Single transverse extended incision for radical neck dissection.

OBJECTIVE: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. METHOD: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. RESULTS: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. CONCLUSIONS: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor. OBJETIVO: verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. MÉTODO: estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio piriforme em três, na laringe em dois, no seio maxilar em um e em um caso a lesão primária era oculta. Houve 29 esvaziamentos, sendo oito bilaterais e 10 unilaterais (26 radicais e três seletivos). O estadiamento revelou nove pacientes com tumor T4, um T3, seis T2, um T1 e um Tx. Cinco pacientes eram N0, nove N2b, um N2c e três N3. A média de linfonodos dissecados foi de 34,25. O esvaziamento cervical foi realizado por meio de uma única incisão localizada no terço médio do pescoço, coincidente com dobra cutânea, com extensão de cerca de 2 a 3 cm para trás da borda anterior do músculo trapézio e 3 a 4 cm da linha média para os esvaziamentos cervicais unilaterais. RESULTADOS: como complicações houve necrose de retalho miocutâneo em um paciente com radioterapia prévia, uma fistula linfática, uma deiscência do traqueostoma, um abscesso cervical, uma fístula salivar e uma deiscência de sutura. CONCLUSÕES: a incisão única e estendida proporciona exposição adequada das estruturas do pescoço, sem comprometer o tempo cirúrgico, mesmo em esvaziamentos bilaterais. Não compromete a ressecção de todos os linfonodos cervicais, apresenta excelentes resultados estéticos e funcionais e é facilmente associada com outras abordagens para ressecção do tumor primário.

Single transverse extended incision for radical neck dissection / Esvaziamento cervical radical por incisão transversa única estendida

ABSTRACT Objective: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. Method: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. Results: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. Conclusions: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor.

RESUMO Objetivo: verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. Método: estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio piriforme em três, na laringe em dois, no seio maxilar em um e em um caso a lesão primária era oculta. Houve 29 esvaziamentos, sendo oito bilaterais e 10 unilaterais (26 radicais e três seletivos). O estadiamento revelou nove pacientes com tumor T4, um T3, seis T2, um T1 e um Tx. Cinco pacientes eram N0, nove N2b, um N2c e três N3. A média de linfonodos dissecados foi de 34,25. O esvaziamento cervical foi realizado por meio de uma única incisão localizada no terço médio do pescoço, coincidente com dobra cutânea, com extensão de cerca de 2 a 3 cm para trás da borda anterior do músculo trapézio e 3 a 4 cm da linha média para os esvaziamentos cervicais unilaterais. Resultados: como complicações houve necrose de retalho miocutâneo em um paciente com radioterapia prévia, uma fistula linfática, uma deiscência do traqueostoma, um abscesso cervical, uma fístula salivar e uma deiscência de sutura. Conclusões: a incisão única e estendida proporciona exposição adequada das estruturas do pescoço, sem comprometer o tempo cirúrgico, mesmo em esvaziamentos bilaterais. Não compromete a ressecção de todos os linfonodos cervicais, apresenta excelentes resultados estéticos e funcionais e é facilmente associada com outras abordagens para ressecção do tumor primário.

Extracranial neurogenic tumors of the head and neck, / Tumores neurogênicos extracranianos na cabeça e pescoço

ABSTRACT INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5 cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5 cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.

Resumo INTRODUÇÃO: Tumores dos nervos periféricos tipicamente derivam das células de Schwann da bainha dos nervos periféricos. Por serem incomuns, devem ser lembrados no diagnóstico diferencial pré-operatório. OBJETIVO: Relatar a experiência de serviço de referencia terciária. MÉTODO: De 1977 a 2013, 42 pacientes com tumores neurogênicos periféricos da cabeça e pescoço foram operados e analisados retrospectivamente. A confirmação diagnóstica pré-operatória deu-se por biópsia ou método de imagem. RESULTADOS: A média da idade foi de 41,7 anos, sendo 15 indivíduos (36%) do gênero masculino. O tamanho médio foi de 5,5 cm e 26 (61%) localizavam-se na face lateral do pescoço. A maior parte (39,9%) apresentou-se como tumor palpável assintomático. A maioria (39,9%) foi ressecadapor acesso cervical. A maioria originou-se de nervos cranianos. CONCLUSÕES: Tumores neurogênicos extracranianos apresentam-se com tamanho médio de 5,5 cm, na face lateral do pescoço, costumam originar-se de nervos cranianos e ser ressecados por via cervical.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer / Prevalência das alterações em tomografias computadorizadas de tórax em pacientes com câncer de cabeça e pescoço

Objective: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. Methods: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic / tumoral Results: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. Conclusion: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

Objetivo: avaliar a prevalência de alterações encontradas na tomografia computadorizada (TC) de tórax em pacientes com carcinoma epidermóide de cabeça e pescoço. Métodos: Foram analisadas retrospectivamente 209 TC de tórax de pacientes com carcinoma epidermoide de cabeça e pescoço. As alterações tomográficas foram estratificadas como: inflamatórias/infecciosas, parenquimatosas, nodulares incaracterísticas e nodulares metastáticas/tumorais Resultados: foram diagnosticadas alterações em 66,6 % dos exames. Destes, 25,3% representaram enfisema pulmonar; 18,8% micronódulos incaracterísticos; 12,9% metástases; 11,9% de linfonodomegalias torácicas; e, em 6,6%, foram detectadas tuberculose pulmonar ativa ou sequela, pneumonia ou sinais inflamatórios/infecciosos e espessamento ou derrame pleural. Conclusão: a prevalência de exames com alteração e o considerável índice de metástases detectadas, indicam que a TC de tórax deve ser solicitada para complementação diagnóstica e/ou estadiamento nos casos de câncer de cabeça e pescoço.

Extracranial neurogenic tumors of the head and neck.

INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.

Review of survival rates 20-years after conservative surgery for papillary thyroid carcinoma / Revisão dos resultados de sobrevida a 20 anos da cirurgia conservadora no carcinoma papilífero da tireoide

INTRODUCTION: A less extensive thyroidectomy could be used for patients in the low risk group.OBJECTIVE: To perform a critical follow-up after lobectomy with isthmusectomy for the treatment of papillary thyroid carcinoma in patients with a single nodule limited to the periphery of the lobe.METHODS: Thirty-one patients with thyroid papillary carcinoma operated on till 1993 were selected. They had undergone lobectomy with isthmusectomy. This is a retrospective cohort study in which the oncological outcome (contralateral and regional recurrence) and the reoperation complications (recurrent nerve paralysis/paresis and hypoparathyroidism) were evaluated. Descriptive analysis was employed.RESULTS: In the last decade (2003-2013), 6 (20%) contralateral recurrences were observed in the remaining lobe and in 1 of these cases (3%), contralateral lymph node metastases were noted. A completion thyroidectomy plus lymphadenectomy was performed, without modification of global survival.CONCLUSION: Because of the rate of 20% of contralateral recurrence after a 20-year follow-up, we suggest modification of the surgical paradigm for total thyroidectomy as an initial therapy.

INTRODUÇÃO: Uma cirurgia menos extensa da glândula tireoide poderia ser utilizada em pacientes do grupo de baixo risco.OBJETIVO: Realizar seguimento crítico após hemitireoidectomia para tratamento do carcinoma papilífero de tireoide em casos de nódulo único limitado à periferia do lobo.MÉTODO: Foram selecionados 31 pacientes portadores de carcinoma papilífero de tireoide operados, até 1993, por lobectomia mais istmectomia. Trata-se de um estudo retrospectivo de coorte sendo avaliados o resultado oncológico (recidiva contralateral e regional) e complicações de reoperação (paralisia/paresia de nervo recorrente e hipoparatireoidismo). Utilizou-se análise descritiva.RESULTADOS: Na última década, foram observados 6 (20%) casos de recidivas contralaterais (lobo remanescente) sendo que, em um caso, estava acompanhado de metástases linfonodais contralaterais (3%), sem impacto na sobrevida dos pacientes reoperados.CONCLUSÃO: A ocorrência de 20% de recidiva contralateral após uma média evolutiva de 20 anos sugere revisão do paradigma conservador para a totalização imediata da tireoidectomia.

Review of survival rates 20-years after conservative surgery for papillary thyroid carcinoma.

INTRODUCTION: A less extensive thyroidectomy could be used for patients in the low risk group. OBJECTIVE: To perform a critical follow-up after lobectomy with isthmusectomy for the treatment of papillary thyroid carcinoma in patients with a single nodule limited to the periphery of the lobe. METHODS: Thirty-one patients with thyroid papillary carcinoma operated on till 1993 were selected. They had undergone lobectomy with isthmusectomy. This is a retrospective cohort study in which the oncological outcome (contralateral and regional recurrence) and the reoperation complications (recurrent nerve paralysis/paresis and hypoparathyroidism) were evaluated. Descriptive analysis was employed. RESULTS: In the last decade (2003-2013), 6 (20%) contralateral recurrences were observed in the remaining lobe and in 1 of these cases (3%), contralateral lymph node metastases were noted. A completion thyroidectomy plus lymphadenectomy was performed, without modification of global survival. CONCLUSION: Because of the rate of 20% of contralateral recurrence after a 20-year follow-up, we suggest modification of the surgical paradigm for total thyroidectomy as an initial therapy.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer.

OBJECTIVE: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. METHODS: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic/tumoral. RESULTS: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. CONCLUSION: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

Delayed postoperative radiation therapy in local control of squamous cell carcinoma of the tongue and floor of the mouth / Retardo da radioterapia pós-operatória no controle local do carcinoma epidermoide de língua e soalho de boca

Objective To evaluate the effect of time between surgery and postoperative radiation therapy on local recurrence of squamous cell carcinoma of the tongue and floor of the mouth. Methods A total of 154 patients treated between 1996 and 2007 were selected considering local recurrence rate and time of the adjuvant radiotherapy. Results Local recurrence was diagnosed in 54 (35%) patients. Radiation therapy reduced the rate of local recurrences, although with no statistical significance. The time between surgery and initiation of postoperative radiotherapy did not significantly influence the risk of local recurrence in patients referred to adjuvant treatment (p=0.49). Conclusion In the presence of risk factors for local recurrence, a short delay in starting the adjuvant radiation therapy does not contraindicate its performance. .

Objetivo Avaliar o efeito do tempo entre o tratamento cirúrgico e a radioterapia pós-operatória nas recidivas locais do carcinoma epidermoide de língua e soalho da boca. Métodos Foram selecionados 154 pacientes tratados entre 1996 e 2007, considerando a frequência das recidivas locais e o tempo para início da radioterapia adjuvante. Resultados As recidivas locais foram diagnosticadas em 54 (35%) pacientes. A radioterapia reduziu a frequência de recidivas locais, embora sem significância estatística. O tempo entre a cirurgia e o início da radioterapia pós-operatória não influenciaram, de forma significante, no risco de recidivas locais entre o pacientes que tinham indicação de tratamento adjuvante (p=0,49). Conclusão Na presença de fatores de risco para recidiva local, um pequeno atraso no início da radioterapia adjuvante não contra-indica sua realização. .

Delayed postoperative radiation therapy in local control of squamous cell carcinoma of the tongue and floor of the mouth.

OBJECTIVE: To evaluate the effect of time between surgery and postoperative radiation therapy on local recurrence of squamous cell carcinoma of the tongue and floor of the mouth. METHODS: A total of 154 patients treated between 1996 and 2007 were selected considering local recurrence rate and time of the adjuvant radiotherapy. RESULTS: Local recurrence was diagnosed in 54 (35%) patients. Radiation therapy reduced the rate of local recurrences, although with no statistical significance. The time between surgery and initiation of postoperative radiotherapy did not significantly influence the risk of local recurrence in patients referred to adjuvant treatment (p=0.49). CONCLUSION: In the presence of risk factors for local recurrence, a short delay in starting the adjuvant radiation therapy does not contraindicate its performance.

Valor prognostico da metastase regional no carcinoma epidermoide de lingua e soalho bucal / Prognostic value of regional metastasis in squamous cell carcinoma of the tongue and floor of mouth

A presença da metástase linfonodal é um fator limitante da sobrevida no câncer da boca. OBJETIVO: Avaliar as causas de falha no tratamento dos carcinomas de língua e soalho de boca em função do estadiamento. MÉTODO: Foram analisados 365 casos de carcinoma epidermoide de boca, tratados de 1978 a 2007, sendo 48 T1, 156 T2, 98 T3 e 63 T4, dos quais 193 foram pNo e 172 pN+. RESULTADOS: Entre os casos pN+, foram observados 17/46 recidivas (36,9%) nos casos não irradiados e 46/126 (36,5%) nos casos irradiados. Quanto aos resgates, nos casos pN0, obtivemos 16/51 (31,3%) e, nos pacientes pN+, de 3/77 (3,9%). CONCLUSÃO: O sucesso dos resgates é menor em pacientes com pN+, com maior recidiva local e menor sobrevida. .

The presence of metastatic nodes is a survival-limiting factor for patients with mouth tumors. OBJECTIVE: To evaluate the causes of treatment failure in carcinomas of the tongue and floor of the mouth due to staging. METHOD: This study included 365 patients with squamous cell carcinoma of the mouth treated from 1978 to 2007; 48 were staged as T1, 156 as T2, 98 as T3, and 63 as T4, of which 193 were pNo and 172 pN+. RESULTS: Among the pN+ cases, 17/46 (36.9%) of the patients not treated with radiation therapy had relapsing tumors, against 46/126 (36.5 %) of the patients who underwent radiation therapy. Success rates in the group of subjects submitted to salvage procedures were 16/51 (31.3%) for pN0 patients and 3/77 (3.9%) for pN+ patients. CONCLUSION: Salvage procedure success and survival rates are lower for pN+ patients; pN+ individuals also have more relapsing local disease. .

Value of immunohistochemistry in the diagnosis of malignant cervical lymph nodes.

UNLABELLED: The cervical lymph nodes are relevant due to the diversity of clinical entities. The use of immunohistochemistry is a real method to elucidate the diagnosis of adenopathy, both primary and metastatic neoplasms. OBJECTIVE: To assess the value of immunohistochemistry in the diagnosis of cervical lymph nodes malignancies. METHOD: Retrospective study of the database histopathological specimens from 2009 to 2011. RESULTS: Out of 32 biopsies of cervical lymph nodes, in 16 (50%) the immunohistochemistry was employed, being 68.75% (11) in hematological neoplasms and 31.25% (5) in carcinomas. It was used in all cases of lymphoma. CONCLUSION: The immunohistochemistry was used in 50% of the biopsies of lymph nodes under suspicion of malignancy, being 31.25% in epithelial lesions and 68.75% in lymphoproliferative lesions.

Papel da imuno-histoquimica no diagnostico de adenopatias cervicais malignas / Value of immunohistochemistry in the diagnosis of malignant cervical lymph nodes

As adenopatias cervicais constituem importante condição clínica, devido à grande variedade de diagnósticos diferenciais que englobam. O uso da imuno-histoquímica tornou-se importante método auxiliar na avaliação diagnóstica de lesões linfonodais, tanto primárias como secundárias. OBJETIVO: Avaliar o uso da imuno-histoquímica no diagnóstico de malignidade nas biópsias de linfonodos. MÉTODO: Estudo retrospectivo, realizado de 2009 a 2011, com base nos resultados anatomopatológicos arquivados de biópsias de linfonodos. RESULTADOS: A casuística constituiu-se de 32 casos de biópsias de linfonodos, com uso de imuno-histoquímica em 50% (16) casos, dos quais 68,75% foram de linhagem hematogênica e 31,25%, de carcinomas. O método foi utilizado em todos os casos de linfoma. CONCLUSÃO: A imuno-histoquímica foi utilizada em 50% dos casos de biópsias de linfonodos suspeitos de malignidade, sendo em lesões de linhagem epitelial em 31,25% e, para linhagem hematopoiética, em 68,75% dos casos. .

The cervical lymph nodes are relevant due to the diversity of clinical entities. The use of immunohistochemistry is a real method to elucidate the diagnosis of adenopathy, both primary and metastatic neoplasms. OBJECTIVE: To assess the value of immunohistochemistry in the diagnosis of cervical lymph nodes malignancies. METHOD: Retrospective study of the database histopathological specimens from 2009 to 2011. RESULTS: Out of 32 biopsies of cervical lymph nodes, in 16 (50%) the immunohistochemistry was employed, being 68.75% (11) in hematological neoplasms and 31.25% (5) in carcinomas. It was used in all cases of lymphoma. CONCLUSION: The immunohistochemistry was used in 50% of the biopsies of lymph nodes under suspicion of malignancy, being 31.25% in epithelial lesions and 68.75% in lymphoproliferative lesions. .

Análise do PET-CT no estadiamento do câncer epidermoide de cabeça e pescoço / Analysis of PET-CT in the staging of head and neck cancer

Introdução: O carcinoma epidermoide na cabeça e pescoçotem uma recidiva loco-regional em 40% dos casos em dois anos,tornando necessário o seguimento convencional e por meio deexames de imagens, somando-se a técnica do 18F-FDG-PET.Objetivo: Demonstrar os primeiros dois anos de indicações eresultados da PET-CT em uma instituição pública. Método: Estudoretrospectivo de 50 exames de julho de 2009 a junho de 2012,realizados consecutivamente em 49 pacientes com carcinomaepidermoide das vias aerodigestivas superiores de estádiosclínicos I (4,1%), II (10,2%), III (32,7%) e IV (53%). Resultados:Em 12 casos, o exame foi realizado durante o estadiamento inicial.Em quatro casos, a PET foi realizado por tumor primário oculto naapresentação inicial. A PET-CT foi realizada pós-tratamento em31 casos, sendo que houve mudança de estádio clínico em 12desses pacientes após a realização da PET-CT. Foram realizadosdois exames em pacientes sob cuidados paliativos com sobrevidasuperior à esperada, sendo um diagnosticado sem doença e outrocom segunda lesão. Conclusão: O diagnóstico e estadiamento docâncer na cabeça e pescoço fazem-se por meio de exame diretocom biópsia e exame histológico. Exames de imagem metabólicose anatômicos - PET-CT - auxiliam, especialmente, no diagnósticodas recidivas loco-regionais.

Epidemiological assessment and therapeutic response in hypopharyngeal cancer.

UNLABELLED: Despite the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality. OBJECTIVE: To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer. METHOD: We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma. RESULTS: The mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. The main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). The clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). The treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment. CONCLUSION: Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.

Conflitos de interesses na pesquisa médico-farmacológica / Conflicts of interest in the medical pharmacological research

A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga em seres humanos. Seu controle visa proteger os sujeitos de efeitos adversos inaceitáveis e de ineficiência do medicamento testado diante de outras possibilidades mais eficientes. Parcerias entre a indústria farmacêutica e pesquisadores externos estabelecem potenciais conflitos de interesses. Consulta bibliográfica realizada neste estudo indica que pesquisas com financiamento da indústria farmacêutica têm proporção mais alta de resultados favoráveis e que os conflitos de interesses representam vieses, podendo alterar resultados. Há estudos que comparam a eficácia de diferentes drogas e outros que comparam seus custos. Mesmo resultados negativos devem ser publicados. Conclui que o setor privado deve financiar a ciência para beneficiar o ser humano, especialmente no combate à doença; no entanto, deve manter empenho em financiar as pesquisas sem influenciar seus desenhos, resultados e destinações, caminhando em direção ao respeito à dignidade da pessoa.

The clinical medical pharmacological research corresponds to the experimental application of specific drug in human beings. Such application aims to protect them from unacceptable adverse effects and its inefficiencywhen comparing with other possibilities, more efficient. Partnerships between the pharmaceutical industryand external researchers establish potential conflict of interest. Literature use for this work indicates that researches performed under the sponsorship of pharmaceutical industry have a high rate of favorable results,and the conflicts of interest represent gaps which may interfere the result. There are studies that compare theefficiency of different drugs, whereas others compare their costs. All results should be published, even whennegative. The present work concludes that the private sector must sponsor the science in order to improve human beings, especially to avoid diseases. However, it must keep its engagement in sponsoring the research withany influence on its methods, results and application, for a respectful understanding of the dignity of a person.