Predictors of Survival After Head and Neck Squamous Cell Carcinoma in South America: The InterCHANGE Study.

PURPOSE: Head and neck squamous cell carcinoma (HNSCC) incidence is high in South America, where recent data on survival are sparse. We investigated the main predictors of HNSCC survival in Brazil, Argentina, Uruguay, and Colombia. METHODS: Sociodemographic and lifestyle information was obtained from standardized interviews, and clinicopathologic data were extracted from medical records and pathologic reports. The Kaplan-Meier method and Cox regression were used for statistical analyses. RESULTS: Of 1,463 patients, 378 had a larynx cancer (LC), 78 hypopharynx cancer (HC), 599 oral cavity cancer (OC), and 408 oropharynx cancer (OPC). Most patients (55.5%) were diagnosed with stage IV disease, ranging from 47.6% for LC to 70.8% for OPC. Three-year survival rates were 56.0% for LC, 54.7% for OC, 48.0% for OPC, and 37.8% for HC. In multivariable models, patients with stage IV disease had approximately 7.6 (LC/HC), 11.7 (OC), and 3.5 (OPC) times higher mortality than patients with stage I disease. Current and former drinkers with LC or HC had approximately 2 times higher mortality than never-drinkers. In addition, older age at diagnosis was independently associated with worse survival for all sites. In a subset analysis of 198 patients with OPC with available human papillomavirus (HPV) type 16 data, those with HPV-unrelated OPC had a significantly worse 3-year survival compared with those with HPV-related OPC (44.6% v 75.6%, respectively), corresponding to a 3.4 times higher mortality. CONCLUSION: Late stage at diagnosis was the strongest predictor of lower HNSCC survival. Early cancer detection and reduction of harmful alcohol use are fundamental to decrease the high burden of HNSCC in South America.

Reconstrução craniofacial com retalhos microcirúrgicos: análise crítica / Craniofacial reconstruction with free flaps: a critical analysis

Introdução: Os defeitos craniofaciais após ressecção tumoral representam uma situação extrema em cirurgia reparadora devido à complexidade das estruturas envolvidas, pela configuração tridimensional do defeito e pelo grande impacto funcional e estético que implicam. Portanto, a utilização de retalhos livres tornou-se uma grande opção para as reconstruções envolvendo a região craniofacial. Métodos: Análise retrospectiva de 23 prontuários médicos de pacientes submetidos à ressecção de tumores da região craniofacial e que foram submetidos à reconstrução com retalhos microcirúrgicos no período de janeiro de 2005 a dezembro de 2007. Foram avaliados: variáveis demográficas; tipo histológico do tumor; retalho utilizado; índice de sucesso e complicações. Resultados: O tipo histológico mais comum foi o carcinoma espinocelular com 35%, seguido do carcinoma basocelular com 26%. O retalho microcirúrgico mais utilizado foi o reto abdominal com 40%, seguido do retalho ântero-lateral da coxa com 24%. As complicações imediatas e tardias foram de 26%, com índice de sucesso de 95,6%. Conclusão: Tendo em vista a magnitude do defeito residual após a ressecção tumoral, a reconstrução com retalhos microcirúrgicos apresenta-se como opção segura, em tempo único e com baixo índice de complicações, oferecendo ao paciente um rápido restabelecimento e retorno ao convívio familiar.

Introduction: Craniofacial defects after tumor resection represent an extreme situation in reconstructive surgery, because of the complex structure, the three dimensional configuration of the wound and a huge functional and aesthetic impact. Therefore, the use of free flaps became a useful option for the reconstruction of craniofacial defects. Methods: Retrospective review of 23 medical charts of patients underwent tumor resection in craniofacial area and reconstructed with free flaps between January, 2005 and December, 2007. Results: Squamous cell carcinoma was the most frequent histological type with 35%, followed by basal cell carcinoma with 26%. The rectus abdominis free flap was used in 40% and anterolateral thigh free flap was used in 24%. Immediate and late complications were seen in 26%. Success rate was 95.6%. Conclusion: Because the magnitude of residual defect after tumor ablation, the use of free flaps become mandatory and permit a better functional and aesthetic results with lower rates of complications.

Níveis de depressão em portadores de câncer de cabeça e pescoço / Depression level in patients with head and neck cancer

Objetivos: avaliar os níveis de sintomas depressivos em pacientes com dor orofacial crönica por câncer de cabeça e pescoço e verificar a associação destes com a gravidade da dor crônica. Método: o protocolo seguido foi observacional transversal. A casuística foi composta de sessenta pacientes com diagnóstico de câncer na região da cabeça e pescoço, divididos igualmente em portadores ou não de dor orofacial crônica realcionada ao processo de câncer. Os níveis de sintomas depressivos e a intensidade e severidade da dor foram avaliados pelo eixo II do RDC/TMD. Resultados: não foram encontradas diferenças estatisticamente significantes entre os níveis de sintomas depressivos presentes nos dois grupos de pacientes com câncer de cabeça e pescoço, havendo uma moderada correlação estatisticamente significante entre os níveis de sintomas depressivos e a severidade da dor crônica sentida nso pacientes com dor. Conclusões: podemos concluir que esiste uma correlação positiva moderada entre os níveis de severidade da dor e de sintomas depressivos

Objective: to assess the levels of depression symptoms in head and neck cancer patients with chronic orofacial pain and to verify the association between them and the chronic pain severity. Methods: it was an observational and sectional protocol. The sample consisted of sixty patients, uniformly divided in having chronic orofacial pain related to cancer process or not. Depression levels, pain intensity and severity were assessed with RDC/TMD axis II. Results: the study did not demstrate statiscally significant difference in depression levels in both head and neck cancer paind groups, with the occurrence of moderate statiscally significant correlation between depression levels and chronic pain intensity felt in pain patients. The study demonstrated a moderate statiscally sifnificant correlation between chronic pain severity and depression levels presented by pain patients. Conclusion: there is a positive moderate correlation between chronic pain severity graduation and derpession levels