomography. Exclusion criteria: patients older than 18 years of age or diagnostic suspicion of lymphangioma without imaging studies, and/or who did not attend the control appointment, patients diagnosed with lymphangioma who did not receive bleomycin for treatment, children with other vascular malformations. Data analysis was performed in the statistical program International Business Machines Statistical Package for the Social Sciences. RESULTS. The median age in women was 6,25 years and 3,8 years in men. Ten patients were men. The average follow-up was 26,86 +/- 16,78 months. The average size of the lymphatic malformations was 5,77 +/- 3,73 cm. The most frequent location was cervical with 52,38%. Most were macronodular with 85,71%. The response was good or excellent in 81,00% of cases with the first infiltration and rose to 95,00% with the second and third, as required. CONCLUSION. The treatment of lymphangiomas with bleomycin was very effective in the population studied.
Тема - темы
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Bleomycin/therapeutic use , Lower Extremity , Upper Extremity , Head and Neck Neoplasms/drug therapy , Lymphangioma/drug therapy , Antibiotics, Antineoplastic/therapeutic use , Axilla , Cross-Sectional Studies , Retrospective Studies , Treatment Outcome , NeckРеферат
El producto Nimotuzumab, altamente demandado para el tratamiento de cáncer de cabeza y cuello, se produce en el Centro de Inmunología Molecular a partir del cultivo, fermentación y purificación en la línea NS0/H7. El uso de tecnologías adecuadas para la producción a gran escala de anticuerpos monoclonales, de acuerdo con las buenas prácticas de manufactura y con costos de producción razonables, se convierte en una necesidad para introducir anticuerpos terapéuticos en mercados de alta demanda y con elevados requerimientos de calidad. El incremento en la presencia de dímeros en el producto final afecta su calidad, por ende, la eficiencia y eficacia del proceso. Se utilizaron las bases de datos del centro para realizar un análisis de componentes principales, empleando el programa The Unscrambler 10.4 y se determinaron como variables más influyentes en la variabilidad de los resultados: las conductividades del producto ajustado y de salida en la columna de proteína A y membrana SQ y la masa de IgG en sobrenadante y eluato de proteína. Se realizó un análisis de Pareto para determinar los parámetros críticos del proceso, resultando ser: el pH de los tampones de elución y ajuste, del producto ajustado, de la salida en proteína y membrana, la masa de IgG en eluato de proteína y sobrenadante, y la conductividad del producto ajustado(AU)
ABSTRACT Nimotuzumab is produced at the Center of Molecular Immunology (CIM). It is obtained from the culture, fermentation, and purification in the cell line NS0/H7. This product has a high demand both domestically and internationally for the treatment of head and neck cancer. The use of adequate technologies for the large-scale production of this product following good manufacturing practices and reasonable production costs becomes a necessity to introduce this therapeutic antibody in high demand markets with high-quality requirements. The increase in dimers in the final product will affect its quality, which in turn affects the efficiency and effectiveness of the process. Production databases were used to perform principal component analysis using The Unscrambler 10.4 software. The conductivity of the adjusted product, pH at the output product in the protein column and membrane, the mass of supernatant, and of the eluate are detected as the variables with a higher influence on aggregate formation. The Pareto analysis was carried out to determine the critical parameters of the process: pH of elution and adjust buffers, and adjusted products, pH at the exit of protein column and membrane, the mass of protein in the eluate, and in the supernatant, and the conductivity of the adjusted product(AU)
Тема - темы
Humans , Male , Female , Reference Drugs , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/drug therapy , Antibodies, MonoclonalРеферат
En Cuba, el cáncer es la segunda causa de muerte con 24.902 defunciones en el 2018; de ellas, 795 fueron por tumores de laringe y 826 por tumores de labio, cavidad bucal y faringe. El anticuerpo monoclonal nimotuzumab (CIMAher®) está registrado como tratamiento combinado con radioterapia o quimioterapia para el cáncer de células escamosas de cabeza y cuello estadios avanzados. Del mismo se conoce su efectividad y perfil de seguridad, no así el impacto económico que acarrearía la incorporación del mismo al Sistema Nacional de Salud (SNS) cubano; de forma tal de asignar y reajustar presupuestos en la esfera de medicamentos. Por tanto, se hizo necesario realizar un análisis de impacto presupuestario, con el objetivo de estimar el impacto financiero de la incorporación del nimotuzumab (CIMAher®) al paquete de beneficios del SNS cubano. Se tomaron los datos de prevalencia e incidencia de la enfermedad en los estadios III/IV. Se estableció un escenario actual con la terapia radio/quimioterapia secuencial y una tasa de penetración de 100%. El escenario futuro fue radio/quimioterapia secuencial + nimotuzumab (CIMAher®) con tasa anual de penetración 20, 40, 60, 80 y 100 por ciento. La perspectiva fue desde el SNS y un horizonte temporal de 5 años (2019-2023). El análisis de impacto presupuestal mostró que, desde perspectiva, horizonte y tasa de penetración establecidos, el SNS debe invertir aproximadamente de 10 a 65 millones de pesos cubanos (CUP); cifras menores al presupuesto destinado a salud pública(AU)
In Cuba, cancer is the second cause of death with 24,902 deaths in 2018; 795 were due to laryngeal tumors and 826 due to tumors of the lip, oral cavity and pharynx. The monoclonal antibody nimotuzumab (CIMAher®) is registered as a combined treatment with radiotherapy or chemotherapy for advanced squamous cell carcinoma of the head and neck. Its effectiveness and safety profile are known, but not their economic impact into the Cuban National Health System (NHS); in order to allocate and readjust budgets in the field of medicines. Therefore, it was necessary to perform a budget impact analysis in order to estimate the financial impact of the incorporation of nimotuzumab (CIMAher®) into the benefits package of the Cuban NHS. Data on prevalence and incidence of the disease in stages III / IV were taken into account. The current scenario was with the therapy radio/sequential chemotherapy and penetration rate of 100 percent. The future scenario was radio/sequential chemotherapy + nimotuzumab (CIMAher®) and annual penetration rate of 20, 40, 60, 80 and 100 percent. The perspective was from the NHS and a time horizon of five years (2019-2023). The budget impact analysis showed that from an established perspective, horizon and penetration rate, the NHS must invest 10-65 million Cuban pesos (CUP) approximately; lower values than the budget allocated to Public Health(AU)
Тема - темы
Humans , Male , Female , Reference Drugs , Analysis of the Budgetary Impact of Therapeutic Advances , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/epidemiology , CubaРеферат
Introducción: Los tumores malignos de cabeza y cuello incluyen varios subtipos histológicos y el pronóstico depende de su ubicación anatómica. Objetivo: Describir las características clínicas y el tratamiento de pacientes pediátricos con tumores malignos de cabeza y cuello. Métodos: Estudio descriptivo, longitudinal y retrospectivo realizado en el servicio de Oncopediatría del Instituto Nacional de Oncología y Radiobiología, desde el 1ro. de enero de 2005 al 31 de diciembre de 2017. Se registraron variables demográficas, clínicas y terapéuticas. Se identificaron los pacientes a partir de las bases de datos del registro hospitalario del citado instituto. Se seleccionaron todos los pacientes con tumores de cabeza y cuello que tuvieron diagnóstico histológico. Resultados: Se identificaron 73 pacientes, con ligero predominio del sexo femenino (60,3 por ciento), con una edad media de 12 años (rango entre 0 y 18 años). El tipo histológico más frecuente fue el carcinoma tiroideo (35,6 por ciento), seguido de los rabdomiosarcomas (27,3 por ciento). El tratamiento más utilizado fue la cirugía (38,3 por ciento) seguido de la combinación de cirugía más radioterapia y quimioterapia (22,0 por ciento). Conclusiones: El tumor maligno de cabeza y cuello más frecuente en pacientes pediátricos es el carcinoma tiroideo. El tratamiento de elección es la resección total, acompañado de radioterapia y quimioterapia, dependiendo del tipo histológico y la etapa clínica(AU)
Introduction: Malignant tumors of the head and neck include several histological subtypes and the prognosis depends on their anatomical location. Objective: To describe the clinical characteristics and treatment of patients diagnosed with malignant head and neck tumors. Methods: A descriptive, longitudinal and retrospective study was carried out from January 1, 2005 to December 31, 2017 at the Oncopediatrics service in the National Institute of Oncology and Radiobiology, according to demographic, clinical and therapeutic variables. Patients were identified from the databases of the hospital registry of the above mentioned institute. All patients with head and neck tumors that had a histological diagnosis were selected. Results: 73 patients were identified, with a slight predominance of females (60.3 percent), with a mean age of 12 years (range between 0 and 18 years). The most frequent histological type was thyroid carcinoma (35.6 percent), followed by rhabdomyosarcomas (27.3 percent). The most used treatment was surgery (38.3 percent) followed by the combination of surgery plus radiotherapy and chemotherapy (22 percent). Conclusions: Tumors of the head and neck are infrequent. The treatment of choice is total resection, accompanied by radiotherapy and chemotherapy, depending on the histological type and the clinical stage(AU)
Тема - темы
Humans , Infant , Child, Preschool , Child , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/drug therapy , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Head and Neck Neoplasms/radiotherapyРеферат
Resumen El ácido valproico es un fármaco antiepiléptico con más de 50 años de uso clínico. En la década pasada se descubrieron sus efectos anticancerígenos. El análisis de grupos de pacientes que utilizaron este fármaco durante años ha mostrado que disminuye la frecuencia de cáncer de cabeza y cuello. Estudios recientes evidencian el efecto anticáncer al combinar el ácido valproico con la quimioterapia, terapia biológica e inhibidores de sistemas antioxidantes, con resultados excepcionales. En esta revisión se analiza el metabolismo del ácido valproico y su aplicación contra el cáncer.
Abstract Valproic acid is an antiepileptic drug with more than 50 years of clinical use. In the past decade, its anticancer effects were discovered. Analyses in groups of patients who used this drug for years have shown that it decreases the frequency of head and neck cancer. Recent studies show the anticancer effect of combining valproic acid with chemotherapy, biological therapy and antioxidant systems inhibitors, with exceptional results. In this review, we analyze the metabolism of valproic acid and its application against cancer.
Тема - темы
Humans , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Valproic Acid/administration & dosage , Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Valproic Acid/pharmacology , Head and Neck Neoplasms/drug therapy , Anticonvulsants/administration & dosage , Anticonvulsants/pharmacology , Neoplasms/pathologyРеферат
RESUMEN Los análogos del platino, como el cisplatino, y la radioterapia son usados de forma individual y en conjunto para el tratamiento de diversas neoplasias en población adulta y pediátrica. Sin embargo, el uso de estos tratamientos puede generar ototoxicidad, especialmente cuando son usados de forma combinada para neoplasias que comprometen cabeza y cuello, manifestándose principalmente como una hipoacusia progresiva e irreversible que compromete la calidad de vida. Diversos mecanismos han sido propuestos para explicar el daño en las estructuras auditivas generado por estos tratamientos, incluyendo la producción de especies reactivas del oxígeno y la inflamación, desencadenando muerte celular. Si bien distintas estrategias otoprotectoras han sido probadas en humanos, es aún incierta su efectividad y seguridad en combinación con los tratamientos oncológicos. El objetivo de la siguiente revisión es proporcionar una visión general y actualizada de la ototoxicidad inducida por quimio-radioterapia basada en platinos, discutiendo sus bases, características clínicas, potenciales tratamientos y estrategias preventivas que se han desarrollado en los últimos años.
ABSTRACT Platinum analogues, such as cisplatin, and radiotherapy are used separately or in combination to treat several neoplasms in pediatric and adult populations. Nonetheless, the use of these treatments may lead to ototoxicity, especially when these treatments are concomitantly used to treat head and neck cancers, which can manifest as progressive and irreversible hearing loss that decreases quality of life. Several mechanisms have been proposed in order to explain the damage to the auditory structures induced by these treatment modalities, including: reactive oxygen species production and inflammation, leading to cell death. Although several otoprotective strategies have been attempted in humans, their effectiveness and security are unclear. The objective of this review is to provide an updated and general overview on platinum-based chemoradio-therapy induced ototoxicity, discussing its basis, clinical features, potential treatments and preventive strategies developed in recent years.
Тема - темы
Humans , Cisplatin/adverse effects , Chemoradiotherapy/adverse effects , Ototoxicity/etiology , Ototoxicity/prevention & control , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Hearing Loss, Sensorineural/etiologyРеферат
Objetivo: este trabalho propõe condutas bucais aos pacientes com indicação quimioterápica, a partir de uma revisão de literatura, visto que o paciente é pouco orientado em muitos casos. Material e métodos: a busca foi realizada a partir da base de dados PubMed/Medline. Apenas estudos observacionais e revisões da literatura, em inglês, espanhol e português, publicados entre 2001 e 2019, que abordassem o tratamento antineoplásico e apresentassem complicações bucais foram incluídos. Resultados: dez artigos preencheram os critérios de inclusão. Notou-se que a maioria dos efeitos adversos cessam ao fim da quimioterapia. As principais alterações bucais observadas foram mucosite, xerostomia e candidose. Diversas alternativas terapêuticas se mostraram eficazes, sendo fundamental individualizar o paciente e propor a melhor opção para o quadro específico apresentado. Considerações finais: A participação do cirurgião-dentista na equipe oncológica é extremamente importante, realizando intervenções odontológicas e orientando os pacientes, colaborando para uma melhor qualidade de vida e contribuindo significativamente no prognóstico da doença.(AU)
Objective: This study suggests oral management for chemotherapy patients, through a literature review, considering that patients are poorly instructed in most cases. Material and methods: The search was performed in the PubMed / Medline database. Only observational studies and literature reviews in English, Spanish, and Portuguese, published between 2001 and 2019, which discussed antineoplastic treatment and presented oral complications were included. Results: Ten articles met the inclusion criteria. Most adverse effects were observed to cease at the end of chemotherapy. The main oral changes observed were mucositis, xerostomia, and candidosis. Several therapeutic alternatives seem to be effective, and it is essential to individualize the patient and propose the best option for the specific condition. Final considerations: The participation of dentists in the cancer team is extremely important for performing dental interventions, guiding patients, helping to provide a better quality of life, and contributing significantly to the prognosis of the disease.(AU)
Тема - темы
Humans , Stomatitis/chemically induced , Xerostomia/chemically induced , Candidiasis, Oral/chemically induced , Head and Neck Neoplasms/drug therapy , Antineoplastic Agents/adverse effects , Risk Factors , Head and Neck Neoplasms/complicationsРеферат
Introdução: A verificação do tempo até o tratamento de pacientes com câncer é importante para a avaliação da resolutividade do serviço de saúde. No Brasil, a Lei nº 12.732 determina o início do tratamento para pacientes com neoplasia maligna em sessenta dias contados a partir da data do diagnóstico, entretanto, são escassos os estudos que avaliam a eficácia da referida lei. Objetivos: 1 Descrever o itinerário dos pacientes com câncer de cabeça e pescoço do Estado de São Paulo no serviço de saúde, a partir da queixa principal; 2 Descrever o tempo decorrido entre queixa principal, diagnóstico, admissão e tratamento em pacientes com carcinoma epidermoide de cabeça e pescoço; 3 Comparar as médias de tempo até o tratamento segundo variáveis clínicas e sociodemográficas; 4 Verificar se houve mudanças no tempo até o tratamento antes e após a Lei nº 12.732. Metodologia: A população do estudo foi composta por pacientes com câncer de cabeça e pescoço pertencentes à segunda fase do Projeto Head and Neck Genome Project (GENCAPO II). Foram incluídos pacientes atendidos em cinco hospitais de referência para o tratamento de câncer no estado de São Paulo no período de 2011 a 2017. Dados clínicos relativos às datas e características dos pacientes foram extraídos do banco de dados do próprio GENCAPO II e do Registro de Câncer de Base Populacional do Município de São Paulo. Para a verificação da trajetória do paciente, foram descritas as médias e medianas dos dias, dias mínimos e máximos. A mesma verificação foi utilizada para descrever o período anterior e posterior à lei. As médias dos tempos avaliados foram comparadas com as variáveis clinicas e sociodemográficas por meio do teste de não paramétrico Mann-Whitney e Kruskal-Wallis. Resultados: Foram incluídos 1159 casos válidos. Verificou-se maior proporção de pacientes do sexo masculino, com idade média de 59,1 anos, não brancos, e com escolaridade igual ou inferior a ensino fundamental incompletos. A maioria (90,7%) foi diagnosticada nos estádios avançados e com tumores de boca. Foram identificados grupos com itinerários diferentes: Grupo 1. Com diagnóstico anterior à admissão no centro de tratamento, Grupo 2. com diagnóstico posterior à admissão no centro de tratamento, para os quais não se sabe se houve biópsia prévia à admissão e Grupo 3. com biópsia prévia à admissão e rebiópsia no centro de tratamento. A média do tempo entre diagnóstico e o início do tratamento foi de 96 dias no Grupo 1 , 58 dias no Grupo 2 e 118 dias no Grupo 3. A média de tempo entre o diagnóstico e o tratamento no Grupo 1 foi menor entre os pacientes brancos em comparação com os da raça/cor não branca (102 x 93), o mesmo ocorrendo no Grupo 2 (59 x 57) e Grupo 3 (177 x 76). A média de tempo entre o diagnóstico e o tratamento foi superior entre os pacientes com câncer de laringe no Grupo 1 e de boca no grupo 2. O tempo entre diagnóstico e tratamento diminuiu após a lei dos sessenta dias no Grupo 1 (de 96 dias para 93 dias) e no Grupo 2 (de 66 dias para 46 dias). Conclusão: Não houve um itinerário único para todos os pacientes. Realizar rebiópsia elevou o tempo para início do tratamento. Os negros tiveram maior tempo entre diagnóstico e tratamento. Após a lei dos sessenta dias, houve redução em dias entre diagnóstico e tratamento. São necessários meios que garantam a acessibilidade ao serviço de saúde e aperfeiçoem o itinerário do paciente.
Тема - темы
Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/drug therapy , Epidemiology , Noncommunicable DiseasesРеферат
Introducción: La radioterapia es una de las variantes de tratamiento más antiguas con que contamos hoy día para curar los pacientes afectos de neoplasias malignas, pero debe ser cuidadosamente seleccionada en pacientes pediátricos. Objetivo: Evaluar la respuesta al tratamiento radiante en niños con tumores de cabeza y cuello. Métodos: Se realizó un estudio descriptivo, retrospectivo lineal, donde se incluyeron 26 pacientes ingresados en el Servicio de Oncocirugía del hospital William Soler desde enero de 2000 a enero de 2013, con diferentes tipos de tumores malignos de cabeza y cuello y edades comprendidas entre 1 y 18 años. Se tuvieron en cuenta los efectos tóxicos a largo plazo del tratamiento radiante, asociado o no a tratamiento quimioterápico adyuvante o concurrente y a la cirugía. Resultados: Todos los pacientes recibieron radioterapia corporal externa, el 73,1 por ciento de los casos recibió quimioterapia adyuvante en su mayoría con diagnóstico de linfomas y 7,7 por ciento recibió quimioterapia concurrente. Esta última en dos pacientes: uno con sarcoma facial y otro con carcinoma de parótida. Cinco pacientes (19,2 por ciento) solo recibieron cirugía y radioterapia como tratamiento: dos casos con neuroblastoma, un caso con sarcoma facial y dos con hemangiopericitomas. Conclusión: El estudio demostró la gran utilidad del empleo de la radioterapia en el control de las enfermedades malignas de la infancia localizadas en cabeza y cuello(AU)
Introduction: Radiotherapy is one of the oldest treatments used nowadays for curing patients suffering from malignant neoplasias, but it must be carefully selected in pediatric patients. Objective: To evaluate the response of radiotherapy treatments in children with head and neck tumors. Methods: A descriptive, lineal retrospective study was carried out, in which were included 26 patients admitted in the Service of Oncosurgery of William Soler Hospital from January, 2000 to January, 2013. These patients presented different kinds of head and neck malignant tumors; their ages were among 1 and 18 years. The long term toxic effects of radiotherapy were taken into account, being those associated or not to concurrent or adyuvant chemotherapy, and to surgery. Results: All the patients received physical external radiotherapy. 73,1 percent of the cases (most of them with a diagnosis of lymphoma) received adyuvant chemotherapy and 7,7 percent had concurrent chemotherapy. This last one in two patients: one with facial sarcoma and the other one with parotid carcinoma. Just five patients (19.2 percent) had surgery and radiotherapy as treatment: two cases with neuroblastoma, one case with facial sarcoma, and two cases of hemangiopericytomas. Conclusions: This study has demonstrated the usefulness of radiotherapy in the control of head and neck malignant diseases in children(AU)
Тема - темы
Humans , Infant , Child, Preschool , Child , Adolescent , Treatment Outcome , Drug-Related Side Effects and Adverse Reactions/prevention & control , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/therapy , Epidemiology, DescriptiveРеферат
ABSTRACT Objective To evaluate the oral health of patients with head and neck cancer after antineoplastic treatment, and to compare them with patients with no history of cancer. Methods A total of 75 patients, divided into Study Group, composed of individuals after antineoplastic treatment (n=30), and Control Group, with individuals with no history of cancer (n=45), aged 37 to 79 years. The oral health status was evaluated through the index of decayed, missing or filled permanent teeth (DMFT), community periodontal index and evaluation of the use and need of prosthesis. All of these items were evaluated according to the criteria recommended by the World Health Organization. The statistical analysis was descriptive and used the Pearson's χ2 test. Results The community periodontal index was higher in the Study Group when compared to the Control Group (p<0.0001). The need for an upper (p<0.001) and lower (p<0.0001) prostheses was higher in the Study Group. Also, the use of upper prosthesis was higher in the Study Group (p<0.002). The missing or filled permanent teeth index between the two groups (p>0.0506) and the use of lower prosthesis (p>0.214) did not present a relevant statistical difference. Conclusion Periodontal disease and edentulism are the most significant changes in individuals who received antineoplastic therapy for head and neck cancer as well as greater need for oral rehabilitation.
RESUMO Objetivo Avaliar a saúde bucal de pacientes com câncer de cabeça e pescoço após tratamento antineoplásico, e compará-los com pacientes sem histórico de câncer. Métodos Foram avaliados 75 pacientes, divididos em Grupo de Estudo de indivíduos após tratamento antineoplásico (n=30) e Grupo de Controle de indivíduos sem histórico de câncer (n=45), com faixa etária de 35 a 79 anos. A condição de saúde oral foi avaliada pelo índice de dentes permanentes cariados, perdidos e obturados (CPOD), pelo índice periodontal comunitário e por uma avaliação de uso e necessidade de prótese, conforme critérios preconizados pela Organização Mundial da Saúde. A análise estatística foi descritiva e realizada por meio do teste do χ2 de Pearson. Resultados O índice periodontal comunitário foi maior no Grupo de Estudo quando comparado ao controle (p<0,0001). A necessidade de prótese superior (p<0,001) e inferior (p<0,0001) foi maior no Grupo de Estudo. O uso de prótese superior foi maior no Grupo de Estudo (p<0,002). O índice de dentes permanentes cariados, perdidos e obturados entre os dois grupos (p>0,0506) e o uso de prótese inferior (p>0,214) não apresentaram diferença estatística relevante. Conclusão A doença periodontal e o edentulismo são as alterações mais significativas em indivíduos que receberam terapia antineoplásica de câncer de cabeça e pescoço, assim como maior necessidade de reabilitação oral.
Тема - темы
Humans , Male , Female , Adult , Aged , Periodontal Diseases/etiology , Radiotherapy/adverse effects , Oral Health , Dental Caries/etiology , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Antineoplastic Agents/adverse effects , Brazil , Case-Control Studies , Periodontal Index , DMF Index , Dental Prosthesis/statistics & numerical data , Head and Neck Neoplasms/physiopathology , Middle AgedРеферат
Introducción: los efectos adversos severos son la causa principal de las interrupciones en las sesiones de radioterapia, lo cual repercute negativamente en el beneficio terapéutico esperado de estas intervenciones. Por tanto, la participación del estomatólogo en el diseño y ejecución de los protocolos de tratamiento estomatológico en pacientes con cáncer es tan importante como lo es el esquema de la terapia oncoespecífica. El control de las condiciones bucales desfavorables previo al comienzo del tratamiento constituye un factor de protección y condiciona la continuidad y el éxito terapéutico. Objetivos: identificar los eventos adversos a consecuencia del tratamiento radioionizante y determinar la relación entre los eventos adversos y las condiciones bucales preexistentes en pacientes geriátricos con cáncer de cabeza y cuello. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal en 72 pacientes geriátricos con cáncer de cabeza y cuello tributarios de radioterapia. Se evaluó el estado de salud bucal previo al inicio del tratamiento y durante este, basado en la guía de criterios comunes de toxicidad. Las variables estudiadas fueron edad, género, sitio topográfico, etapa clínica, estado de salud bucal, severidad de los efectos adversos e interrupciones de la radioterapia. El procesamiento de los datos se realizó utilizando el programa SPSS 11.0 y Epidat. Resultados: el 67 por ciento de los pacientes estaba comprendido en el grupo etario de 60-69 años, el 70 por ciento eran hombres. El 67 por ciento de todos los pacientes examinados tenían una condición bucal desfavorable y de ellos el 56 por ciento tuvo que interrumpir el tratamiento radioterapéutico. A partir de la sesión de radioterapia número 20 correspondiente a 40 Gy, todos los pacientes presentaron al menos un efecto adverso. Los principales eventos adversos fueron disgeusia, xerostomía y radiomucositis. Se demostró una asociación significativa entre los efectos adversos por radioterapia y el estado desfavorable de las condiciones bucales previo al inicio del tratamiento. Conclusiones: los resultados indican que la evaluación bucal estomatológica antes, durante y después de la terapia oncoespecífica debe constituir una práctica habitual en la atención de pacientes con cáncer de cabeza y cuello, pues la interrupción del tratamiento radiante por el agravamiento de los efectos adversos conspira contra la efectividad de esta terapéutica(AU)
Introduction: severe adverse effects are the main cause for interrupting radiotherapy sessions, a fact that has a negative repercussion in the therapeutically benefit expected from theses interventions. Therefore, the dental surgeon's involvement in designing and practicing these dental management protocols in patients with cancer is so important as the oncospecific therapies scheme. The control of unfavorable oral conditions before treatment is a protection factor and conditions therapeutic continuation and success. Objectives: to identify adverse events as a result of radioionic treatment and determine the relationship between adverse events and pre-existing oral conditions in geriatric patients with head and neck cancer. Methods: adescriptive, prospective and longitudinal study was carried out in 72 geriatric patients with head and neck cancer and who were receiving radiotherapy. The oral health status was evaluated right before and during treatment, based on the guidelines of common toxicity criteria. The variables studied were age, gender, topographic site, clinical stage, oral health status, severity of adverse effects and interruptions of radiotherapy. Data processing was performed using the programs SPSS 11.0 and Epidat. Results: 67 percent of the patients were included in the age group of 60-69 years, 70 percent were men. 67 percent of all examined patients had an oral condition that was unfavorable and, out of these, 56 percent had to interrupt the radiotherapeutic treatment. From the radiotherapy session number 20 on, corresponding to 40 Gy, all the patients presented at least one adverse effect. The main adverse events were dysgeusia, xerostomia and radiomucositis. A significant association was proved between the adverse effects of radiotherapy and the unfavorable oral conditions prior to the start of treatment. Conclusions: the results indicate that oral assessment in dentistry before, during and after oncoespecific therapy should be a common practice in the care of patients with head and neck cancer, since the interruption of radiotherapy due to the worsening of adverse effects negatively influence the effectiveness of this therapy(AU)
Тема - темы
Humans , Male , Middle Aged , Aged , Head and Neck Neoplasms/drug therapy , Oral Health/statistics & numerical data , Oral Manifestations , Radiotherapy/adverse effects , Epidemiology, Descriptive , Longitudinal Studies , Prospective Studies , Treatment OutcomeРеферат
Background: It is expected that about 65,000 new patients will be diagnosed with head and neck cancer in 2017 in the United States. Patients with recurrent or advanced or metastatic head and neck do not have good survival due to aggressive and recurrent nature of this cancer. Moreover, cumulative and residual toxicities from previous and ongoing treatments significantly impede quality of remaining part of their life. Currently available chemotherapeutic regimens for this group are derived from the treatments used for the potentially curable disease. These regimens and associated toxicity are obviously not the best matches for the treatment with palliative intent. We here present a retrospective study where we used dose-adjusted chemotherapy specifically for palliative treatment this sub-group of head and neck cancer patients. Methods: Study population was identified from the University of Florida, and IRB approval was obtained. We used currently available and approved chemotherapeutic agents (including Taxols, Platins, 5-Fluorouracil and Epidermal Growth Factor Receptor inhibitors) for treatment of head and neck cancer but dose-adjusted at approximate 50% dose of currently recommended doses. We then gave personalized doses for a prolonged period by titrating doses based on response and tolerability of each patient. Data was collected for treatment, response, side effects, and outcomes. KM analysis was performed for survival data. Results: Total of 32 patients were included in this study with a median age of 65.2 years and a median follow-up of 10.1 months. 62.5% (n = 20) had locally advanced disease and rest had metastatic disease. 37.5% (n = 12) had new disease while rest had recurrent cancer. Of 32 patients, 14 patients received TPF based while 18 patients received PFE based chemotherapy. Total of 270 chemotherapy cycles were delivered among these 32 patients. They received a median of 9 cycles (range 314) over a median of 6.2 months (range 1.821.1). With this treatment approach, we noted median progression-free survival of 14.0 months and median overall survival of 15.7 months. Notable grade 3 toxicities were generalized fatigue in 12.5% (n = 4), nausea/vomiting in 6.3% (n = 2), diarrhea in in 6.3% (n = 2), mouth soreness in 6.3% (n = 2), rash in 3.1% (n = 1), neutropenia in 18% (n = 6) and anemia in 15.6% (n = 5) while notable grade 4 toxicities were neutropenia and anaphylaxis in 3.1% (n = 1) patient each (AU)
Тема - темы
Humans , Male , Female , Palliative Care , Recurrence , Carcinoma, Squamous Cell/therapy , Drug Therapy , Administration, Metronomic , Head and Neck Neoplasms/drug therapy , Antineoplastic AgentsРеферат
Introdução: no Brasil, a mortalidade por doenças crônico-degenerativas vem mostrando uma ascensão progressiva, destacando-se as neoplasias malignas como a segunda causa de morte. O câncer bucal possui uma predominância em países em desenvolvimento, em especial na classe social com níveis socioeconômicos mais baixos. Objetivo: verificar o perfil epidemiológico dos pacientes submetidos à radioterapia/quimioterapia e atendidos na Faculdade de Odontologia da UFMG. Métodos: consistiu de um estudo retrospectivo, descritivo do tipo transversal. Foram analisados todos os registros dos pacientes atendidos no projeto de extensão: Atendimento de suporte odontológico ao paciente portador de neoplasia maligna e irradiado em região de cabeça e pescoço, no intervalo de 2005 a 2104. Após a coleta, as informações foram digitadas e organizadas em base do programa R versão 3.0.3. Resultados: dos 458 registros analisados entre 2005 e 2014, 351 (76,6 por cento) corresponderam a indivíduos do sexo masculino e 107 (23,4 por cento), do sexo feminino, com 55,57 (± 12,2) anos de média de idade. Verificou-se que o carcinoma de células escamosas foi o mais prevalente com 334 (73,2 por cento) dos casos. Em relação à localização do tumor, a cavidade oral apareceu com 193 (43,0 por cento) dos casos, já os tumores localizados em faringe e laringe, foram 156 (34,7 por cento). Em relação ao tratamento, a radioterapia foi realizada em 409 (89,7 por cento) dos pacientes, já a quimioterapia foi realizada em 237 (52,7 por cento) dos casos. Ao analisar as complicações pós-radioterapia, foram registrados 144 (32,6 por cento) casos de mucosite, 76 (17,2 por cento) de candidíase e apenas 40 (10,6 por cento) de osteorradionecrose. Conclusão: houve uma maior prevalência de pacientes do sexo masculino, com a sexta década de vida, como a mais acometida, sendo expressivo o número de casos em que o tratamento preconizado foi a radio e quimioterapia. O tipo de Câncer mais frequente foi o de células escamosas, localizados principalmente na cavidade oral e a complicação pós-radioterápica mais encontrada foi a mucosite(AU)
Introducción: en Brasil, la mortalidad por enfermedades crónicas ha mostrado un aumento progressivo; se destacan las neoplasias malignas como la segunda causa principal de muerte. El cáncer oral tiene un predominio en los países en desarrollo, sobre todo en la clase social con niveles socioeconómicos más bajos. Objetivo: verificar el perfil epidemiológico de los pacientes sometidos a radioterapia/ quimioterapia atendidos en la Facultad de Odontología de la UFMG. Métodos: consistió en un estudio retrospectivo, descriptivo de corte transversal. Se analizaron todos los registros de los pacientes atendidos en el proyecto de extensión: Apoyo y cuidado dental para los pacientes con neoplasias malignas e irradiado en la cabeza y el cuello desde el 2005 a 2104. Después de la recolección de datos, se introdujo la información y se organizó sobre la base del programa R versión 3.0.3. Resultados: de los 458 expedientes analizados entre 2005 y 2014, 351 (76,6 por ciento) correspondieron a hombres y 107 (23,4 por ciento) a mujeres, con una media de 55,57 (± 12,2) años de edad. Se encontró que el carcinoma de células escamosas prevaleció en 334 (73,2 por ciento) casos. En cuanto a la ubicación del tumor, la cavidad oral apareció con 193 (43, 0 por ciento) de los casos, ya que los tumores localizados en la faringe y la laringe fueron 156 (34,7 por ciento). Respecto al tratamiento, la radioterapia se realizó en 409 (89,7 por ciento) pacientes, ya que la quimioterapia se efectuó en 237 (52,7 por ciento) casos. Mediante el análisis de las complicaciones posradiación, hubo 144 (32,6 por ciento) casos de mucositis, 76 (17,2 por ciento) de candidiasis y solo 40 (10,6 por ciento) de osteorradionecrosis. Conclusiones: hubo una mayor prevalencia de pacientes del sexo masculino, y la sexta década de la vida fue la más afectada, con un número significativo de casos en que el paciente fue tratado con la radiación y la quimioterapia. El tipo más frecuente de cáncer en la boca fue de células escamosas, siendo la mucositis bucal la complicación más frequente posradioterapia(AU)
Introduction: in Brazil, the mortality from chronic diseases has shown a progressive rise, highlighting the malignant neoplasms as the second leading cause of death. The oral cancer is predominant in developing countries, particularly in lower socioeconomic sectors. Objective: to verify the epidemiological profile of patients undergoing radiotherapy/chemotherapy and treated at the dental school of UFMG. Methods: retrospective, descriptive and cross-sectional study. All the medical records of patients seen in the extension project "Support and dental care for patients with malignant and irradiated tumor in the head and the neck" were analyzed from 2005 to 2014. After data collection, they were entered and organized according to R program version 3.0.3. Results: out of 458 records analyzed in the period of 2005 through 2014, three hundred and fifty one (76.6 percent) and 107 (23.4 percent) belonged to males and females, respectively, with mean age of 55.57 (± 12.2). It was found that the squamous cell carcinoma was prevailing in 334 (73. 2 percent) cases. Regarding the location of the tumor, the oral cavity comprised 193 (43.0 percent) cases, since the tumors located in the pharynx and the larynx were present in 156 (34.7 percent). In terms of treatment, radiotherapy was performed in 409 (89.7 percent) patients and chemotherapy in 237 (52.7 percent) cases. By analyzing the post-radiation complications, there were found 144 (32.6 percent) cases of mucositis, 76 (17.2 percent) candidiasis and just 40 (10.6 percent) osteoradionecrosis. Conclusions: malignant neoplasms show higher prevalence in male patients and the 60 year age group was the most affected, with a significant number of patients treated with radiation and chemotherapy. The most frequent type of oral cancer was the squamous cell cancer, being mucositis the most frequent oral complication after treatment(AU)
Тема - темы
Humans , Male , Female , Middle Aged , Carcinoma, Squamous Cell/radiotherapy , Data Collection , Head and Neck Neoplasms/drug therapy , Health Profile , Stomatitis/complications , Cross-Sectional Studies , Epidemiology, Descriptive , Retrospective StudiesРеферат
Abstract The mouth and oropharynx cancer is the 6th most common type of cancer in the world. The treatment may involve surgery, chemotherapy and radiotherapy. More than 50% of drugs against cancer were isolated from natural sources, such as Catharanthus roseus and epipodophyllotoxin, isolated from Podophyllum. The biggest challenge is to maximize the control of the disease, while minimizing morbidity and toxicity to the surrounding normal tissues. The Erythroxylum suberosum is a common plant in the Brazilian Cerrado biome and is popularly known as "cabelo-de-negro". The objective of this study was to evaluate the cytotoxic activity of Erythroxylum suberosum plant extracts of the Brazilian Cerrado biome associated with radiotherapy in human cell lines of oral and hypopharynx carcinomas. Cells were treated with aqueous, ethanolic and hexanic extracts of Erythroxylum suberosum and irradiated at 4 Gy, 6 Gy and 8 Gy. Cytotoxicity was evaluated by MTT assay and the absorbance was measured at 570 nm in a Beckman Counter reader. Cisplatin, standard chemotherapy, was used as positive control. The use of Erythroxylum suberosum extracts showed a possible radiosensitizing effect in vitro for head and neck cancer. The cytotoxicity effect in the cell lines was not selective and it is very similar to the effect of standard chemotherapy. The aqueous extract of Erythroxylum suberosum, combined with radiotherapy was the most cytotoxic extract to oral and hypopharynx carcinomas.
Resumo O câncer de boca e de orofaringe emerge como o 6º tipo de câncer mais comum no mundo. O tratamento pode envolver cirurgia, quimioterapia e radioterapia. Mais de 50% das drogas com atividade de combate ao câncer foram isoladas de fontes naturais, tais como a Catharanthus roseus e a epipodofilotoxina, isolada de Podophyllum. O maior desafio é maximizar o controle da doença, enquanto minimiza a morbidade e toxicidade para os tecidos normais circundantes. O Erythroxylum suberosum é uma planta comum no bioma Cerrado brasileiro e é popularmente conhecida como "cabelo-de-negro". O objetivo deste estudo foi avaliar a citotoxicidade dos extratos da planta Erythroxylum suberosum do bioma Cerrado brasileiro, associados à radioterapia em linhagens celulares humanas de carcinomas de língua e de hipofaringe. As células foram tratadas com os extratos aquoso, etanólico e hexânico do Erythroxylum suberosum e irradiadas com 4 Gy, 6 Gy e 8 Gy. A citotoxidade foi avaliada pelo ensaio de MTT e a absorvância foi medida a 570 nm em uma leitora Beckman. A cisplatina, quimioterápico padrão, foi utilizada como controle positivo. O uso de extratos de Erythroxylum suberosum mostrou potencial efeito radiosensibilizante in vitro no câncer de cabeça e pescoço. O efeito da citotoxicidade nas linhagens foi de forma não seletiva e muito semelhante ao efeito da quimioterapia padrão. O extrato aquoso de Erythroxylum suberosum, combinado com radioterapia, foi o extrato mais citotóxico para os carcinomas de língua e hipofaringe, associados à radioterapia.
Тема - темы
Humans , Antineoplastic Agents/therapeutic use , Erythroxylaceae/chemistry , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Plant Extracts/therapeutic use , Cell Line, Tumor , Combined Modality TherapyРеферат
Introduction: About 870,000 new cases of malignant airway and digestive tract tumor are diagnosed annually worldwide. Patients undergoing radiotherapy (RT) for head and neck develop as side effects oral mucositis and other complications that can lead to discontinuation of anticancer treatment. Aim: This study was conducted to determine whether oral care can reduce the rates of discontinuation of anticancer treatment. Method: We selected patients with carcinoma of the head and neck radiotherapy with or without chemotherapy (CT) in the Hospital São Vicente de Paulo de Passo Fundo. A total of 187 patients were evaluated and divided into two groups: Group I (patients receiving dental treatment) and Group II (patients not receiving dental treatment). Group I patient were submitted to daily assessments, receiving guidance, following a protocol for dental treatment and adjuvant application of low intensity laser throughout the period they performed RT. Group II - patients were evaluated and followed only, for not allowing the proposed treatment. Results: The interruption of radiation treatment was 2.4% of the patients in Group I, and Group II 34.6%. Conclusions: prevention and early treatment of complications related to RT like oral mucositis can decrease the chance of the patient to abandon radiotherapy and consequently contribute for a better prognosis for cure and patient survival (AU)
Introdução: Cerca de 870 mil novos casos de neoplasias malignas de vias aéreas e tumores do aparelho digestivo são diagnosticados anualmente em todo o mundo. Os pacientes submetidos à radioterapia (RT) de cabeça e pescoço desenvolvem efeitos colaterais como mucosite oral e outras complicações que podem levar à interrupção do tratamento anticâncer. Objetivo: Este estudo foi realizado para determinar se cuidados bucais podem reduzir as taxas de abandono do tratamento anticâncer. Método: Foram selecionados pacientes com carcinoma de cabeça e pescoço submetidos a radioterapia (RT), com ou sem quimioterapia (QT), no Hospital São Vicente de Paulo de Passo Fundo. Um total de 187 pacientes foram avaliados e divididos em dois grupos: Grupo I (pacientes que recebem tratamento dental) e Grupo II (pacientes que não receberam tratamento dental). Os pacientes do grupo I foram submetidos a cuidados diários, recebendo orientação, seguindo um protocolo de tratamento odontológico e aplicação adjuvante do laser de baixa intensidade durante todo o período que realizaram RT. Os pacientes do grupo II foram avaliados odontologicamente e acompanhados somente. Resultados: A interrupção do tratamento com radiação foi de 2,4% dos pacientes do Grupo I e no Grupo II 34,6%. Conclusões: a prevenção e o tratamento precoce das complicações relacionadas com a RT, como mucosite oral, podem diminuir a chance de o paciente abandonar a radioterapia e, consequentemente, contribuir para um melhor prognóstico de cura e sobrevida dos pacientes (AU)
Тема - темы
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Radiation Injuries , Low-Level Light Therapy/adverse effects , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Stomatitis/chemically induced , Dental Care for Chronically Ill , Withholding TreatmentРеферат
Introdução: o hemangioma da infância é uma proliferação neoplásica benigna de células endoteliais, decorrente de um desequilíbrio na angiogênese. Atinge 10 a 12% das crianças com menos de ano de vida, sendo, portanto, o tumor mais comum da infância. O tratamento, geralmente, é expectante, mas são utilizados, em alguns casos, propranolol oral, corticosteroides, interferon alfa-2a, laserterapia, embolização, imunomoduladores e cirurgia. Descrição do caso: criança do sexo masculino com hemangioma em couro cabeludo de 3 cm de diâmetro. Utilizou-se maleato de timolol 0,5%, solução oftálmica, três gotas duas vezes ao dia na superfície da lesão, durante dois anos. Após um ano de tratamento, a lesão apresentava-se praticamente plana, com involução quase completa e alopecia residual. Nenhum efeito colateral foi observado durante o período de tratamento. Discussão: o hemangioma da infância possui amplo espectro clínico e graus variados de gravidade, o que torna o seu manejo difícil e controverso. Diante do alto número de efeitos colaterais descritos para os tratamentos convencionais, o timolol tópico tem se tornado excelente alternativa para os casos não complicados. Conclusão: o timolol tópico vem sendo uma nova opção terapêutica eficaz e desprovida de efeitos colaterais para o tratamento do hemangioma da infância, sendo capaz de acelerar sua involução e prevenir complicações. Entretanto, é necessário que sejam realizados estudos que padronizem a dosagem terapêutica mais segura e avaliem o real risco x benefício do uso do fármaco no tratamento desse tipo de tumor.(AU)
Introduction: Infantile hemangioma is a benign neoplastic proliferation of endothelial cells, resulting from an imbalance in angiogenesis. Reaches 10-12% of children under one year old, therefore it is the most commom tumor of childhood. Treatment is usually expectant, but in some cases can be used oral propranolol, corticosteroids, interferon alpha-2a, laser therapy, embolization, immunomodulators and surgery. Case report: Male child with scalp hemangioma of 3 cm diameter. It was used eye drop solution of timolol maleate 0.5%, three drops, twice daily, on the surface of the lesion, during two years. After one year, it was almost plane and completely involuted with residual alopecia. No side effects were observed during the treatment. Discussion: Infantile hemangioma has a wide spectrum of clinical presentation and varying degrees of severity, which make it difficult and controversial management. Due to the high number of side effects reported for conventional treatments, topical timolol has become an excellent alternative for uncomplicated cases. Conclusion: Topical timolol has been an effective therapeutic option devoid of side effects for treatment of infantile hemangioma, being able to accelerate tumors involution and to prevent complications. Still, it is necessary studies to standardize the safest therapeutic dose and evaluate the actual risk-benefit ratio of timolol use in treatment of this tumor.(AU)