Obstrução lacrimal pós-tratamento oncológico: revisão de literatura / Lacrimal drainage system obstruction after cancer treatment: a literature review

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.

ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.

Avaliação da Qualidade de Vida e Prevalência de Sintomas Depressivos em Pacientes Oncológicos Submetidos à Radioterapia / Assessment of Quality of Life and Prevalence of Depressive Symptoms in Oncologic Patients submitted to Radiotherapy / Evaluación de la Calidad de Vida y Prevalencia de Síntomas Depresivos en Radioterapia en Pacientes Oncológicos

Introdução: A qualidade de vida de pacientes oncológicos tem sido objeto de estudo em muitos trabalhos brasileiros. Contudo, apesar da alta prevalência de indivíduos submetidos à radioterapia, poucos estudos com ênfase nesse grupo de pacientes foram identificados. Objetivo: Avaliar a qualidade de vida e a prevalência de sintomas depressivos em pacientes com neoplasias malignas durante o tratamento radioterápico. Método: Estudo transversal quantitativo realizado com 153 pacientes oncológicos em vigência de tratamento radioterápico em um centro especializado em oncologia e radioterapia, localizado no Noroeste do Estado do Paraná. Os dados foram coletados entre março e setembro de 2018. O European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) e o Inventário de Depressão de Beck foram utilizados para avaliar a qualidade de vida e os sintomas depressivos, respectivamente. Resultados: Os domínios "qualidade de vida", "função cognitiva" e "função social" foram os que menos se mostraram prejudicados na amostra estudada, enquanto "insônia", "perda de apetite" e "dificuldades financeiras" destacaram-se entre os maiores preditores de baixa qualidade de vida. Ademais, contatou-se que 22% dos indivíduos avaliados apresentaram algum grau de transtorno de humor, sendo 11% diagnosticados com depressão. Conclusão: O declínio na qualidade de vida e a prevalência de sintomas depressivos em pacientes oncológicos, mesmo os em vigência de radioterapia, enaltecem a importância de intervenções precoces que visem a restabelecer a funcionalidade e o bem-estar.

Introduction: The quality of life of cancer patients has been studied in many Brazilian papers. However, despite the high prevalence of individuals undergoing radiotherapy, few studies with emphasis in this group of patients have been identified. Objective: To evaluate the quality of life and the prevalence of depressive symptoms in patients with malignant neoplasms undergoing radiotherapy treatment. Method: Quantitative cross-sectional study with 153 cancer patients undergoing radiotherapy treatment at an oncology and radiotherapy specialized center, located in the northwest of Paraná state. Data were collected between March and September 2018. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Beck Inventory were used to assess quality of life and depressive symptoms, respectively. Results: The domains "quality of life", "cognitive function" and "social function" were the least affected in the studied sample, while "insomnia", "loss of appetite" and "financial difficulties" stood out among the higher predictors of poor quality of life. In addition, it was found that 22% of the individuals evaluated had some degree of mood disorder, 11% being diagnosed with depression. Conclusion: The decline in quality of life and the prevalence of depressive symptoms in cancer patients, even those undergoing radiotherapy, emphasize the importance of early interventions aimed at restoring functionality and well-being.

Introducción: La calidad de vida de los pacientes con cáncer se ha estudiado en muchos estudios brasileños. Sin embargo, a pesar de la alta prevalencia de individuos sometidos a radioterapia, se han identificado pocos estudios con énfasis en este grupo de pacientes. Objetivo: Evaluar la calidad de vida y la prevalencia de síntomas depresivos en pacientes con neoplasias malignas sometidas a radioterapia. Método: Estudio transversal cuantitativo realizado con 153 pacientes con cáncer sometidos a tratamiento de radioterapia en un centro especializado en oncología y radioterapia, ubicado en el Noroeste del Estado de Paraná. Los datos se recopilaron entre marzo y septiembre de 2018. El European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) y el Inventario Beck se utilizaron para evaluar la calidad de vida y los síntomas depresivos, respectivamente. Resultados: Los dominios "calidad de vida", "función cognitiva" y "función social" fueron los menos afectados en la muestra estudiada, mientras que el "insomnio", la "pérdida de apetito" y las "dificultades financieras" se destacaron entre los dominios. predictores más altos de mala calidad de vida. Además, se encontró que el 22% de los individuos evaluados tenían algún grado de trastorno del estado de ánimo, y el 11% fue diagnosticado con depresión. Conclusión: La disminución de la calidad de vida y la prevalencia de síntomas depresivos en pacientes con cáncer, incluso en aquellos que reciben radioterapia, enfatizan la importancia de las intervenciones tempranas destinadas a restaurar la funcionalidad y el bienestar.

Proctitis crónica hemorrágica por radioterapia en el Instituto Nacional de Enfermedades Neoplásicas del Perú, 2011-2013 / Radiotherapy associated chronic hemorrhagic proctitis at the National Institute of Neoplastic Diseases of Peru, 2011-2013

Objetivo: Estudiar las características clínicas y endoscópicas de la proctitis crónica hemorrágica por radioterapia en el Instituto Nacional de Enfermedades Neoplásicas del Perú. Materiales y métodos: Estudio descriptivo, retrospectivo y longitudinal, con una población de 588 pacientes con esta patología, en el periodo 2011-2013, de donde se seleccionaron 114 pacientes por muestreo probabilístico aleatorizado. Se usó la estadística descriptiva e inferencial para el análisis de las variables cualitativas y cuantitativas. Resultados: La investigación encontró como principales resultados, un periodo de latencia de 439,96 días; la severidad de rectorragia clínica fue grado II y III en el 86,84%, la hemoglobina media fue de 11,63 gr/dl, los hallazgos endoscópicos fueron severidad moderada en el 58,77%, extensión solo rectal en el 92,11%, friabilidad leve del 43,86%, compromiso menor del 33% de la superficie rectal en el 71,93% y una longitud media de 7,28 cm. Los hallazgos inflamatorios fueron de cicatrices en el 0,88%, erosiones del 0,88%, de úlceras del 7%, de fístula del 0,88% y del 3,51% de estenosis rectales, el tratamiento de argón plasma coagulación (APC) único o combinado se ofreció en el 96% de los casos. Conclusiones: La proctitis crónica hemorrágica por radioterapia fue una complicación importante de la radioterapia pélvica, con hallazgos clínicos y endoscópicos característicos.

Objective: To study the clinical and endoscopic features of chronic hemorrhagic proctitis by radiotherapy in the National Institute of Neoplastic Diseases of Peru. Materials and methods: The study was descriptive, retrospective and longitudinal, with a population of 588 patients with this pathology, in the period 2011-2013, from which 114 patients were selected by randomized probabilistic sampling. Descriptive and inferential statistics were used for the analysis of qualitative and quantitative variables. Results: The main results were a latency period of 439.96 days; the severity of clinical rectal bleeding was grade 2 and 3 in 86.84%, the mean hemoglobin in chronic hemorrhagic proctitis by radiotherapy was 11.63 g / dl, the endoscopic findings were moderate severity in 58.77%, extension rectal only in 92.11%, slight friability of 43.86%, compromise less than 33% of the rectal surface in 71.93% and an average length of 7.28 cm. The inflammatory findings were 0.88% scars, erosions of 0.88%, ulcers of 7%, fistula of 0.88% and 3.51% of rectal stenosis, single or combined argon plasma coagulation (APC) treatment was offered in 96% of cases. Conclusion: Chronic hemorrhagic proctitis is an important complication of pelvic radiotherapy, with characteristic clinical and endoscopic findings.

Fadiga em Mulheres com Câncer de Mama Submetidas à Radioterapia / Fatigue in Women with Breast Cancer Submitted to Radiotherapy / Fatiga en Mujeres con Cáncer de Mama Sujeto a Radioterapia

Introdução: A fadiga em mulheres com câncer de mama após a radioterapia é um dos efeitos colaterais mais debilitantes, sendo um sintoma subjetivo, multidimensional e multifatorial. Objetivo: Caracterizar a fadiga em pacientes com câncer de mama em radioterapia que realizam o tratamento no Serviço de Radioterapia de um hospital de referência em tratamento oncológico do Estado de Goiás. Método: Trata-se de um estudo longitudinal. A Escala de Fadiga de Piper - revisada foi utilizada para avaliação de fadiga no início (T1), meio (T2) e final (T3) da radioterapia. Resultados: A amostra foi composta por 89 mulheres. A prevalência de fadiga em T1 foi de 26,9%. Houve aumento significativo da fadiga ao longo da radioterapia, sendo que, em T3, 50,8% das mulheres apresentavam fadiga. Houve predomínio da fadiga moderada em T2 e T3, e o aumento mais significativo da intensidade da fadiga foi verificado do momento T1 para T2. A dimensão afetiva da fadiga apresentou escore mais alto comparado às dimensões sensorial/psicológica. Conclusão: A presença e a intensidade da fadiga durante a radioterapia aumentaram significativamente, predominando a fadiga moderada na última semana do tratamento. A magnitude da fadiga exibiu escores mais altos na dimensão afetiva nas avaliações. Portanto, atenção maior à fadiga durante a radioterapia precisa ser dada pelos profissionais de saúde.

Introduction: Fatigue in women with breast cancer after radiotherapy is one of the most debilitating side effects, being a subjective, multidimensional, multifactorial symptom. Objective: To characterize fatigue in patients with breast cancer in radiotherapy who undergo treatment in the radiotherapy service of a reference hospital in cancer treatment in the State of Goiás. Method: This is a longitudinal study. The Piper Fatigue Scale - revised was used to evaluate fatigue at the beginning (T1), middle (T2) and final (T3) of the radiotherapy. Results: The sample consisted of 89 women. The prevalence of T1 fatigue was 26.9%. There was a significant increase in fatigue during radiotherapy, and in T3, 50.8% of the women presented fatigue. There was a predominance of moderate fatigue in T2 and T3, and the most significant increase in fatigue intensity was verified from T1 to T2. The affective dimension of fatigue presented a higher score compared to the sensorial/psychological dimensions. Conclusion: The presence and intensity of fatigue during radiotherapy increased significantly, with moderate fatigue predominating in the last week of treatment. The magnitude of fatigue exhibited higher scores in the affective dimension of the evaluations. Therefore, health professionals must focus more attention to fatigue during radiotherapy.

Introducción: La fatiga en mujeres con cáncer de mama después de la radioterapia es uno de los efectos colaterales más debilitantes, siendo un síntoma subjetivo, multidimensional, multifactorial. Objetivo: caracterizar la fatiga en pacientes con cáncer de mama en radioterapia que realizan el tratamiento en el servicio de radioterapia de un hospital de referencia en tratamiento oncológico del Estado de Goiás. Método: Se trata de un estudio longitudinal. La Escala de Fatiga de Piper - revisada fue utilizada para evaluación de fatiga al inicio (T1), medio (T2) y final (T3) de la radioterapia. Resultados: La muestra fue compuesta por 89 mujeres. La prevalencia de fatiga en T1 fue de 26,9%. Se observó un aumento significativo de la fatiga a lo largo de la radioterapia siendo que, en T3, el 50,8% de las mujeres presentaban fatiga. Se observó un predominio de la fatiga moderada en T2 y T3, y el aumento más significativo de la intensidad de la fatiga fue verificado del momento T1 para T2. La dimensión afectiva de la fatiga presentó una puntuación más alta en comparación con las dimensiones sensorial/psicológica. Conclusión: La presencia e intensidad de la fatiga durante la radioterapia aumentó significativamente, predominando la fatiga moderada en la última semana del tratamiento. La magnitud de la fatiga exhibió escores más altos en la dimensión afectiva en las evaluaciones. Por lo tanto, los profesionales de la salud deben prestar mayor atención a la fatiga durante la radioterapia.

Clinical outcome of sodium alginate therapy in radiation-induced pharyngeal mucositis: experience of a single Japanese institution

Purpose: We investigated the clinical outcome of sodium alginate treatment in radiation-induced pharyngeal mucositis (RIPM) after neck irradiation. Materials and methods: The study population included 32 patients (11 lung cancer, 10 breast cancer, 7 head and neck cancer, and 4 other primary lesions) who underwent neck external beam radiotherapy at the authors' institution between June 2006 and 2016. The patients received 5% sodium alginate solution orally for RIPM. Those who were followed up for less than 2 months or did not receive 5% sodium alginate were excluded from this retrospective study. RIPM was graded weekly as an acute toxicity according to the Common Terminology Criteria for Adverse Events (CTCAE), version 4. The administration of 10-15 ml of sodium alginate before each meal was continued until the radiotherapy was completed and after resolution of odynophagia. The efficacy of sodium alginate was assessed by two radiation oncologists as follows: Grade I, ineffective; grade II, moderately effective; grade III, very effective. When sodium alginate was ineffective, other analgesics, such as nonsteroidal antiinflammatory drugs (NSAIDS) or opioids, were added. Relationships between the presence/absence of additional analgesics and the radiation dose were investigated. Results: The median duration from the start of irradiation to sodium alginate administration was 15 days (range, 5­36 days). RIPM improved in 29/32 patients (grade: II, n = 22; III, n = 7). Three patients showed no improvement. No sodium alginate-related toxicities occurred. Additional analgesics were required in 5/32 patients. The radiation dose in these 5 patients was significantly higher than that in the sodium alginate-alone group (63.6 ± 7.8 Gy vs 48.3 ± 14.8Gy, P = 0.02). Patients who received > 50 Gy tended to require additional analgesics more frequently than those who received ≤50Gy (P = 0.10). Conclusions: The concurrent administration of sodium alginate and neck irradiation was feasible and tolerable without obvious toxicities. Under certain conditions sodium alginate could be a promising alternative to NSAIDs and opioids in RIPM. The results justify further prospective evaluations with detailed treatment protocols to clarify whether sodium alginate can improve RIPM (AU)

Case-control study of oral disease indexes in individuals with head and neck cancer after antineoplastic therapy / Estudo caso-controle de índices de doenças bucais em indivíduos com câncer de cabeça e pescoço após terapia antineoplásica

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.

Manifestaciones bucales por radioterapia en pacientes geriátricos con cáncer de cabeza y cuello / Oral manifestations due to radiotherapy in geriatric patients with head and neck cancer

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)

Influência do tratamento do câncer na rotação pélvica avaliada por baropodometria / Influence of cancer treatment on pelvic rotation assessed by baropodometry

Introdução: O câncer tem sido um crescente problema de saúde pública no Brasil. Comumente, a pessoa com câncer pode apresentar diversas alterações posturais, como a rotação da pelve, ocasionadas pela doença e por efeitos adversos secundários às formas de tratamento. Objetivo: Analisar a influência do posicionamento rotacional da pelve de pessoas com câncer por meio da baropodometria. Métodos: Foram incluídos 45 indivíduos, divididos em: Grupo Quimioterapia e/ou Radioterapia (GQR), Grupo Câncer em Acompanhamento (GCA) e Grupo Controle sem Câncer (GCS). Todos os voluntários foram avaliados quanto ao posicionamento da pelve por meio da baropodometria. Resultados: Não foram encontradas alterações significativas no posicionamento rotacional da pelve nas comparações entre os grupos com câncer e grupo controle (p: 0,112; Poder: 0,838; f2: 1,121). Conclusão: Os resultados sugerem que o câncer e suas formas de tratamento não exerceram influência sobre a postura rotacional da pelve. (AU)

Introduction: Cancer has been a growing public health problem in Brazil. Patients with cancer may commonly present a number postural changes such as the pelvis rotation due to the disease itself and also to secondary adverse effects produced by its forms of treatment. Objective: To assess the rotational positioning of the pelvis in cancer patients using computerized baropodometry. Methods: A total of 45 volunteers were divided into: Chemotherapy combined with radiotherapy Group (QRG), Follow up Cancer Group (CAG) and Control Group without Cancer (CG). All subjects were assessed for the positioning of the pelvis using baropodometry Results: No significant changes were found in the rotational positioning of the pelvis in the comparison between the cancer groups and the control group (p: 0,112; Power: 0,838; Effect: 1,121). Conclusion: The results suggest that the cancer and its forms of treatment have no influence on the rotational posture of the pelvis. (AU)

Estudo prospectivo randomizado de duplo cego de dois protocolos de cobertura antibiótica na prevenção de osteorradionecrose em pacientes tratados com radioterapia de cabeça e pescoço / Prospective randomized double blind study of two antibiotics protocols for the prevention of osteoradionecrosis following dental extractions in irradiated head and neck cancer patients

A osteorradionecrose (ORN) dos maxilares é uma grave complicação do tratamento radioterápico do câncer de cabeça e pescoço. A realização de exodontias em pacientes que realizaram radioterapia de cabeça e pescoço aumenta o risco de ocorrer osteorradionecrose. Foi realizado estudo prospectivo randomizado e duplo cego com dois protocolos antibióticos utilizados para prevenir a ocorrência de ORN. Pacientes do grupo 1 (G1) utilizaram cobertura antibiótica com amoxicilina 500 mg, a cada 8 horas, via oral, por 8 dias iniciando um dia antes da exodontia, pacientes do grupo 2 (G2) utilizaram cobertura antibiótica com amoxicilina 500mg a cada 8 horas via oral, por 4 dias, iniciando um dia antes do procediemento, continuando por 3 dias após a cirurgia, e utilizando placebo de igual aparência por 4 dias. Onze pacientes foram incluídos no estudo sendo 10 deles do sexo masculino. A idade média dos pacientes foi de 56± 7anos, e 63,6% utilizaram mais de 6.000 cGy durante a radioterapia. Foram realizados 36 procedimentos cirúrgicos, e 51 dentes foram extraídos. Dois pacientes (18,1%) apresentaram três áreas (5,9%) com sinais de ORN em um período médio de acompanhamento de 10± 7 meses. Todos as áreas necróticas ocorreram em região posterior (pré-molares e molares), apresentavam um ou os dois dentes com presença de lesão radiográfica, ocorreram após cirurgias com duração maior que 13 minutos, e apresentavam 1 ou 2 dentes com doença periodontal como motivo da exodontia. Duas áreas necróticas ocorreram em mandíbula, e um em maxila. Não houve diferença estatisticamente significante entre a prevalência de sinais de ORN quando considerado o número de pacientes, procedimentos cirúrgicos realizados, dentes extraídos ou o protocolo antibiótico utilizado. O protocolo utilizado por G2 reduziu o risco de sinais de ORN em pacientes que receberam tratamento radioterápico em região de cabeça e pescoço e que necessitaram remover dentes devido a doença periodontal.

Osteoradionecrosis (ORN) of jaws is a severe complication of head and neck cancer radiotherapy. Dental extractions in irradiated head and neck cancer patients increases ORN risk. A prospective, randomized, double blind study with two different ORN prevention antibiotics protocols were performed. Group 1 patients (G1) received 8th hourly oral amoxicillin 500mg for 8 days starting 1 day pre extraction, and group 2 patients (G2) received 8th hourly oral amoxicillin 500mg for 4 days starting 1 day pre extraction, followed by 4 days of a same appearance placebo drug. A total of 11 patients (10 male and one female) underwent extractions of teeth. Mean age of the patients was 56± 7 years, and 63,6% received more than 6.000cGy radiation dosages. Thirty-six surgery procedures were performed, and 51 teeth were extracted. After a mean follow-up period of 10± 7 months three ORN signals (maxilla 1/mandible 2) were reported, in 2 (18,1%) patients. Necrotic areas envolve theposterior region of jaws, presented previous radiographic lesion, had more than 13 minutes of surgery time, and envolved teeth with periodontal disease. No difference in ORN prevalence beetwen groups of patients, surgical procedures, or removed teeth were detected. The G2 protocol decreased ORN risk when teeth with periodontal problems were extracted.

Longitudinal assessment of nutritional risk in patients under chemo or radiotherapy / Avaliação longitudinal do risco nutricional em pacientes sob quimio ou radioterapia

Summary Objective: To compare nutritional risk in adult patients undergoing chemotherapy and radiotherapy in the beginning, middle, and end of oncologic treatment. Method: This prospective, comparative study included 83 adult patients, 44 undergoing chemotherapy (CT group) and 39 undergoing radiotherapy (RT group) at an oncology treatment center. Nutritional risk was determined by NRS-2002 in the beginning, middle, and end of therapy. Statistical analysis was performed using Statistica 8.0 software. Results: No differences in food intake or body mass index were observed between the CT (24.6±4.8 kg/m²) and RT groups (25.0±5.9 kg/m², p=0.75). Weight loss in the preceding 3 months was detected in 56.8% of CT group and 38.5% of RT group (p=0.09). The weight loss percentage compared with the usual weight within 3 months was greater (p<0.001) in the CT (11.4±6.5%) than in the RT group (3.9±6.8%). In the beginning of treatment, we observed high percentages of patients at moderate (18.2 vs. 15.4%, p=0.73) and high nutritional risk (61.4 vs. 48.7%, p=0.25), with no statistical difference between the CT and RT groups, respectively. During therapy, the nutritional risk remained unaltered in both groups. In the end of therapy, the majority of patients were at moderate (18.2 vs. 12.8%, p=0.50) or severe nutritional risk (50.0 vs. 51.3%, p=0.91), in the CT and RT groups, respectively, regardless of the type of oncologic treatment. Conclusion: The high prevalence of patients at moderate or high nutritional risk in the beginning of treatment indicates the need for an early and continuous follow-up of the nutritional status of patients undergoing oncologic treatment.

Resumo Objetivo: comparar o risco nutricional de pacientes adultos submetidos a quimio e radioterapia no início, no meio e ao término do tratamento oncológico. Método: estudo prospectivo e comparativo conduzido com 83 pacientes adultos de um centro de tratamento oncológico, sendo 44 sujeitos sob quimioterapia (grupo QTx) e 39 sob radioterapia (grupo RTx). O risco nutricional foi determinado pelo questionário NRS-2002 no início, ao meio e ao término da terapia. A análise estatística foi feita com o software Statistica 8.0. Resultados: não houve diferença no padrão de ingestão alimentar e no IMC (24,6±4,8 vs. 25±5,9 kg/m²; p=0,75) nos grupos QTx e RTx, respectivamente. Perda de peso nos 3 meses precedentes ocorreu em 56,8% dos pacientes sob quimioterapia e em 38,5% daqueles sob radioterapia (p=0,09). Os pacientes do grupo QTx apresentaram maior porcentagem de perda de peso em relação ao habitual em 3 meses (11,4±6,5 vs. 3,9±6,8%; p<0,001). No início do tratamento, houve alta taxa de risco nutricional moderado (18,2 vs. 15,4%; p=0,73) e grave (61,4 vs. 48,7%; p=0,25), sem diferença estatística entre os grupos QTx e RTx, respectivamente. No meio do tratamento, o risco nutricional foi mantido em ambos os grupos. Ao término da terapia, mais da metade dos pacientes apresentava risco nutricional moderado (18,2 vs. 12,8%; p=0,50) ou grave (50 vs. 51,3%; p=0,91), independentemente da modalidade de tratamento oncológico. Conclusão: a alta prevalência de risco nutricional moderado ou grave no início do tratamento aponta para a necessidade de abordagem nutricional precoce e permanente durante a terapia oncológica.

Tratamiento no quirúrgico en cáncer epidermoide de orofaringe avanzado: análisis de resultados oncológicos en función del subsitio tumoral y fraccionamiento de radioterapia / Nonsurgical treatment in advanced oropharyngeal squamous cell cancer

Objetivo: Reportar resultados de nuestro protocolo de radioquimioterapia concomitante exclusiva en el cáncer de orofaringe avanzado. Materiales y métodos: Estudio retrospectivo que incluyó 87 pacientes. Se realizó radioterapia concomitante con cisplatino semanal. Se aceptó la realización de fraccionamiento convencional (FC), hiperfraccionamiento (Hfx) o fraccionamiento acelerado tipo boost concomitante (FABC). Se revisó la sobrevida global (SG), sobrevida libre de enfermedad (SLE), sobrevida libre de recidiva local (SLRL) y regional (SLRR) según subsitio y fraccionamiento. Resultados: Ingresaron 87 pacientes. Mediana de seguimiento: 120 meses. El 53, 30 y 17% recibieron FC, FABC y Hfx respectivamente. La SG a 2, 5 y 10 años fue de un 73, 61 y 43% respectivamente. La SG a 5 años según subsitio anatómico fue: amígdala 74%, paladar blando 33%, base de lengua 33%, y pared faríngea posterior 33%. Al comparar la SG de amígdala versus otros subsitios se alcanza una diferencia estadísticamente significativa (p < 0,001). La mediana de SG para amígdala no fue alcanzada, mientras que en otros subsitios fue de 22 meses. La SLE fue diferente en los distintos subsitios, superior en amígdala y diferente entre los distintos fraccionamientos, a favor de Hfx, alcanzando diferencias significativas. Las mismas tendencias se demostraron en SLRL y SLRR. Observamos un 23% de segundos primarios, siendo el pulmón el sitio más frecuente. Conclusión: La radioterapia concomitante con cisplatino semanal es un tratamiento adecuado para el cáncer de orofaringe. Ofrece excelentes resultados en cáncer de amígdala, especialmente con fraccionamiento modificado. Para los otros subsitios nos parece recomendable explorar nuevas estrategias de tratamiento.

Objective: To report results of our concomitant radiochemotherapy protocol for advanced oropharyngeal cancer. Materials and methods: Retrospective study. Concomitant radiochemotherapy was performed with weekly cisplatin. Conventional fractionation (CF), hyperfractionation (Hfx) or accelerated fractionation with concomitant boost (FABC) were accepted. Overall survival (OS), Disease-free survival (RFS), Local relapse-free survival (LRFS) and Regional relapse-free survival (RRFS) were calculated, according subsite and radiotherapy fractionation. Results: We found 87 patients. Median follow-up: 120 months. 53%, 30% and 17% received FC, FABC, Hfx respectively. OS at 2, 5 and 10 years was 73%, 61% and 43% respectively. The 5-year OS was, by anatomic subsite: Tonsillar 74%, 33% soft palate, base of tongue 33%, and 33% for posterior pharyngeal wall. By comparing the OS in tonsil versus other subsites we found statistically significant difference in favor of tonsillar cancer (P < .001). Median OS for tonsillar cancer was not achieved, while in other subsites was 22 months. DFS was different in different subsites, better for amygdala and different among different fractionations, better for Hfx, reaching significant differences. The same trends were demonstrated in LRFS and RRFS. We observed a 23% of second cancers, being lung the most common site. Conclusion: Concomitant radiotherapy with weekly cisplatin is an appropriate treatment for oropharyngeal cancer. It provides excellent outcomes in tonsillar cancer, especially with modified fractionation and Hfx type. For other subsites it seems advisable to explore a new treatment approach.

Insuficiencia mesentérica crónica luego de radioterapia para aórtica / Surgical revascularization for treatment of chronic mesenteric ischemia secondary to radiotherapy

Background: Chronic mesenteric ischemia is observed in older people and is often due to atherosclerosis. Radiotherapy is an important risk factor for atherosclerosis. Aim: To report our experience with chronic mesenteric ischemia secondary to retroperitoneal radiotherapy. Material and methods: Review of medical records of four male patients aged 39 to 65 years, treated for chronic mesenteric ischemia secondary to para-aortic radiotherapy between 1993 and 2011. Results: All of them had the classic symptoms of ischemia characterized by post prandial abdominal pain and weight loss. One had also isolated diarrhea episodes. Revascularization was achieved with open or endovascular surgery, with good results during a follow up period ranging from two to 20 years. Conclusions: Surgical revascularization is a good treatment for chronic mesenteric ischemia secondary to radiotherapy.

Introducción: La insuficiencia mesentérica crónica es un diagnóstico infrecuente, generalmente secundario a enfermedad aterosclerótica, siendo considerada una enfermedad de pacientes añosos. Se sabe que la radioterapia es un factor de riesgo importante para aterosclerosis. Describimos nuestra experiencia en el manejo de la isquemia mesentérica crónica secundaria a radioterapia retroperitoneal. Materiales y métodos: Análisis retrospectivo de las fichas clínicas de los pacientes tratados en nuestro centro por insuficiencia mesentérica crónica posterior a radioterapia del territorio para-aórtico entre 1993 y 2011. Resultados: Un total de 4 pacientes de sexo masculino fueron identificados. Edad promedio: 49 +/- 12 años (rango 39-65). Todos presentaron los síntomas clásicos de insuficiencia mesentérica caracterizados por dolor abdominal postprandial y baja de peso. Uno de ellos además tenía episodios repetidos de diarrea. La revascularización mesentérica se obtuvo mediante cirugía abierta o endovascular con excelentes resultados a corto y largo plazo con un seguimiento promedio de 9,3 años (rango 2-20). Discusión: El curso acelerado de la aterosclerosis posterior a radioterapia se ha descrito en múltiples territorios vasculares. Síntomas de insuficiencia mesentérica crónica pueden ser malinterpretados en estos pacientes debido a su similitud con los síntomas observados en la ileitis actínica. Un diagnóstico y tratamiento oportuno son críticos para evitar complicaciones mayores y deterioro de calidad de vida de estos pacientes. Conclusión: La insuficiencia mesentérica crónica inducida por radioterapia es una condición infrecuente. El manejo con cirugía abierta o endovascular son seguras y otorgan resolución sintomática a largo plazo.

Oral alterations in children with cancer: literature review / Alteraciones orales en niños con cáncer: revisión del tema

For dentists, there is little information on malignant tumors and complications both because their natural evolution is secondary to treatment, despite cancer in children represents 3 percent of all cancer cases. The goal is to make a brief review of the most common neoplasm in children, to identify them and find out the oral alterations with highest incidence both as secondary to the pathology and as a side effect of treatment. This review analyses various types of malignant neoplasms which may occur in this stage of life. They are divided into haematological: leukemias, lymphomas and solid tumors. The most common leukemia is acute lymphoblastic (ALL) followed by acute myeloid and granulocytic. Lymphomas develop from the lymphatic system and are divided into Hodgkin's and non-Hodgkin's. Cancer has become a chronic disease favoring a new group of patients who achieve survival but suffer side effects due to therapies, drugs, doses and the child's characteristics. Oral complications appear in 40 percent of cases and the most frequent are mucositis, opportunistic infection, xerostomia, bleeding, periodontal disease and disorders in the development of teeth and jaw. Although cancer is located outside of the maxillofacial area, chemotherapy is aggressive for a developing organism. The side effects of radiation therapy affect the general and specific area to radiate as well as the surrounding organs and tissues. Recently, advances in diagnosis and treatment have increased survival from 20 percent to 80 percent, with long-term treatment.

Existe poca información para el odontólogo sobre tumores malignos y complicaciones por su evolución natural como secundaria al tratamiento a pesar de ser el cáncer en niños el 3 por ciento de todos los cánceres. El objetivo es hacer una revisión sucinta de las neoplasias más frecuentes en niños, identificarlas y conocer las alteraciones orales con mayor incidencia secundarias tanto a la patología como el efecto secundario del tratamiento. Realizamos una revisión analizando los diferentes tipos de neoplasias malignas que puede presentarse en esta etapa de vida, las cuales se dividen en hematológicos: leucemias y linfomas y tumores sólidos. La leucemia más frecuente es la linfoblastica aguda (LLA), después la Mieloide Aguda, y Granulocítica. Los linfomas se desarrollan del sistema linfático, se dividen en Hodgkin y no Hodgkin. El cáncer se ha convertido en una enfermedad crónica. Ello favorece un nuevo grupo de pacientes que logran supervivencia suficiente para que puedan producirse efectos secundarios por las terapias utilizadas, fármacos, dosis y las características de cada niño. Las complicaciones orales aparecen en un 40 por ciento, las más frecuentes: mucositis, infección oportunista, xerostomía, hemorragias, enfermedad periodontal, alteraciones del desarrollo de dientes y maxilar. Aunque el cáncer esté localizado fuera del área maxilofacial, la quimioterapia es agresiva en un organismo en desarrollo. Los efectos secundarios de la radioterapia son generales y específicos de la zona a irradiar, órganos y tejidos circundantes. Últimamente, los avances en diagnóstico y tratamiento aumentaron la supervivencia del 20 por ciento al 80 por ciento, con tratamientos a largo plazo.

Perceptions by pregnant and childbearing-age women in southern Brazil towards teratogenic risk from medicines and radiotherapy / Percepções de risco teratogênico de medicamentos e radioterapia por gestantes e mulheres em idade fértil no Sul do Brasil / Percepciones de riesgo teratogénico de medicamentos y radioterapia en mujeres embarazadas y en edad fértil en el sur de Brasil

Mistaken perception of teratogenic risk can keep pregnant women from using safe medicines. The current study analyzed women’s concepts and perceptions towards teratogenic risk from medicines and exposure to radiotherapy during pregnancy. The quantitative data resulted from interviews with 287 pregnant and non-pregnant women. Two qualitative focus groups were conducted. No significant differences were observed between the two groups in terms of perceptions of teratogenic risk. Median perceptions of non-teratogenic exposures (paracetamol and metoclopramide) were close to the expected values, while higher values were found for teratogenic exposures (misoprostol and radiotherapy). The logic women used to estimate risk was classification of medicines as “strong” or “weak”. Medicines perceived as “weak” by the women do not pose any teratogenic risk, as shown by the median perceptions close to the true values. Meanwhile, “strong” medicines were viewed as dangerous, thus explaining the high median perceptions of teratogenic exposures.

Percepção de risco teratogênico equivocada pode privar a gestante do uso de medicamentos seguros. O estudo analisou concepções e percepções de risco teratogênico de mulheres sobre o uso de medicamentos e exposição à radioterapia durante a gestação. Dados quantitativos resultaram da realização de entrevistas com 287 gestantes e não gestantes. Qualitativamente, dois grupos focais foram realizados. Não se observaram diferenças significativas nas percepções de risco teratogênico entre grupos. As medianas das percepções para as exposições não teratogênicas – paracetamol e metoclopramida – foram próximas do valor esperado, e para as exposições teratogênicas – misoprostol e radioterapia – valores maiores foram encontrados. A lógica acionada pelas mulheres na estimação do risco é a da classificação dos medicamentos em fortes e fracos. Medicamentos percebidos pelas mulheres como fracos não apresentam risco, evidenciado pela aproximação das medianas ao valor esperado. Já medicamentos fortes são vistos como perigosos, justificando as altas medianas das exposições teratogênicas.

Percepción equivocada del riesgo teratogénico puede privar a las embarazadas de la utilización de medicamentos seguros. En este estudio se analizan las concepciones y la percepción de riesgo teratogénico de mujeres con respecto al uso de medicamentos y exposición a la radioterapia durante el embarazo. Los datos cuantitativos resultan de la administración de entrevistas a 287 mujeres embarazadas y no embarazadas; los cualitativos, de dos grupos focales. No se encontraron diferencias significativas en la percepción de riesgo entre los grupos. Las medianas para la percepción de riesgo a las exposiciones no teratogénicas resultaron cerca del valor esperado, mientras que para las exposiciones teratogénicas se encontraron valores más altos. La lógica usada por las mujeres para estimar el riesgo clasifica los medicamentos en fuertes y débiles. Aquellos percibidos como débiles no suponen riesgo (lo que se evidencia por la aproximación de las medianas al valor real). Por otra parte, los fuertes son vistos como peligrosos, lo que justifica las medianas altas para los riesgos teratogénicos.

Qualidade de vida em mulheres submetidas a tratamento para o câncer do colo do útero: uma revisão sistemática da literatura / Quality of life in women undergoing treatment for cervical cancer: a systematic review of the literature

Tem sido observado o aumento do número de sobreviventes ao câncer do colo do útero, o que também está associado aos avanços científicos na abordagem terapêutica da doença. Porém, o tratamento desta neoplasia pode, por outro lado, levar a efeitos adversos tardios, como disfunções sexuais, intestinais e urinárias, que podem comprometer a qualidade de vida (QV) destas mulheres. O presente estudo teve como objetivo realizar uma revisão sistemática a respeito da QV em mulheres submetidas ao tratamento para o câncer do colo uterino. Realizou-se, então, busca nas bases de dados bibliográficos Medline e LILACS para identificar artigos originais, disponíveis na íntegra, publicados entre 2005 e 2012, no idioma inglês. A partir da análise dos artigos considerados, percebe-se o impacto negativo das intervenções terapêuticas, especialmente da radioterapia e suas sequelas na função sexual e QV. Além disso, destacam-se outros fatores associados à QV relacionados às características individuais, à rede social de apoio, à gravidade da doença e ao tratamento instituído. Verifica-se, então, a importância da avaliação da QV e do conhecimento dos fatores associados, visando auxiliar na adoção de estratégias que possam propiciar um atendimento mais integral...

It has been observed the increase of the number of cervical cancer survivors, which is also associated with scientific advances in the therapeutic management of the disease. However, the treatment of this malignancy can lead to late adverse effects such as sexual, intestinal and urinary dysfunctions, which can compromise women's quality of life. The present study aims to conduct a systematic review about life quality in women undergoing treatment for cervical cancer. We searched the bibliographic databases Medline and LILACS to identify full original articles, published between 2005 and 2012, in English. One realizes the negative impact of therapeutic interventions, especially radiotherapy and its sequelae in sexual function and quality of life. In addition, we highlight other factors associated to quality of life related to individual characteristics, the social support network, the severity of disease and treatment. Thus, it is important to assess quality of life and to know the associated factors, to aid in the adoption of strategies that can provide a more comprehensive...

Tratamiento de la rectitis actínica hemorrágica con aplicación tópica de formalina al 4 por ciento / Treatment of hemorrhagic radiation rectitis with topical application of 4percent formaldehyde

Background: Hemorrhagic radiation rectitis occurs in 15 percent of patients subjected to pelvic irradiation. One of the treatment alternatives is the topical application of 4 percent formaldehyde. Aim: To report the results of the use of topical formaldehyde in radiation rectitis. Material and Methods: Twenty patients aged 36 to 80 years (13 women) with hemorrhagic radiation rectitis were prospectively recruited. Fistula or stenosis was discarded endoscopically. Formaldehyde was applied in the operating room or at the outpatient clinic. Results: Fifteen patients required repeated transfusions. The application was performed in the operating room in five patients. Bleeding stopped in three patients with one application, in 12 patients with two applications and in four, with three applications. In one patient, bleeding did not stop after the first application and had a sigmoid perforation; therefore no further application was attempted. One patient had a severe proctitis after the procedure, which subsided with symptomatic treatment after 15 days. Conclusions: Topical formaldehyde application for hemorrhagic rectitis is effective to stop bleeding but has complications in 10 percent of patients.

Introducción: La rectitis actínica hemorrágica es una complicación que se presenta en el 15 por ciento de los pacientes sometidos a radioterapia por una neoplasia pélvica. Existen distintas alternativas para su tratamiento, entre las que se cuenta la aplicación de formalina al 4 por ciento. Presentamos los resultados del tratamiento de esta complicación en una serie prospectiva no aleatoria. Material y Método: Desde marzo de 2004 a mayo de 2007 se reclutaron en forma prospectiva todos los pacientes tratados por una rectitis actínica hemorrágica en nuestro servicio. En todos los pacientes se descartó una estenosis o fístula por endoscopia flexible. Los pacientes fueron sometidos a aplicación de formalina en pabellón o ambulatoria según la evaluación del tratante. Resultados: La serie corresponde a 20 pacientes, 13 mujeres, con un promedio de edad de 61 años (36-80), 15 requerían transfusiones a repetición. La indicación de radioterapia fue por un cáncer cérvico uterino en 9 casos, de próstata en 7 casos y endometrio en 4. El promedio de sesiones necesarias para controlar el sangrado fue de 2 (1-3); en 5 pacientes la aplicación se realizó en pabellón. Tres pacientes mejoraron con una aplicación, 12 pacientes con 2 aplicaciones y 4 con 3 procedimientos. Un paciente continúa sangrado después de un procedimiento, pero presenta una perforación de sigmoides en terreno neoplásico y no se intentó una segunda sesión, por lo que se considera un fracaso del procedimiento. Además un paciente presentó una proctitis intensa que cedió con tratamiento sintomático en 15 días, con lo que la morbilidad del procedimiento alcanza a un 10 por ciento. El éxito acumulado es de un 95 por ciento de los casos, con detención del sangrado, sin necesidad de transfusiones. Conclusión: Estimamos que el tratamiento con formalina al 4 por ciento es un procedimiento seguro para el tratamiento de la rectitis actínica hemorrágica, con buenos resultados en la gran mayoría de los pacientes ...

Efeitos da radioterapia sobre as condições bucais de pacientes oncológicos / Effects of radiotherapy on the oral consitions of oncologic patients

o presente estudo avaliou as condições bucais de 50 pacientes oncológicos submetidos à radioterapia de cabeça e pescoço (rT). os exames clínicos foram realizados antes do tratamento, imediatamente após 30 dias da rT e 6 meses após a conclusão da rT. As condições periodontais foram avaliadas segundo os critérios do Periodontal screening and recording (Psr) e determinou-se a necessidade de tratamento odontológico. A presença de xerostomia, mucosite e outros efeitos colaterais da rT foi também avaliada. Os pacientes irradiados logo após o início da radioterapia desenvolvem severa mucosite, dermatite, disgeusia, xerostomia e, em menor extensão, candidose. Após a conclusão da radioterapia, 68% dos pacientes apresentavam mucosite grau III ou IV. Verificou-se que o desenvolvimento de mucosite dificulta a higiene bucal, o que colabora para exacerbar a inflamação nos tecidos periodontais. Os dados do presente estudo mostraram que a principal causa de abandono da RT e da severidade das sequelas da RT dependem das condições bucais dos pacientes antes do início do tratamento e da ausência de tratamento odontológico prévio à RT.

Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving > 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.

Función tiroidea postratamiento de cáncer escamoso de orofaringe, hipofaringe y laringe / Thyroid function after oropharyngeal, hypophariyngeal and laryngeal squamous cell carcinoma treatment

Introducción: El hipotiroidismo es una de las complicaciones del tratamiento del cáncer de cabeza y cuello, con incidencias que varían desde 7 por ciento a 57 por ciento. Objetivo: Estimar frecuencia de hipotiroidismo en pacientes con cáncer faringo laríngeo y determinar factores de riesgo. Material y método: Se realizó un estudio transversal, midiendo la función tiroidea de todos los pacientes diagnosticados y tratados por carcinoma escamoso de orofaringe, hipofaringe y laringe en el Servicio de Otorrinolaringología del Hospital San Juan de Dios entre enero de 2006 y diciembre de 2007. Resultados: El 55,5 por ciento presentó una función tiroidea alterada en la evaluación posterior al tratamiento. La modalidad de tratamiento es crucial, variando de 35 por ciento de alteración en el grupo tratado con radioterapia v/s 83 por ciento de afección cuando ésta se asoció a cirugía. La quimioterapia no mostró efectos. Conclusiones: El hipotiroidismo es una complicación frecuente, pero poco reconocida, que ocurre en más del 50 por ciento de los pacientes tratados por cáncer de orofaringe, hipofaringe y laringe.

Introduction: Hypothyroidism is a complication of head and neck cancer treatment, it incidence goes from 7 percent to 57 percent. Aim: To estímate frequency of hipothyroidism in patients with cáncer ofpharynxand larynx and to dertermine factor of risk. Material and method: Transversal study Thyroid function measurement in patients diagnosed and treated for oropharyngeal, hypophariyngeal and laryngeal squamous cell carcinoma at San Juan de Dios's Hospital since January 2006 to December 2007. Results: 55,5 percent presented an altered thyroid function after treatment. The treatment modality is crucial, on it's frequency, changing from 35 percent with radiotherapy, v/s 83 percent when this one was associated with surgery. The chemotherapy did not show effects. Conclusions: The hypothyroidism is a frequent, but slightly recognized complication, which happens in more than 50 percent of patients treated for for oropharyngeal, hypophariyngeal and laryngeal squamous cell carcinoma.

Sperm banking for male cancer patients: social and semen profiles

PURPOSE: Report the characteristics of cryopreserved semen from a cohort of male cancer patients, attitudes towards cryopreservation and outcomes of semen samples based on a 12-year cryopreservation program. MATERIAL AND METHODS: Data from 98 male cancer patients whose sperm samples were banked were evaluated. Demographic parameters, semen characteristics, destination of sperm banked samples and questionnaires answered by the patients regarding cryopreservation time were evaluated. RESULTS: The cancer diagnoses were testicle (56.1 percent), prostate (15.3 percent), Hodgkin's lymphomas (9.2 percent), non-Hodgkin's lymphomas (7.1 percent), leukemia (3.1 percent) and other malignancies (9.2 percent). The patients with testicular cancer presented lower sperm concentration (p < 0.001); however, there were no differences with the percentage of normozoospermic patients among cancer type groups (p = 0.185). A shorter time between cancer diagnosis and sperm banking was observed for testicular and prostate cancer patients (p < 0.001). Most of the patients (89.5 percent) favored sperm banking as a fertility preservation method. CONCLUSIONS: Although less than 20 percent of banked sperm samples were disposed of, the majority of patients related sperm banking with safe for fertility preservation. Our results show that all male cancer patients of reproductive age facing cancer treatment could be offered sperm banking.