Trans Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in Brazil: Safety and complications during learning curve

ABSTRACT Background: The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Materials and Methods: Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. Results: A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. Conclusion: The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.

Ocotea pulchellaas an alternative against schistosomiasis: chemical analysis, development of nanoemulsion and biological control activity / Ocotea pulchellacomo una alternativa ante esquistosomiasis: análisis químico, desarrollo de una nanoemulsión y actividad en control biológico

The aim of this work was to evaluate the potential of the essential oil (EO) from Ocotea pulchella leaves as an alternative in the control of schistosomiasis. It was tested O. pulchella EO nanoformulation to assess its activity against adult Biomphalaria glabrata, their spawning and Schistossoma mansoni cercariae. Additionally, the EO chemical composition was investigated by gas-chromatography. Nanoemulsion were elaborated by the low energy method. The adult mollusks, their spawning and cercariae were placed in contact with nanoemulsion to calculate lethal concentrations. Myristicin, bicyclogermacrene and α-Pinene were the main substances in the EO. Nanoemulsion caused mortality of adult B. glabrata, its egg embryos and S. mansoni. These results suggest the use of this nanoemulsion as an alternative in the control of the schistosomiasis cycle.

El objetivo de este trabajo fue evaluar el potencial de los aceites esenciales (AE) de las hojas de Ocotea pulchellacomo una alternativa en el control de esquistosomiasis. Se probó una nanoformulación de AE de O. pulchellapara evaluar su actividad ante adultos de Biomphalaria glabrata, sus huevos y cercarías de Schistossoma mansoni. La nanoemulsión fue elaborada por el método de baja energía. Los moluscos adultos, sus huevos y cercarías se colocaron en contacto con la nanoemulsión para calcular concentraciones letales. Los compuestos mayoritarios en el AE fueron miristicina, biciclogermacreno y α-pineno. La nanoemulsión causó mortalidad en adultos de B. glabrata, sus huevos y a S. mansoni. Los resultados sugieren el uso de esta nanoemulsión como una alternativa en el control del ciclo de esquistosomiasis.

Nanoemulsion containing essential oil from Xylopia ochrantha Mart. produces molluscicidal effects against different species of Biomphalaria (Schistosoma hosts)

BACKGROUND This work describes a chemical study of the essential oil from leaves of Xylopia ochrantha, an endemic Annonaceae species from Brazil, and its activity against Biomphalaria species. Considering its poor solubility in aqueous medium, the essential oil was nanoemulsified to evaluate its action on controlling some mollusc species of genus Biomphalaria, snail hosts of Schistosoma mansoni that causes schistosomiasis, which mainly affects tropical and subtropical countries. OBJECTIVES The main aims of this work were to analyse the chemical composition of essential oil from X. ochrantha, and to evaluate the effect of its nanoemulsion on molluscs of genus Biomphalaria and their oviposition. METHODS Chemical analysis was performed by gas chromatography coupled to mass spectrometry. Nanoemulsions were prepared by a low energy method and characterised by particle size and polydispersity index. Biological assays evaluating the mortality of adult species of B. glabrata, B. straminea and B. tenagophila and their ovipositions upon contact with the most stable nanoemulsion during 24 and 48 h were performed. FINDINGS Chemical analysis by mass spectrometry revealed the majority presence of bicyclogermacrene and germacrene D in the essential oil. The formulation with a hydrophilic-lipophilic balance (HLB) of 9.26 was the most suitable for the oil delivery system. This nanoemulsion caused the mortality in B. tenagophila, B. straminea and B. glabarata of different sizes at levels ranging from 50 to 100% in 48 h. Additionally, the formulation could inhibit the development of deposited eggs. CONCLUSION Thus, these results suggest the use of nanoemulsified essential oil from X. ochrantha as a possible alternative in controlling some Biomphalaria species involved in the schistosomiasis cycle.

Effects of albumin administration in serum liver enzymes of rats in the presence of extrahepatic biliary obstruction / Efeitos da administração de albumina nos níveis séricos de enzimas hepáticas em ratos com obstrução biliar extra-hepática

PURPOSE: To study the influence of albumin on changes of liver function in the extrahepatic biliary obstruction through an experimental model in rats. METHODS: Sixty rats were divided into four groups: Group C (Control): 6 animals. Group M (Fictitious Operation): 18 rats underwent laparotomy and handling of the bile ducts; Groups O (extrahepatic biliary obstruction) and A (Treated with 2 percent albumin): 18 animals in each group underwent ligation of the ductus liver; The animals in groups M, O and A were divided into three subgroups of 6 animals each to be killed in the 7, 14 and 21 days postoperative (POD). Blood was drawn for determination of total bilirubin (TB), indirect bilirubin (IB), direct bilirubin (DB), alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT). RESULTS: On POD 7, BI levels were 4.5 mg / dl in group O and 2.1 mg / dl in group A (p = 0.025). On the 14th POD, the levels of PA were 1185.2 U / l in the group and O 458.3 U / l in group A (p = 0.004). ALT levels were 101.7 U / l in the group O and 75.7 U / l in group A (= 0.037). On POD 21, the levels of ALP were 1069.5 U / l in the group O and 468.3 U / l in group A (p = 0, 004). CONCLUSION: The administration of albumin reduced the serum levels of bilirubin in the 7th day of supplementation.

OBJETIVO: Estudar a influência da albumina em alterações funcionais do fígado na obstrução biliar extra-hepática por meio de um modelo experimental desenvolvido em ratos. MÉTODOS: 60 ratos distribuídos em quatro grupos: Grupo C (Controle): 6 animais. Grupo M (Operação Fictícia): 18 ratos submetidos à laparotomia e manuseio das vias biliares; Grupos O (Obstrução Biliar Extra-hepática) e A (Tratados com albumina a 2 por cento): 18 animais, em cada grupo, submetidos à ligadura do ducto hepático; Os animais dos grupos M, O e A foram distribuídos em três subgrupos de 6 animais cada, para serem mortos nos 7°, 14° e 21° dias pós- operatórios (DPO). Foi colhido sangue para dosagem de bilirrubina total (BT), bilirrubina indireta (BI), bilirrubina direta (BD), fosfatase alcalina (FAL), aspartato aminotransferase (AST) e alanina aminotransferase (ALT). RESULTADOS: no 7º DPO, os níveis de BI foram 4,5 mg/dl no grupo O e 2,1mg/dl no grupo A (p=0,025). No 14º DPO, os níveis de FAL foram 1185,2 U/l no grupo O e 458,3 U/l no grupo A (p=0,004). Os níveis de ALT foram de 101,7 U/l no grupo O e 75,7 U/l no grupo A (=0,037). No 21º DPO, os níveis de FAL foram de 1069,5 U/l no grupo Oe de 468,3 U/l no grupo A (p =0, 004). CONCLUSÃO: a administração de albumina reduziu os níveis séricos de bilirrubina indireta no 7°dia de suplementação.

Sarcomas de partes moles de cabeça e pescoço na infância: análise de fatores prognósticos e epidemiológicos, preditivos de resposta ao tratamento / Head and neck soft tissue sarcomas in pediatric patients: analysis of prognostic and epidemiological factors predictable of treatment outcome

Introdução: Sarcomas de cabeça e pescoço (SCP) são tumores raros, acometendo em torno de 6.000 crianças por ano nos Estados Unidos. O rabdomiossarcoma é tipo histológico mais comum e possui uma sobrevida média de 50%. A principal causa é genética, associando-se secundariamente à radiação. Suas manifestações clínicas dependem da localização, mas manifesta-se geralmente como uma massa dolorosa. Metástase linfática é rara. O diagnóstico é clínico, comprovado por biópsia e melhor avaliado pela ressonância e tomografia. O tratamento de escolha é a radioterapia associada à quimioterapia. Objetivo: Avaliar os fatores epidemiológicos, preditivos de resposta terapêutica e sobrevida dos pacientes portadores de SCP na infância, matriculados no INCA. Métodos: Estudo retrospectivo pela análise de prontuários dos casos de SCP na população pediátrica, tratados em uma única instituição entre janeiro/1997 e janeiro/2007, excluindo-se: osteossarcomas, condrossarcomas, tumores desmóides, sarcomas de Kaposi, hemangiopericitoma e carcinossarcomas. Resultados: Foram encontrados 39 pacientes, a maioria do gênero masculino (1,5:1). O sítio tumoral mais comum foi a órbita. Estadiamento T2 foi o mais encontrado com estágio avançado predominante. Rabdomiossarcoma alveolar foi o tipo histológico mais comum. O principal tratamento realizado foi a radioterapia com quimioterapia e a sobrevida global de 70,12%. Conclusão: O gênero mais acometido foi o masculino. Não houve predomínio de faixa etária. O tipo histológico mais comum foi o rabdomiossarcoma e o tratamento mais utilizado foi a associação da quimioterapia com radioterapia. Os fatores prognósticos envolvidos e considerados significativos incluem o subtipo e grau histológico bem como tipo de tratamento. O tipo histológico influenciou na sobrevida livre de doença dos pacientes.

Introduction: Head and neck soft tissue sarcomas are rare tumors. About 6,000 children are affected per year in the US. The rabdomiossarcoma is the commonest type, and has a overall survival rate of 50%. The main cause is genetical. The clinical manifestations are dependent of the anatomic situation, but it generally manifests as a painful mass. Lymphatic metastasis are rare. The diagnosis is clinical proven by a biopsy and better evaluated by the MRI and CT. The treatment of choice is radiotherapy associated with chemotherapy. Objective: To evaluate the epidemiological factors, and predictable factors of therapeutic outcome and overall survival in pediatric patients with HNSTS. Methods: Retrospective analysis of HNSTS cases, in a pediatric population, treated in a single institution between January, 1997 and January, 2007, excluding: osteosarcomas, condrosarcomas, desmoids tumors, Kaposi's sarcoma, hemangiopericitoma and carcinosarcomas. Results: 39 patients were found; men were the majority of the cases (1.5:1). The commonest tumor site was the orbit. Stage T2 was most found with an advanced predominant stage. Alveolar rhabdomyosarcoma was the commonest subtype. The principal treatment was radiotherapy with chemotherapy and the overall survival was 70.12%. Conclusion: The most prevalent gender was male. There was not a predominant age group. The commonest subtype was the rhabdomyosarcoma and the most utilized treatment was the association of chemotherapy with radiation. The most significant prognostic factors were the subtype and historical degree as well as the treatment that was implemented. The histological type has influence on the disease free survival of the patients.

Análise crítica da aplicação da pesquisa do linfonodo sentinela no tratamento do câncer inicial de boca / Critical analysis of the sentinel lymph node biopsy in the treatment of early oral cancer

Introdução: A pesquisa do linfonodo sentinela (LNS) tende a diminuir as comorbidades do tratamento desnecessário referentes ao esvaziamento cervical. Objetivo: Avaliar a efetividade do LNS na detecção de metástases ocultas em pacientes com carcinoma espinocelular (CEC) de boca. Métodos: Estudo prospectivo com 25 pacientes com CEC de boca T1/T2 com pescoço N0. A linfocintigrafia pré-operatoria foi feita com 99mTc-fitato injetado peri-lesional. O local do LNS era marcado pela medicina nuclear. No peroperatório, era injetado azul patente peri-lesional e os LNS avaliados com um gama probe. Após a pesquisa do LNS, todos foram submetidos a esvaziamento cervical seletivo, conforme o padrão do serviço. Todos os LNS foram enviados para estudo anatomo-patológico para comparação. Resultados: O local mais frequente foi a língua, com 62% e o soalho, 38%. Em relação ao estadiamento, 56% eram T2 e 44% T1. Do total de pacientes, 25% tiveram LNS positivo, sendo todos detectados na pesquisa do LNS, com sensibilidade de 100%, especificidade de 8% e verdadeiros-negativo de 100%, porém, encontramos problemas como: interferência na detecção da radiação pela proximidade do tumor-LNS, múltiplos LNS, LNS pequenos, profundos, múltiplos níveis e não corados pelo azul. Conclusão: A pesquisa do LNS pode diminuir a morbidade do esvaziamento cervical. Em virtude de vários fatores, principalmente a alta taxa de interferência (tumor-linfonodo) essa técnica ainda não deve ser o padrão para o tratamento do pescoço nesses pacientes, devendo existir um estudo multicêntrico prospectivo avaliando sua eficácia oncológica em cinco anos.

Introduction: The management of the neck in oral cavity cancer is still a challenge for the head and neck surgeon. Objective: To assess the feasibility of the sentinel lymph node (SLN) in squamous cell carcinoma (SCC) of the oral cavity staging T1/T2. Methods: It was a prospective study with 25 patients with N0 SCC of the oral cavity. Lymphoscintigraphy with 99mT was done before the surgery and the lymph node spot was marked. In the operation room, blue dye was injected around the tumor and the sentinel lymph node evaluated with a gamma probe. After the research of the sentinel lymph node, all patients underwent the selective neck dissection. All lymph nodes were submitted for histopathological study. Results: The most frequent location was the tong (62%) followed by the floor of the mouth (38%). The stage was 56% for T2 and 44% for T1. A rate of 25% of the patients had positive SLN, but one of them had 4 other lymph nodes compromised. The sensibility was 100%, specificity 8% and true negative 100%, but there were problems, such as the interference in the detection of radiation next the tumor, multiples SLN, small, deep and multiples levels of SLN, does not colored for blue dye. Twelve patients (75%) had all the lymph nodes negative. Conclusion: Sentinel lymph node biopsy will get a great importance in reducing the comorbidity of neck dissection. However, because of many factors, mainly the great interference (tumor-lymph node) this technique must not be the gold standard for the treatment of the neck in early oral cancer up to now.

Impacto prognóstico do subtipo histológico na sobrevida de pacientes com sarcomas de cabeça e pescoço / Prognostic impact of histologycal subtype on survival of head and neck sarcoma's patients

Introdução: Sarcomas de partes moles em cabeça e pescoço (SPMCP) formam um grupo heterogêneo de neoplasias. Possuem origens embriológicas e histológicas diferentes, apesar de sua origem mesenquimal. São tumores raros, representando cerca de 10% de todos os sarcomas e apenas 1% de todas as neoplasias que acometem a cabeça e pescoço. São inúmeros os subtipos histológicos, os quais apresentam sobrevidas e peculiaridades distintas. Objetivo: Avaliar os subtipos histológicos e o grau histopatológico como fatores preditivos de resposta terapêutica e sobrevida dos pacientes portadores de SPMCP. Métodos: Retrospectivo uni-institucional, através da análise dos prontuários de pacientes matriculados no Instituto Nacional de Câncer (INCA) no período de janeiro de 1997 a janeiro de 2007, com diagnóstico histopatológico (confirmado por imunoistoquímica) de sarcoma de cabeça e pescoço pela seção de Patologia da instituição. Foram excluídos os seguintes subtipos histológicos: osteossarcomas, condrossarcomas, tumores desmóides, sarcomas de Kaposi, hemangiopericitoma e carcinossarcomas. A análise estatística dos dados foi feita com o programa SPSS 10.0, usando o teste de x2, considerando p significativo menor que 0,05. Foram utilizados o teste de Kaplan-Meier para o cálculo da curva de sobrevida global e o teste Log Rank para o estudo das diferenças entre as sobrevidas. Resultados: Os subtipos com as melhores sobrevidas foram o fibrohistiocitoma malígno, leiomiossarcoma, rabdomiossarcoma soe e sarcoma alveolar. Os subtipos com os piores resultados foram o neurofibrossarcoma, sarcoma epitelióide, rabdomiossarcoma alveolar e lipossarcoma. O alto grau histopatológico é um fator significativo de pior prognóstico. Os pacientes adultos portadores de sarcomas de alto grau possuem sobrevida global em cinco anos de 13,7% e nenhum deles encontra-se vivo em 10 anos em comparação com os de baixo grau que apresentam sobrevida de 72,2% em cinco anos e 54,1% em 10 anos (p = 0,001). Conclusão...

Introduction: Head and neck soft tissue sarcomas (HNSTS) forms a heterogeneous group of neoplasms. They have different embriological and histological origin, although its mesenchymal origin. They are rare tumors, representing about 10% of all sarcomas and only 1% of all the neoplasms of the head and neck. The histological subtypes are so many, presenting different survival rates and distinct peculiarities. Objective: To evaluate the histological subtypes and degree as predictive factors of the therapeutic survival of the patients with HNSTS. Methods: A single-institucional retrospective study, through the analysis of patients´ files in the National Cancer Institute (INCA) within the period from January 1997 to January 2007, with histopathological diagnosis of sarcoma of head and neck by the Pathology Service of that institution. The following histological subtypes were excluded: osteosarcomas, condrosarcomas, desmoid tumors, Kaposi sarcomas, hemangioperycitoma and spindle cell sarcoma. The statistical analysis of the data was made with the SPSS 10,0 program, using the test of x2, considering significant p that were inferior to 0.05. The Kaplan-Meier test for the overall survival curves calculation and the Log Rank test for the study of the differences between the survival curves were employed. Results: The subtypes with the best survival rates were the malignant fibrohistiocytoma, rabdomyosarcoma and leiomyosarcoma. The subtypes with the worse prognosis had been the neurofibrosarcoma, liposarcoma, and rabdomyosarcoma alveolar. The histological degree is a significant factor of worse prognosis. Adult patients carrying sarcomas of high degree present a 5 years global survival rate of 13.7% and nobody is alive in 10 years. In comparison with the ones of low degree that present survival of 72.2% in 5 years and 54.1% in 10 years (p = 0,001). Conclusion: Patients with high grade head and neck soft tissue sarcoma have much inferior survival rates compared with the...

Sarcomas de partes moles em cabeça e pescoço: análise de fatores prognósticos / Head and neck soft tissue sarcomas: prognostic factors

Introdução: Sarcomas de partes moles em cabeça e pescoço (SPMCP) no adulto são raros e possuem diversos fatores prognósticos. Objetivo: Avaliar os fatores prognósticos em pacientes com SPMCP e seu impacto na sobrevida. Métodos: Análise retrospectiva dos prontuários dos pacientes portadores de sarcomas de cabeça e pescoço matriculados no INCA, com entrada de material para análise histopatológica com imunoistoquímica entre janeiro 1997 e janeiro 2007. Resultados: Os fatores encontrados que tiveram impacto prognóstico com relação à sobrevida livre de doença foram: fazer cirurgia (p = 0,01); ausência de invasão de pele (p = 0,01), músculo (p = 0,002) e osso (p = 0,008) à análise univariada. À análise multivariada, apenas a ausência de invasão óssea teve impacto na sobrevida livre de doença (p = 0,03). Por meio da análise univariada, constatou-se que os fatores com impacto na sobrevida global foram: estágio T inicial (p = 0,012), fazer cirurgia (p = 0,0027), baixo grau histológico (p = 0,001) e ausência de invasão de pele (p = 0,01), músculo (p = 0,0002) e osso (p 0,0002). Já na análise multivariada apenas o estágio T inicial (p 0,021), fazer cirurgia (p = 0,0001) e baixo grau (p = 0,002) foram significativos. Conclusão: Os fatores que aumentam a sobrevida livre de doença dos pacientes com SPMCP são: tratamento cirúrgico e a ausência de invasão da pele, músculo e osso. Os fatores que aumentaram a sobrevida global foram: estágio T1, tratamento cirúrgico, baixo grau histológico e ausência de invasão de pele, músculo e osso.

Introduction: Sarcomas of the head and neck region are rare. There are a variety of prognostic factors to be studied. Objective: to identify prognostic factors of head and neck sarcomas that have impact on survival. head and neck sarcomas patients, identified in our institution between January, 1997 and January, 2007 were analyzed. All cases underwent pathologic review with immunohistochemical stains before statistical analysis. Results: The factors that have impact on the disease free survival was: presence of surgery (p = 0.01) and no skin involvement (p = 0.01), muscle involvement (p = 0.002) or bone involvement (p = 0.008) in the univariate analysis. In the multivariate analysis only no bone invasion was important (p = 0.03). Important prognostic factors for overall survival were initial stage T (p = 0.012), presence of surgery (p = 0.0027), low histological grade (p = 0.001) and no involvement of skin (p = 0.01), muscle (p = 0.0002) or bone (p = 0.0002) by univariate analysis. By multivariate analysis only inicial stage T (p = 0.021), presence of surgery (p = 0.0001) and low grade (p = 0.002) were important. Conclusion: The factors that positively affect disease free survival were surgery, and no involvement of skin, muscle and bone. The overall survival was positively influenced by stage T1, presence of surgery, low histological grade and no involvement of skin, muscle and bone.

Evolução dos angiossarcomas da cabeça e pescoço / Head and neck angiosarcomas evolution

Introdução: Os angiossarcomas são tumores raros e agressivos da cabeça e pescoço. Surgem freqüentemente no couro cabeludo de homens idosos e em estádio avançado. Objetivo: Descrever as variáveis epidemiológicas dos casos de angiossarcoma, tratados no INCA, bem como os fatores preditivos com na evolução da doença. Métodos: Análise retrospectiva dos prontuários dos pacientes portadores de angiossarcoma tratados no INCA entre janeiro de 1996 e janeiro de 2006. Foram comparadas variáveis epidemiológicas desses tumores com os outros sarcomas de partes moles de cabeça e pescoço (SCP) e análise de fatores prognósticos daqueles. Resultados: Os angiossarcomas corresponderam a 21,1% (23 casos) dos SCP. Acometeram indivíduos com mais de 65 anos em 69,6%, homens em 61%, originaram-se no couro cabeludo em 73,9% e estadio avançado em 66,6%. A recidiva regional foi mais freqüente que os outros SCP (p= 0,03). Fatores de mau prognóstico foram o estadio avançado (p= 0,02), invasão de pele (p= 0,0003) e músculo (p=0,0002). A cirurgia foi o fator que aumentou a sobrevida global (p= 0,003). Essa foi de 14,6%. Conclusão: O angiossarcoma foi o subtipo histológico mais comum dos SCP. Acometeu mais freqüentemente os homens e idosos e com uma péssima sobrevida global. Os principais fatores preditivos de um desfecho ruim são: estádio avançado à apresentação, invasão de pele e músculo. A cirurgia mostrou-se fundamental no aumento da sobrevida desses pacientes.

Introduction: Angiossarcomas are rare aggressive tumors of head and neck. They appear frequently in the scalp of old men and in advanced stage. Objective: To describe the epidemiologic characteristics of the cases of angiosarcoma treated in INCA as well as the predictive factors that had impact in the evolution of the illness. Methods: Retrospective analysis of patients data records with angiosarcoma treated in the INCA between January, 1996 and January, 2006. The angiosarcoma epidemiologic characteristics had being compared with the others head and neck soft tissue sarcomas (HNS) and the angiosarcoma prognostic factors have being studied. Results: Angiossarcomas corresponded 21.1% (23 cases) of the HNS. They occurred in patients older than 65 years in 69.6%, men in 61%, originated in scalp in 73.9% and presented at advanced stage in 66.6%. The regional recurrence were more frequent than other HNS (p=0.03). The poor prognostic factors were the advanced stage (p=0.02), skin (p=0.0003) and muscle invasion (p=0.0002). The surgery was the factor that increased the overall survival (OS). The OS was 14.6%. Conclusion: Angiossarcoma was the most common histological subtype of the HNS occurring more frequently in older men and had poor prognosis. The main predictive factors of a bad outcome are: the advanced stage in the presentation, the invasion of skin and muscle. The surgery had an important role in increasing the survival of those patients.

Efetividade do tratamento cirúrgico em sarcomas de partes moles da cabeça e pescoço / The efficacy of surgery in the treatment of head and neck soft tissue sarcomas

Introdução: sarcomas da cabeça e pescoço (SCP) são tumores malignos raros, formando um grupo heterogêneo (diferentes subtipos histológicos e comportamentos clínico-biológicos), dificultando a realização de estudos para definir seu tratamento ideal. A cirurgia é considerada a principal modalidade terapêutica para a maioria dos SCP. Objetivo: avaliar a efetividade do tratamento cirúrgico nos SCP de partes moles. Métodos: estudo retrospectivo pela análise de prontuários dos casos de SCP tratados em uma única instituição entre janeiro/1997 e janeiro/2007, excluindo-se: osteosarcomas, condrosarcomas, tumores desmóides, sarcomas de Kaposi, hemangiopericitoma e carcinosarcomas. Resultados: cento e quarenta e cinco casos foram incluídos no estudo (106 adultos e 39 pediátricos). Nos adultos, 63 casos receberam tratamento cirúrgico. Observou-se um aumento da sobrevida global (SG) estatisticamente significante (p<0,001 e Log Rank = 19,43) nos SCP de adultos tratados com cirurgia. No grupo pediátrico, o número de casos cirúrgicos foi pequeno (13/39) e a análise confrontando a SG dos casos operados com a SG dos não-operados não foi estatisticamente significante (p=0,254). O esvaziamento cervical foi realizado em apenas 11 casos (oito adultos e três pediátricos), dos quais apenas quatro casos (todos em adultos) apresentaram comprovação histopatológica de metástase linfonodal na análise dos espécimes cirúrgicos. O percentual de metástase linfonodal encontrado nos adultos foi de 3,77% (4/106). Conclusão: o tratamento cirúrgico é efetivo, aumentando a SG de adultos portadores de SCP de partes moles. Na população pediátrica estudada, o tratamento mais empregado foi a quimio/radioterapia. O índice de metástases linfonodais encontrado não indica o esvaziamento cervical profilático.

Introduction: head and neck sarcomas (HNS) are rare malignant tumors, forming a heterogeneous group, once they have several histological subtypes and different clinical-biological behavior. This makes difficult the achievement of scientific studies to define the optimal treatment for those tumors. Surgery is usually considered the primary treatment. Objective: to evaluate the effectiveness of surgical treatment for soft tissue HNS. Methods: retrospective analysis of HNS cases treated in a single institution between January 1997 and January 2007, excluding osteosarcomas, condrosarcomas, desmoid tumors, Kaposi's sarcoma, hemangiopericytomas and carcinosarcomas. Results: 145 cases were included in the study (106 adults and 39 children). Sixty three cases of SCP in adults received surgical treatment. There was an increase in overall survival (OS) statistically significant (p <0001 and Log Rank = 19.43) in the HNS adults treated with surgery. In the pediatric group, the number of cases treated with surgery was small (13/39) and the analysis of data comparing the OS of surgical cases with the OS of non-surgical cases was not statistically significant for this group (p = 0,254). Neck dissection was performed in only 11 cases (8 adults and 3 children), of which only 4 cases (all adults) had evidence of lymph node metastasis in the analysis of the surgical specimens (4/106 = 3.77%). Conclusion: the surgical treatment is effective, increasing OS in adults with soft tissue HNS. In the studied pediatric population, the most used treatment was chemo/radiotherapy. The low occurrence of lymph node metastases does not indicate the prophylactic neck dissection for HNS.

Análise de fatores clínicos, histopatológico e moleculares (p53, Ki67, Bcl2 e PCNA) preditivos de resposta terapêutica à quimioterapia e radioterapia em pacientes com carcinoma espinocelular de laringe e orofaringe / Analysis of clinical, histopathological and molecular (P53, Ki-67, Bcl-2 and PCNA) factors predictive of the therapeutic response to chemotherapy and radiotherapy in patients with laryngeal and oropharyngeal squamous cell carcinoma

Introdução: tratamento padrão-ouro para pacientes com carcinoma espinocelular (CEC) em estádios clínicos (EC) III e IV é o cirúrgico, seguido de radioterapia (RXT). Na preservação de órgãos, vários esquemas com radioterapia e quimioterapia são estudados. No entanto, quais pacientes irão melhor responder a esses protocolos é um questionamento ainda sem resposta. Objetivos: avaliar 21 fatores clínicos e um histopatológico, assim como a expressão p53, Bcl2, Ki67 e PCNA como fatores preditivos de resposta a radioterapia e quimioterapia em pacientes com CEC de laringe e orofaringe. Pacientes e Método: no período de janeiro de 2000 a agosto de 2003, 57 pacientes com CEC da laringe e orofaringe (EC III e IV) foram tratados com RXT e quimioterapia no INCA-MS-RJ. Avaliamos, através de análise imunoistoquímica nos blocos de parafina desses pacientes, a expressão da p53, Bcl2, Ki67 e PCNA na mucosa normal, assim como no tumor. Essa expressão foi correlacionada com a resposta ao tratamento, assim como avaliamos a associação de 22 fatores com essa resposta. Resultados: a toxicidade do tratamento foi alta, levando a 100% dos pacientes a interromperem o tratamento de alguma forma. Resposta completa foi observada em 68,4% dos casos, com sobrevida global de 58,24% e sobrevida livre de doença de 56,4%. Dos 22 fatores preditivos, apenas a ausência de hiperalimentação por sonda nasoenteral (SNE) (p=0,0006), tamanho do tumor (T) (p=0,009) e ausência de traqueostomia prévia (p=0,0002) foram preditivos de boa resposta ao tratamento (análise univariada). A expressão negativa do Bcl2 no tumor, na mucosa e em ambos (p=0,017, 0,04 e 0,028, respectivamente) foram preditivos de boa resposta (análise univariada), com probabilidade, respectivamente, de 3,64; 5,29 e 7,68 vezes maior de resposta quando comparado com a população que o expressou. A expressão positiva do Bcl2 foi de 25,5%, do p53 de 55,3%, do Ki67 de 82,6%, do PCNA de 76%. Nenhuma dessas expressões teve impacto na resposta ao tratamento. Entretanto, ao realizarmos a análise multivariada, apenas a ausência da traqueostomia prévia ao tratamento (p=0,0056) e ausência de hiperalimentação por SNE (p=0,002) foram fatores preditores de boa resposta. Conclusões: das 22 variáveis, apenas a ausência de hiperalimentação pela SNE e ausência de traqueostomia prévia foram fatores preditivos de boa resposta ao tratamento. De uma forma isolada (análise univariada), a não expressão imunoistoquímica do Bcl2 no tumor, na mucosa e em ambos (principalmente) estiveram associados a uma melhor resposta terapêutica.

Introduction: the standard treatment for patients with HNSCC stages III and IV is surgical plus radiation therapy (RT). In order to preserve the organs, several schemes using RT and chemotherapy (CT) have been studied. Nevertheless, the patients submitted to this treatment who will better respond to these protocols is not known yet. Objective: to evaluate 22 factors as well as the expressions of proteins p53, Bcl2, Ki67 and PCNA as predictive factors, in response to RT and CT in patients with laryngeal and oropharyngeal SCC. Materials and methods: from January, 2000 to August, 2003, 57 patients with laryngeal and oropharyngeal SCC (Stages III and IV) were treated with RT and CT at INCA-MS-RJ. We analyzed the paraffin blocks of those patients throughout immunohistochemistry study. The positive and negative expressions of p53, Bcl2, Ki67 and PCNA on normal mucosa,as well as in the tumor (and in both of them). The expression was correlated to the response of treatment, as we analyzed the association of 22 clinical factors of patients showing this response. Results: the toxicity of treatment was high, taking 100% of patients to somehow interrupt the treatment. A complete response was observed in 68.4% of the cases, with overall survival rate of 58.24% and disease-free survival rate of 56.4%. Among the 22 predictive factors, only the lack of hypernutrition through nasoenteral tube (p=0.0006), tumor size (T), p=0.009 and the lack of tracheotomy were predictive of a better response to the treatment (univariated analysis). Only the Bcl2 negative expression in the tumor, mucosa and in both (p=0.017, 0.04 and 0.028, respectively) were predictive of a better response (univariated analysis) with support of 3.64; 5.29 and 7.68, respectively, much higher when compared to the population who expressed it. Positive expression of Bcl2 was 25.5%; p53 55.3%; Ki67 82.6%; PCNA 76%. None of those expressions caused any impact to response of treatment. Nevertheless, when a multivariated analysis was made, only the lack of previous tracheotomy to treatment (p=0.0056) and the lack of hypernutrition through NET (p=0.002) were predictive factors for a better result. Conclusions: among 22 predictive factors, only the lack of hypernutrition through SNE and the lack of previous tracheotomy were predictive factors for better results. Throughout an univariated analysis the non-immunohistochemistry expression of Bcl2 in the tumor, on mucosa and in both (mainly), had a good impact in therapeutic response.