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1.
Support Care Cancer ; 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900618

RESUMO

OBJECTIVE: To evaluate the occurrence and severity of oral complications, number of radiotherapy (RT) interruptions and quality of life (QoL) in a population of head and neck cancer patients receiving a preventive oral care program (POCP) and photobiomodulation therapy (PBMT). METHODS: Prospective cohort of 61 head and neck cancer patients undergoing radiochemotherapy were monitored and submitted to a POCP that included oral hygiene and plaque control, removal of infection foci, dental restorations, periodontal therapy, fluorotherapy, oral hydration, and denture removal at night, combined with daily PBMT. Outcomes included occurrence of adverse effects such as severity of oral mucositis (OM) and oral symptoms (pain, solid and fluid dysphagia, odynophagia, dysgeusia), quality of life impacts, and interruptions of radiotherapy (RT) due to symptoms. Disease-free and overall survival rates were evaluated. RESULTS: There was a significant improvement in oral health conditions between initial assessment and the two longitudinal assessments (p < 0.05), which indicates that the POCP was effective for plaque control and reduction of gingival inflammation. All participants were free of OM at the beginning of the RT regimen and only 45.9% after the 7th session, and few patients ranked the highest score of OM. For all symptoms related to OM, there was a progressive increase of severity until the 14th RT session, which remained stable until the completion of the RT regimen. The same effect was observed for the quality of life measures. Discontinued RT due to OM occurred in only three patients (5%), and the maximum duration was 10 days. The overall survival rate was 77% and disease-free survival was 73.8%. Lower survival time was observed for patients with no response to RT (p < 0.01). CONCLUSIONS: The findings of this study suggest a positive effect of an oral preventive care program for head and neck cancer patients submitted to RT. The PBMT associated with a rigorous POCP resulted in satisfactory control of oral adverse effects, reduction of quality of life impacts, and interruption of RT regimen due to severe OM.

2.
Trials ; 20(1): 97, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709370

RESUMO

BACKGROUND: Oral mucositis (OM) is the most frequent and debilitating acute side effect associated with head and neck cancer (HNC) treatment. When present, severe OM negatively impacts the quality of life of patients undergoing HNC treatment. Photobiomodulation is a well-consolidated and effective therapy for the treatment and prevention of severe OM, and is associated with a cost reduction of the cancer treatment. Although an increase in the quality of life and a reduction in the severity of OM are well described, there is no study on cost-effectiveness for this approach considering the quality of life as a primary outcome. In addition, little is known about the photobiomodulation effects on salivary inflammatory mediators. Thus, this study aimed to assess the cost-effectiveness of the photobiomodulation therapy for the prevention and control of severe OM and its influence on the salivary inflammatory mediators. METHODS/DESIGN: This randomized, double-blind clinical trial will include 50 HNC patients undergoing radiotherapy or chemoradiotherapy. The participants will be randomized into two groups: intervention group (photobiomodulation) and control group (preventive oral care protocol). OM (clinical assessment), saliva (assessment of collected samples) and quality of life (Oral Health Impact Profile-14 and Patient-Reported Oral Mucositis Symptoms questionnaires) will be assessed at the 1st, 7th, 14th, 21st and 30th radiotherapy sessions. Oxidative stress and inflammatory cytokine levels will be measured in the saliva samples of all participants. The costs are identified, measured and evaluated considering the radiotherapy time interval. The incremental cost-effectiveness ratio will be estimated. The study will be conducted according to the Brazilian public health system perspective. DISCUSSION: Photobiomodulation is an effective therapy that reduces the cost associated with OM treatment. However, little is known about its cost-effectiveness, mainly when quality of life is the effectiveness measure. Additionally, this therapy is not supported by the Brazilian public health system. Therefore, this study widens the knowledge about the safety of and strengthens evidence for the use of photobiomodulation therapy, providing information for public policy-makers and also for dental care professionals. This study is strongly encouraged due to its clinical relevance and the possibility of incorporating new technology into public health systems. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials-ReBEC, RBR-5h4y4n . Registered on 13 June 2017.


Assuntos
Quimiorradioterapia/efeitos adversos , Irradiação Craniana/efeitos adversos , Neoplasias de Cabeça e Pescoço/radioterapia , Terapia com Luz de Baixa Intensidade/métodos , Lesões por Radiação/prevenção & controle , Glândulas Salivares/efeitos da radiação , Estomatite/prevenção & controle , Biomarcadores/metabolismo , Brasil , Quimiorradioterapia/economia , Análise Custo-Benefício , Irradiação Craniana/economia , Citocinas/metabolismo , Método Duplo-Cego , Neoplasias de Cabeça e Pescoço/economia , Custos de Cuidados de Saúde , Humanos , Mediadores da Inflamação/metabolismo , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/economia , Estresse Oxidativo , Lesões por Radiação/economia , Lesões por Radiação/etiologia , Lesões por Radiação/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Saliva/metabolismo , Glândulas Salivares/metabolismo , Índice de Gravidade de Doença , Estomatite/economia , Estomatite/etiologia , Estomatite/metabolismo , Fatores de Tempo , Resultado do Tratamento
3.
Chem Biol Interact ; 291: 228-236, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-29906455

RESUMO

Preclinical repeated-dose toxicity and efficiency studies developed by our group suggest the potential of FITOPROT in treating mucositis. This serious limiting side effect is observed at a rate of 40-100% in patients under antineoplastic therapy and despite different palliative measures and therapeutic agents have been investigated, still no therapy was completely successful. Therefore, this study aimed to establish the safety and recommended phase II dose of FITOPROT for the prevention and treatment of chemoradiotherapy-induced oral mucositis (OM) in patients with head and neck cancer. Twenty healthy adult participants were randomized into two groups that received pre-established concentrations of the collutory: group 1 (FITOPROT A - mucoadhesive formulation containing 10 mg/mL of curcuminoids extract plus 20% v/v of Bidens pilosa L. extract) and group 2 (FITOPROT B - mucoadhesive formulation containing 20 mg/mL of curcuminoids extract, plus 40% v/v of Bidens pilosa L. extract). Participants rinsed their mouths with FITOPROT, three times daily, for ten consecutive days. No participant experienced toxicity or unacceptable discomfort and/or adverse reactions (CTCAE v5.0), with laboratory and clinical parameters under normal conditions. Side effects observed were low intensity and temporary mucosa/dental surface pigmentation (n = 7) and tooth sensitivity (n = 4), which disappeared after formulation use ceased. No significant cellular genotoxic effects were observed (p > 0.05), and micronuclei frequencies were not changed (p > 0.05). Biochemical assays reveled no altered levels of myeloperoxidase (p = 0.2268), malondialdehyde (p = 0.1188) nor nitric oxide (p = 0.5709) concentration, and no significant difference were found in the levels of pro-inflammatory cytokines (p > 0.05). Thus, FITOPROT demonstrated to be safe and tolerable in both tested doses and is suitable for evaluation in a phase II trial as treatment against OM.


Assuntos
Adesivos/uso terapêutico , Asteraceae/química , Bidens/química , Curcumina/uso terapêutico , Extratos Vegetais/uso terapêutico , Estomatite/tratamento farmacológico , Estomatite/prevenção & controle , Adesivos/farmacologia , Adulto , Curcumina/farmacologia , Citocinas/metabolismo , Demografia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Mutagênicos/toxicidade , Extratos Vegetais/farmacologia , Saliva/metabolismo , Estomatite/patologia , Adulto Jovem
4.
BMC Res Notes ; 10(1): 14, 2017 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-28057062

RESUMO

BACKGROUND: Granular cell tumor is a rare benign tumor that can present a pseudoepitheliomatous hyperplasia of the covering epithelium. This lesion is not encapsulated and can be characterized by a pseudo invasive growth pattern, represented by the tumoral cells that infiltrate between adjacent connective tissue elements. Diagnostic difficulties may arise because histopathological features of the pronounced pseudoepitheliomatous hyperplasia can be confused with a well-differentiated oral squamous cell carcinoma. The aim of this case report is to demonstrate the role of an immunohistochemical panel in the diagnosis of a granular cell tumor in the tongue with clinical and microscopic features resembling an oral squamous cell carcinoma. CASE PRESENTATION: A 44-year-old white man with a history of heavy smoking and alcohol abuse presented an ulcerated nodular lesion in the dorsum of the tongue. The lesion was asymptomatic with fast growth. The clinical diagnosis was an oral squamous cell carcinoma. An incisional biopsy was performed and the ensuing histopathological analysis showed a pseudoepitheliomatous hyperplasia in the overlying epithelium mimicking the invasion of epithelial tumor cells into the connective tissue as in an oral squamous cell carcinoma. Immunohistochemical antibodies (S-100, vimentin, CD68, p53, Ki-67, E-cadherin, collagen IV and cytokeratin AE1/AE3) were used to characterize molecular aspects of the lesion. Strong staining of S-100 protein, CD68, vimentin, E-cadherin and low proliferative activity observed with Ki-67 expression confirmed the diagnosis of a granular cell tumor. The patient was submitted to surgical excision of the whole lesion. At a 12-month check-up, there was no evidence of recurrence. CONCLUSION: This case report showed that the immunohistochemical profile was helpful in determining the clinical behavior of the tumor and establishing the final diagnosis with appropriate treatment.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Tumor de Células Granulares/diagnóstico , Neoplasias da Língua/diagnóstico , Adulto , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Caderinas/metabolismo , Carcinoma de Células Escamosas/patologia , Colágeno Tipo IV/metabolismo , Tumor de Células Granulares/patologia , Humanos , Hiperplasia , Imuno-Histoquímica , Queratinas/metabolismo , Antígeno Ki-67/metabolismo , Masculino , Proteínas S100/metabolismo , Língua/patologia , Neoplasias da Língua/patologia , Proteína Supressora de Tumor p53/metabolismo , Vimentina/metabolismo
5.
Spec Care Dentist ; 33(6): 294-300, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24164228

RESUMO

The aim of this study was to assess the effect of low level laser therapy on reducing the occurrence and severity of oral complications in patients with head and neck cancer undergoing radiotherapy. Sixty head and neck cancer outpatients from a cancer hospital receiving radiotherapy were selected and randomly assigned into two groups. The laser group was irradiated with an InGaAlP laser and the control received sham laser. The assessment of complications (oral mucositis, pain) was carried out one week after starting radiotherapy, and at the fifteenth and thirtieth sessions of radiotherapy. All patients from both groups showed some degree of oral mucositis. Better outcomes were observed in the laser group when compared with the control in the follow-up sessions, indicating lower degrees of oral mucositis, pain and higher salivary flow (p < .05). These findings support the use of laser therapy as an adjuvant treatment for the control of oral complications.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Terapia com Luz de Baixa Intensidade , Doenças da Boca/induzido quimicamente , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Head Neck ; 34(3): 398-404, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21472883

RESUMO

BACKGROUND: Low-level laser therapy has been used to reduce complications of head and neck cancer treatment. The aim was to assess the impact of laser in the quality of life (QOL) of patients receiving radiotherapy. METHODS: Sixty outpatients were randomly assigned into 2 groups. The laser group received applications and the placebo group received sham laser. QOL was assessed using the University of Washington QOL questionnaire. A repeated-measures analysis of variance (ANOVA) was used for comparisons of overall QOL scores and Mann-Whitney test compared changes in domain scores. RESULTS: A decrease in QOL scores was observed in both groups and the reduction in the laser group was significantly lower (p < .01). Changes in QOL scores regarding pain, chewing, and saliva domains were evident in the placebo group. Both health-related QOL and overall QOL were rated higher by patients who received laser therapy. CONCLUSION: Laser therapy reduces the impact of radiotherapy on the QOL of patients with head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço/terapia , Terapia com Luz de Baixa Intensidade , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Estudos de Coortes , Fracionamento da Dose de Radiação , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Recuperação de Função Fisiológica , Estomatite/etiologia , Estomatite/patologia , Estomatite/prevenção & controle , Resultado do Tratamento
7.
Tumour Biol ; 32(2): 409-16, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21136231

RESUMO

Human papillomavirus (HPV) has been cited as a possible initiating agent in the pathogenesis of oral cancer. However, the literature tends to be both controversial and inconclusive about the prevalence of HPV and its potential for proliferation in oral squamous cell carcinoma (SCC). The aim of this study was to investigate the cellular proliferation and the presence of HPV in SCC and verrucous carcinoma (VC). Forty-seven samples of SCC were selected and divided into three groups: 39 SCC, 8 VC, and 9 of normal mucosa (control-CT). Quantitative analyses of all groups showed a greater expression of PCNA, followed by Ki-67 and cyclin B1. A significant difference was observed in cyclin B1 expression in the SCC group compared with VC. PCNA, Ki-67, and cyclin B1 were statistically significant when comparing the SCC and CT groups. However, when SCC and VC were compared, there was no difference in Ki-67 expression. Our results showed that only cyclin B1 had an association with histological grade, and that poorly differentiated tumors presented a higher expression of cyclin B1. Therefore, considerable differences in the cellular proliferation between SCC and VC were observed, and no correlation with HPV was established, since all samples were negative for HPV.


Assuntos
Alphapapillomavirus/isolamento & purificação , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Carcinoma Verrucoso/patologia , Carcinoma Verrucoso/virologia , Proliferação de Células , Neoplasias Bucais/patologia , Neoplasias Bucais/virologia , Idoso , Brasil , Carcinoma de Células Escamosas/metabolismo , Carcinoma Verrucoso/metabolismo , Estudos de Casos e Controles , Ciclina B1/metabolismo , Feminino , Humanos , Antígeno Ki-67/metabolismo , Masculino , Neoplasias Bucais/metabolismo , Antígeno Nuclear de Célula em Proliferação/metabolismo
8.
Artigo em Inglês | MEDLINE | ID: mdl-20219590

RESUMO

OBJECTIVE: This study was undertaken to gain insight into the distinctive features of squamous cell carcinoma of the lip (LSCC) and oral cavity (OCSCC). STUDY DESIGN: A total of 37 cases of LSCC and 54 of OCSCC were compared regarding clinical and microscopic findings. RESULTS: Predominance of head and neck TNM stages (HNTNM) T1-T2 in LSCC and T3-T4 in OCSCC was observed. A significant percentage (33.3%) of patients with OCSCC at HNTNM T1-T2 presented cervical lymph node metastasis and 18.75% died, whereas lymph node metastasis was absent and no patient died with LSCC at HNTNM T1-T2. LSCC demonstrated a higher number of cases with intense peritumoral inflammatory infiltrate compared with OCSCC. The analysis of the proliferative index demonstrated a significantly higher percentage of PCNA+ and Ki-67+ cells in OCSCC compared with LSCC. CONCLUSION: Our results suggest that OCSCC and LSCC demonstrate distinct clinical and microscopic characteristics that reflect different biologic behavior and prognosis.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Labiais/patologia , Neoplasias Bucais/patologia , Idoso , Carcinoma de Células Escamosas/mortalidade , Contagem de Células , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Labiais/mortalidade , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/mortalidade , Estadiamento de Neoplasias , Método Simples-Cego , Taxa de Sobrevida
9.
Rev. odonto ciênc ; 25(2): 204-207, 2010. ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: lil-573170

RESUMO

Purpose: Epidermoid and dermoid cysts are extremely rare developmental cysts of a benign nature, which may occur anywhere in the body, although about 7% are found in the head and neck. This article reports a clinical case of a patient who had an epidermoid cyst and its magnetic resonance imaging (MRI) features. Case report: This case discusses an epidermoid cyst in a 36-year-old woman complaining about speech difficulty. Clinical examination revealed an extensive swelling on the floor of the mouth. MRI findings showed a cystic homogenous lesion located underneath the mylohyoid muscle which was removed by surgery. Histological examination of the mass confirmed the diagnosis of an epidermoid cyst. Conclusion: We concluded that MRI was considered useful for a more accurate diagnosis prior to treatment.


Proposta: Cistos epidermóide e dermóide são cistos de desenvolvimento extremamente raros, de natureza benigna, que podem ocorrer em qualquer região do corpo e somente 7% são encontrados na região de cabeça e pescoço. Este artigo apresenta o caso clínico de uma paciente que possuía um cisto epidermóide juntamente com as características das imagens por ressonância magnética. Descrição do caso: Paciente do gênero feminino, 36 anos, apresentou-se com queixa de dificuldade de fonação e deglutição. O exame clínico intrabucal revelou uma extensa tumefação em soalho bucal. As imagens por ressonância magnética indicaram uma lesão de natureza cística, homogênea, de conteúdo sólido e localizada abaixo do músculo milohiódeo. A lesão foi enucleada e encaminhada para exame anatomopatológico, cujo diagnóstico foi compatível com cisto epidermóide. Conclusão: A imagem por ressonância magnética foi essencial para determinar as características da lesão de acordo com a sua localização anatômica.


Assuntos
Humanos , Feminino , Adulto , Cisto Dermoide/diagnóstico , Cisto Epidérmico/diagnóstico , Imagem por Ressonância Magnética , Diagnóstico Diferencial
10.
Histol Histopathol ; 24(4): 457-65, 2009 04.
Artigo em Inglês | MEDLINE | ID: mdl-19224448

RESUMO

Mast cells (MCs) display a diversity of roles that may contribute to the stromal microenvironment alterations during tumor progression. The aim of this study was to investigate MC populations expressing tryptase and c-kit in lip squamous cell carcinoma (lip SCC) (n=37), actinic cheilitis (AC) (n=15) and normal lip mucosa (control) (n=6), as well as their relationship with microscopic parameters (collagen degeneration, elastin changes, angiogenesis and proliferative index). Tryptase, c-kit, CD31 and Ki-67 expressions were analyzed by means of immunohistochemistry and collagen and elastic fibers were visualized with Picrosirus and Verhoeff's stain, respectively. The numbers of tryptase+ MC were significantly higher in lip SCC when compared with control (P=0.01), while a similar density of these cells was observed in AC and lip SCC (P=0.09). The density of c-kit+ MC was similar in all groups examined (P=0.65). MC migration (c-kit+/Tryptase+ relationship) was 69% in lip SCC, 60% in AC and 100% in control. The number of CD31+ blood vessels was significantly higher in the lip SCC when compared with control and AC (P<0.01). The increase of MCs and angiogenesis in lip SCC may reflect an important modification in the tumor microenvironment during squamous photo-carcinogenesis.


Assuntos
Carcinoma de Células Escamosas/patologia , Movimento Celular , Queilite/patologia , Neoplasias Labiais/patologia , Mastócitos/enzimologia , Mastócitos/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/irrigação sanguínea , Carcinoma de Células Escamosas/fisiopatologia , Queilite/fisiopatologia , Colágeno/metabolismo , Elastina/metabolismo , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Feminino , Humanos , Antígeno Ki-67/metabolismo , Neoplasias Labiais/irrigação sanguínea , Neoplasias Labiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/irrigação sanguínea , Mucosa Bucal/patologia , Mucosa Bucal/fisiopatologia , Neovascularização Patológica , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Proteínas Proto-Oncogênicas c-kit/metabolismo , Triptases/metabolismo , Raios Ultravioleta
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