Seguridad y factibilidad de la reconstrucción microquirúrgica en tumores de cabeza y cuello en pacientes mayores de 70 años / Safety and feasibility of free-flap reconstruction in head and neck tumors in patients aged 70 years or older

RESUMEN Antecedentes: debido al aumento en la expectativa de vida, se ha incrementado la incidencia de tumores de cabeza y cuello en pacientes añosos. Objetivo: evaluar los resultados de la reconstrucción con colgajos microquirúrgicos luego de la resección radical (RRMC) de tumores de cabeza y cuello en pacientes de 70 años o mayores. Material y métodos: se analizó una serie de pacientes sometidos a RRCM por tumores de cabeza y cuello en el período 2000-2020. Se dividió la muestra en dos grupos: G1: ≥ de 70 años y G2: < de 70 años. Se analizaron variables demográficas, quirúrgicas, posoperatorias y factores de riesgo de trombosis del colgajo en los pacientes ≥ de 70 años. Resultados: se incluyó un total de 178 pacientes, 61 en G1 y 117 en G2. Ambos grupos fueron homogéneos respecto del sexo, IMC (índice de masa corporal), alcoholismo, tabaquismo, tratamiento neoadyuvante e incidencia de HPV (virus del papiloma humano). Hubo mayor cantidad de pacientes con riesgo ASA ≥ III en G1 vs. G2; (p: 0,005). En G1, 33 (54%) correspondieron a estadio oncológico ≥ III vs. 99 (87%) en G2 (p: 0,001). Cuarenta y dos (69%) pacientes en G1 recibieron adyuvancia vs. 94 (83%) en G2 (p: 0,02) y no hubo diferencias en la morbimortalidad global y en fallas del colgajo. El sexo femenino fue el único factor de riesgo de trombosis del pedículo vascular (p: 0,05). Conclusión: la RRCM para tumores de cabeza y cuello es factible y segura en pacientes añosos, con una incidencia de morbimortalidad similar a la del resto de la población.

ABSTRACT Background: The higher life expectancy has increased the incidence of head and neck tumors in elder patients. Objective: the aim of this study was to evaluate the outcomes of free flap reconstructions after radical resection (FFRR) of head and neck tumors in patients aged 70 years or older. Material and methods: We analyzed a series of patients undergoing FFR due to head and neck tumors between 2000-2020. The patients were divided into two groups: G1: ≥ 70 years, and G2: < 70 years. The demographic, operative and postoperative variables and the risk factors for flap thrombosis in patients ≥ 70 years were analyzed. Results: A total of 178 patients were included, 61 in G1 and 117 in G2. Both groups were homogeneous regarding sex, BMI (body mass index), alcohol consumption, smoking habits, neoadjuvant treatment, and incidence of HPV (human papillomavirus). The incidence of ASA grade ≥ III was significantly higher in G1 vs. G2; (p: 0,005). In G1, 33 patients (54%) corresponded to cancer stage ≥ III vs. 99 (87%) in G2 (p: 0.001). Forty-two (69%) patients in G1 received adjuvant therapy vs. 94 (83%) in G2 (p = 0.02) and there were no differences in overall morbidity and mortality and in flap failure. Female sex was the only predictor of vascular flap thrombosis (p = 0.05). Conclusion: FFRR in head and neck tumors is feasible and safe in elderly patients, with morbidity and mortality rates similar to those of the general population.

Filipino translation and validation of the University of Washington – Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

Influence of Changing Tendency in Sense of Head and Neck Carcinogenesis on Current Therapeutic Ideas and Its Clinical Implications / 肿瘤防治研究

On the basis of the changing tendency in the sense considering tumors as a kind of chronic and systematic disease and the integrating trend of somatic mutation theory with the one of field cancerization, this paper focuses on the limitations of current therapeutic ideas and strategies in head and neck tumors. It also describes the influence of the modern view of oncogenesis for future treatment and the developing drift of therapies in this field. Although most tumors in the head and neck region are solid ones, their tumorogenesis should be considered as the final event of systemic dysfunction under the consideration of holistic view and systems theory. Through reasonable integration of unique advantages derived from various modern therapies at a much higher level of personalized diagnosis and treatment view, patients with head and neck tumors are expected to survive with much better long-term therapeutic effects and much higher quality of life following treatment.

Analysis of setup errors in patients using the customized Klarity AccuCushion® with a thermoplastic fixation mask while receiving radiotherapy / 中国肿瘤临床

Objective: To compare setup errors between patients using the customized Klarity AccuCushion® with a thermoplastic fixation mask and patients using a thermoplastic fixation mask or vacuum fixation cushion alone while receiving radiotherapy. Methods: A total of 66 patients with head and neck (H&N) tumors (n=27) or thoracic and abdominal tumors (T&N) tumors (n=39) were included during Jaurnary 2018 to December 2019. 15 H&N cancer patients using only a single head-neck-shoulder mask were categorized into group A; 12 patients using a customized Klarity AccuCushion® and head-neck-shoulder mask were categorized into group B. Among T&A cancer patients, 19 patients using only a vacuum fixation cushion were classified into group A; the remaining 20 patients using a customized Klarity AccuCushion® and thermoplastic fixation mask were classified into group B. Cone-beam computed tomography was performed, and the setup errors were evaluated. The setup errors in the left-right (LR) direction, superior-inferior (SI) direction, anterior-posterior (AP) direction, and for rotation were compared between groups A and B. Results: Among H&N cancer patients, the setup errors in group B in the LR direction, SI direction, and for rotation were 0.06±0.06 cm, 0.08±0.07 cm, and 0.12±0.17°, respectively, which were smaller than those in group A (0.10±0.11 cm, 0.13±0.14 cm, and 0.25±0.47°, respectively). The differences in setup errors in the LR direction, SI direction, and for rotation were significant between the two groups (P0.05). For T&A cancer patients, significant differences were found in setup errors between the two groups (P<0.05) in the LR direction (group B vs. group A: 0.10±0.08 cm vs. 0.14±0.12 cm) and for rotation (group B vs. group A: 0.09 ± 0.18° vs. 0.22 ± 0.39°). No significant differences were observed in the setup errors in the SI and AP directions. Conclusions: Compared with the immobilization techniques using only a thermoplastic mask and only a vacuumed fixation cushion, the technique using a customized Klarity AccuCushion® with a thermoplastic fixation mask can improve repeatability, stability, and setup errors in radiotherapy.

Filipino translation and validation of the University of Washington - Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

Tumores malignos de cabeza y cuello en pacientes pediátricos / Malignant head and neck tumors in pediatric patients

Introducción: Los tumores malignos de cabeza y cuello incluyen varios subtipos histológicos y el pronóstico depende de su ubicación anatómica. Objetivo: Describir las características clínicas y el tratamiento de pacientes pediátricos con tumores malignos de cabeza y cuello. Métodos: Estudio descriptivo, longitudinal y retrospectivo realizado en el servicio de Oncopediatría del Instituto Nacional de Oncología y Radiobiología, desde el 1ro. de enero de 2005 al 31 de diciembre de 2017. Se registraron variables demográficas, clínicas y terapéuticas. Se identificaron los pacientes a partir de las bases de datos del registro hospitalario del citado instituto. Se seleccionaron todos los pacientes con tumores de cabeza y cuello que tuvieron diagnóstico histológico. Resultados: Se identificaron 73 pacientes, con ligero predominio del sexo femenino (60,3 por ciento), con una edad media de 12 años (rango entre 0 y 18 años). El tipo histológico más frecuente fue el carcinoma tiroideo (35,6 por ciento), seguido de los rabdomiosarcomas (27,3 por ciento). El tratamiento más utilizado fue la cirugía (38,3 por ciento) seguido de la combinación de cirugía más radioterapia y quimioterapia (22,0 por ciento). Conclusiones: El tumor maligno de cabeza y cuello más frecuente en pacientes pediátricos es el carcinoma tiroideo. El tratamiento de elección es la resección total, acompañado de radioterapia y quimioterapia, dependiendo del tipo histológico y la etapa clínica(AU)

Introduction: Malignant tumors of the head and neck include several histological subtypes and the prognosis depends on their anatomical location. Objective: To describe the clinical characteristics and treatment of patients diagnosed with malignant head and neck tumors. Methods: A descriptive, longitudinal and retrospective study was carried out from January 1, 2005 to December 31, 2017 at the Oncopediatrics service in the National Institute of Oncology and Radiobiology, according to demographic, clinical and therapeutic variables. Patients were identified from the databases of the hospital registry of the above mentioned institute. All patients with head and neck tumors that had a histological diagnosis were selected. Results: 73 patients were identified, with a slight predominance of females (60.3 percent), with a mean age of 12 years (range between 0 and 18 years). The most frequent histological type was thyroid carcinoma (35.6 percent), followed by rhabdomyosarcomas (27.3 percent). The most used treatment was surgery (38.3 percent) followed by the combination of surgery plus radiotherapy and chemotherapy (22 percent). Conclusions: Tumors of the head and neck are infrequent. The treatment of choice is total resection, accompanied by radiotherapy and chemotherapy, depending on the histological type and the clinical stage(AU)

Respuesta al tratamiento radioterápico en pacientes con tumores malignos de cabeza y cuello / Response to radiotherapy treatment in patients with head and neck malignant tumors

Introducción: La radioterapia es una de las variantes de tratamiento más antiguas con que contamos hoy día para curar los pacientes afectos de neoplasias malignas, pero debe ser cuidadosamente seleccionada en pacientes pediátricos. Objetivo: Evaluar la respuesta al tratamiento radiante en niños con tumores de cabeza y cuello. Métodos: Se realizó un estudio descriptivo, retrospectivo lineal, donde se incluyeron 26 pacientes ingresados en el Servicio de Oncocirugía del hospital William Soler desde enero de 2000 a enero de 2013, con diferentes tipos de tumores malignos de cabeza y cuello y edades comprendidas entre 1 y 18 años. Se tuvieron en cuenta los efectos tóxicos a largo plazo del tratamiento radiante, asociado o no a tratamiento quimioterápico adyuvante o concurrente y a la cirugía. Resultados: Todos los pacientes recibieron radioterapia corporal externa, el 73,1 por ciento de los casos recibió quimioterapia adyuvante en su mayoría con diagnóstico de linfomas y 7,7 por ciento recibió quimioterapia concurrente. Esta última en dos pacientes: uno con sarcoma facial y otro con carcinoma de parótida. Cinco pacientes (19,2 por ciento) solo recibieron cirugía y radioterapia como tratamiento: dos casos con neuroblastoma, un caso con sarcoma facial y dos con hemangiopericitomas. Conclusión: El estudio demostró la gran utilidad del empleo de la radioterapia en el control de las enfermedades malignas de la infancia localizadas en cabeza y cuello(AU)

Introduction: Radiotherapy is one of the oldest treatments used nowadays for curing patients suffering from malignant neoplasias, but it must be carefully selected in pediatric patients. Objective: To evaluate the response of radiotherapy treatments in children with head and neck tumors. Methods: A descriptive, lineal retrospective study was carried out, in which were included 26 patients admitted in the Service of Oncosurgery of William Soler Hospital from January, 2000 to January, 2013. These patients presented different kinds of head and neck malignant tumors; their ages were among 1 and 18 years. The long term toxic effects of radiotherapy were taken into account, being those associated or not to concurrent or adyuvant chemotherapy, and to surgery. Results: All the patients received physical external radiotherapy. 73,1 percent of the cases (most of them with a diagnosis of lymphoma) received adyuvant chemotherapy and 7,7 percent had concurrent chemotherapy. This last one in two patients: one with facial sarcoma and the other one with parotid carcinoma. Just five patients (19.2 percent) had surgery and radiotherapy as treatment: two cases with neuroblastoma, one case with facial sarcoma, and two cases of hemangiopericytomas. Conclusions: This study has demonstrated the usefulness of radiotherapy in the control of head and neck malignant diseases in children(AU)

Study on locoregional response with combined modality using conventional dose radiation therapy and concurrent single agent cispatin chemotherapy in locally advanced hypopharyngeal and laryngeal squamous cell carcinomas

Background: In the Indian situation, as of now, there can only be two ways of controlling malignancies. One is by way of primary prevention and the other being managing the advanced disease. Thus, comparatively newer modalities of concurrent chemoradiation particularly with cisplatinum are producing high locoregional control. Aim: To describe the loco-regional response with combined modality treatment using conventional dose radiation therapy and concurrent single agent cisplatin chemotherapy in locally advanced hypopharyngeal and laryngeal squamous cell carcinomas, to describe the toxicity profile and feasibility of treatment regimen with combined modality chemo-radiation therapy, to describe the success with organ preservation in locally advanced hypopharyngeal and laryngeal cancers using combined modality chemo- radiation therapy. Materials and methods: Total number of patients available for analysis was 26. All the patients were assessed for immediate response and for acute local and systemic toxicities. The end points of the study included. The initial tumor response - immediately on completion of treatment and at 6 weeks, Sivagnanam Balaji, N Sudhahar. Study on locoregional response with combined modality using conventional dose radiation therapy and concurrent single agent cispatin chemotherapy in locally advanced hypopharyngeal and laryngeal squamous cell carcinomas. IAIM, 2018; 5(4): 36-47. Page 37 Acute local and systemic toxicity due to concurrent chemotherapy and radiation therapy, Organ preservation. Results: Concurrent chemoradiation using conventional dose radiation therapy (6600 CGy) and single agent CDDP given on days 1, 22, 43 as studied in this cross sectional study achieves significant local control rates and organ preservation goals. The toxicities seen in this combined modality regimens appeared to be tolerable. Study showed with statistical significance, that the T stage and stage of a disease affects response at local and regional node sites respectively. Conclusion: Concurrent chemoradiation using conventional dose radiation therapy (6600 CGy) and single agent CDDP given on days 1, 22, 43 as studied in this cross sectional study achieves significant local control rates and organ preservation goals.

Evaluation of set-up errors and improvement of precision of tomotherapy in head and neck tumors / 医疗卫生装备

Objective To analyze the factors for tomotherapy precision related to the setup errors in the head and neck tumors to enhance the radiotherapy precision.Methods Totally 35 head and neck tumor patients from February to July 2016 were enrolled into the study,MVCT scan was executed before each time of tomotherapy and setup flow was standardized.There were 1 092 errors sets for the setup guided by MVCT image analyzed,and the method for reducing the setup error and the standardized process for enhancing the tomotherapy precision were put forward accordingly.Results The setup errors at X,Y and Zdirections were (0.98±0.91),(1.63±1.22),(1.11±0.87) mm originally,and became (0.97±0:89),(1.58±1.08),(1.06±0.83) mm after manual matching,and the setup error gained maximum value at Y direction and minimum value at X direction.The numbers of cases with the setup error not less than 3 mm were 6,49 and 18 respectively at X,Y and Z directions,and the corresponding proportions were 0.55％,4.49％ and 1.65％ respectively.The setup error for the tomotherapy in the head and neck tumors was low,and matching contributed to reducing the setup error.Conclusion There are multi factors affecting the setup error of the tomotherapy of the head and neck tumors,and the measures to decrease the setup error include strict institutions,standardized quality control and enhanced radiologist level.

Evaluation of set-up errors and improvement of precision of tomotherapy in head and neck tumors / 医疗卫生装备

Objective To analyze the factors for tomotherapy precision related to the setup errors in the head and neck tumors to enhance the radiotherapy precision.Methods Totally 35 head and neck tumor patients from February to July 2016 were enrolled into the study,MVCT scan was executed before each time of tomotherapy and setup flow was standardized.There were 1 092 errors sets for the setup guided by MVCT image analyzed,and the method for reducing the setup error and the standardized process for enhancing the tomotherapy precision were put forward accordingly.Results The setup errors at X,Y and Zdirections were (0.98±0.91),(1.63±1.22),(1.11±0.87) mm originally,and became (0.97±0:89),(1.58±1.08),(1.06±0.83) mm after manual matching,and the setup error gained maximum value at Y direction and minimum value at X direction.The numbers of cases with the setup error not less than 3 mm were 6,49 and 18 respectively at X,Y and Z directions,and the corresponding proportions were 0.55％,4.49％ and 1.65％ respectively.The setup error for the tomotherapy in the head and neck tumors was low,and matching contributed to reducing the setup error.Conclusion There are multi factors affecting the setup error of the tomotherapy of the head and neck tumors,and the measures to decrease the setup error include strict institutions,standardized quality control and enhanced radiologist level.

Estratégias em reconstruções complexas do couro cabeludo e da fronte: uma série de 22 casos / Strategies in complex reconstructions of the scalp and forehead: a series of 22 cases

INTRODUÇÃO: A região cefálica está exposta a insultos de ordem variada por parte do meio ambiente. As lesões extensas no couro cabeludo representam um grande desafio ao cirurgião plástico devido à pouca mobilidade da pele nesta região, o que dificulta o seu fechamento. Uma grande variedade de técnicas tem sido utilizada para o fechamento de defeitos no couro cabeludo e na fronte. A técnica ideal deve visar o melhor resultado funcional, estético e baixa morbidade do sítio doador. MÉTODOS: Foi realizado um estudo clínico retrospectivo no período de janeiro de 2006 a dezembro de 2014, de uma série de 22 casos com tumores avançados do couro cabeludo e da fronte e perda cutânea extensa pós-trauma. RESULTADOS: Foram realizados 11 retalhos locais de couro cabeludo (bi ou tripediculados), três retalhos coronais da fronte e oito retalhos livres. Houve um caso de perda parcial tardia de um retalho livre pós-radioterapia. CONCLUSÃO: Diferentes técnicas para a reconstrução do couro cabeludo e da fronte são possíveis, cada caso deve ser avaliado individualmente. Os retalhos apresentados foram considerados seguros e com pouca morbidade da área doadora. Os resultados obtidos foram satisfatórios e estão de acordo com a literatura analisada.

INTRODUCTION: The cephalic region is exposed to various insults from the environment. Extensive lesions in the scalp are a great challenge for plastic surgeons, because the low mobility of the skin in this region hampers its closure. A great variety of techniques have been used to close defects on the scalp and forehead. Ideally, scalp closure should provide a better functional and aesthetic outcome, as well as low morbidity at the donor site. METHODS: From January 2006 to December 2014, we performed a retrospective clinical study involving a series of 22 patients with advanced tumors of the scalp or forehead, or with extensive post-trauma skin loss. RESULTS: Reconstructive surgeries with 11 local scalp flaps (bi- or tri-pedicled), three coronal forehead flaps, and eight free flaps were performed. One patient experienced late partial loss of a free flap after radiotherapy. CONCLUSION: Various techniques can be used to reconstruct the scalp and forehead; each case should be assessed individually. The present study indicated that flaps are safe and that they confer low morbidity at the donor area. These results were satisfactory and in agreement with the literature analyzed.

Gastrostomía endoscópica: técnicas básicas, técnicas nuevas, errores semánticos y sugerencias para una clasificación coherente / Endoscopic gastrostomy: basic techniques, new techniques, semantic errors and suggestions for a coherent classification

The use of the term “direct technique” to refer to a modified introducer-type technique; to call the “introducer technique” “push technique”, or the “push technique” “Seldinger technique” are the most common semantic errors we make when classifying endoscopic gastrostomy techniques. The sole criterion we consider appropriate for the classification of these techniques is the access used for the gastrostomy tube, which can be transoral or transabdominal. Gauderer transoral technique (pull-technique) is the most popular globally because it simple, successful, the procedure is shorter, less traumatic and less expensive. Transabdominal techniques, such as “introducer” and “combined techniques” help to prevent wound contamination, tumour spreedingin patients with head and neck tumors, and esophageal tear in low weight newborn babies. These techniques shall be implemented and taught in Endoscopy Centers. The other techniques described are just variations of the basic techniques.

Usar el término “direct technique” para referirse a una técnica “introducer modificada”, llamar técnica “push” a la técnica “introducer” o “Seldingertechnique” a la técnica “push” son los errores semánticos que se cometen con más frecuencia cuando se intenta clasificar las técnicas de la gastrostomía endoscópica. El único criterio que nos parece adecuado para clasificar las técnicas es la vía de acceso de la sonda que puede ser transoral y transabdominal. La técnica transoral por tracción de Gauderer (pull-technique) es la más popular en el mundo por ser simple, exitosa, más breve, menos traumática y menos costosa. Las técnicas transabdominales como “introducer” y las “técnicas combinadas” ayudan a prevenir la contaminación de la herida, la siembra tumoral en pacientes con tumores de cabeza y cuello, y el desgarro esofágico en recién nacidos de bajo peso. Estas técnicas debieran implementarse y enseñarse en los centros de endoscopia. Las otras técnicas descritas son sólo variaciones de las técnicas básicas.

Cirugía Robótica Transoral (TORS), en el manejo de lesiones neoplásicas de cabeza y cuello / Transoral Robotic Surgery (TORS), in the management of head and neck tumors

El cáncer de cabeza y cuello es una enfermedad muy complicada cuya incidencia ha venido incrementando en la última década y está relacionada con la infección del virus del papiloma humano. La base del tratamiento es la cirugía, que debe hacerse con intervenciones extensas y mutilantes a través del cuello, son acompañadas de quimioterapia y radioterapia, dejando secuelas funcionales difíciles de manejar. Desde 2009 se aprobó el uso del robot Da Vinci® para resecar tumores de la orofaringe y supraglotis, con la cirugía robótica transoral. Las bondades de esta técnica, que inciden en la pronta recuperación del paciente, y que están derivadas de la excelente visión tridimensional y la versatilidad de movimientos del instrumental articulado (EndoWrist®), han hecho que las recomendaciones de su uso estén redefiniéndose continuamente. Este artículo resume las ventajas, las desventajas, las indicaciones de manejo actual, el cuidado posoperatorio, la rehabilitación y la terapia adyuvante de este novedoso tratamiento.

Head and neck cancer is a complicated disease, with an increasing incidence in the last decade, and is associated with the human papilloma virus infection. The basic treatment is surgery, which should be done with interventions through the neck, which are extensive and crippling, supplemented by chemotherapy and radiotherapy, leaving hard-to-manage functional sequels. The use of the Da Vinci® robot was approved in 2009 for the resection of tumors of the oropharynx and supraglotis, using transoral robotic surgery. The benefits of this technique, leading to an early recovery of the patient, arise from the excellent three-dimensional views and exceptional movements of the automated instrument (EndoWrist®). This has led to the recommendations for its use being continuously redefined. This article summarizes the indications, advantages, disadvantages, postoperative care, management, rehabilitation, and adjuvant therapy of this new treatment.

Tissue electrical properties in head and neck tumors before and after surgery: Preliminary observations.

Context: Bioelectrical impedance analysis (BIA) detects changes in tissue electrical properties and has been seen as a prognostic tool in several chronic conditions, including cancer. AIMS: The study was conducted to investigate whether there are any tissue electrical differences in patients with head and neck cancer (H and NC) before and after surgery treatment. Settings and Design: The observational study was performed at the Otolaryngology Department, Head and Neck Oncology. Materials and Methods : Tissue electrical properties were assessed in 31 patients with H and NC before and 2 weeks after surgery treatment. Direct bioimpedance measures [resistance, reactance, phase angle (PA)] were determined by BIA. Statistical Analysis Used: The Shapiro-Wilk test was used to assess the distribution conformity of examined parameters with a normal distribution; the Fisher (F) test was used to assess variance homogeneity. For group comparisons of metric data we used the Mann-Whitney U test. P value < 0.05 was considered as statistically significant. The statistical analysis for this study was performed using the computer software STATISTICA v. 8.0 (StatSoft). Results: PA at 50 kHz was found to be significantly (P = 0.000009) lower after surgery in patients with H and NC than before treatment (4.69° ±0.71 vs. 4.22 ± 0.83, respectively). Resistance was significantly (P = 0.0005) greater after surgery in patients with H and NC than before (596.24 ± 96.31 ohm vs 647.64 ± 276.11 ohm, respectively). Conclusions: There are tissue electrical differences before and after surgery in patients diagnosed with H and NC. Further observations would be useful to feedback in support therapy planning of individual patients.

Necessidades de autocuidado à qualidade de vida de clientes com câncer de cabeça e pescoço: contribuição da enfermagem / Self-care needs and quality of life patients with head and neck cancer: contribution of Nursing

Aborda-se a consulta de enfermagem como estratégia de pesquisa, visando identificar necessidades de autocuidado (AC) em clientes com câncer de cabeça e pescoço em tratamento paliativo ambulatorial. Tem-se como objetivos: identificar o perfil sociodemográfico e nosológico dos clientes com câncer de cabeça e pescoço atendidos no ambulatório para cuidados paliativos; identificar a qualidade de vida (QV) dessas pessoas através da consulta de enfermagem; avaliar as mudanças no sistema de autocuidado, considerando a intervenção de enfermagem. O estudo fundamenta-se nos conceitos, protocolos e instrumentos específicos da temática escolhida, e na Teoria do Déficit de Autocuidado de Orem. Escolheu-se o método quantitativo, descritivo, com delineamento pré-experimental tempo-série anterior e posterior em grupo único, que recebeu orientações para o autocuidado na consulta de enfermagem (CE). Foram sujeitos do estudo 77 clientes cadastrados no ambulatório especializado em tratamento paliativo, do INCA do Rio de Janeiro, no período de março a agosto de 2011. Variáveis sociodemográficas e nosológicas compõem o instrumento de produção de dados; enquanto as etapas da sistematização da assistência de enfermagem compõem o formulário para a implementação da CE. Para avaliar a QV aplicou-se o formulário QLQ30-H&N45, sendo os dados produzidos tratados mediante a estatística descritiva. Constatou-se, que a maioria dos 77 (100%) sujeitos do estudo é do sexo masculino e situam-se na faixa etária de 50 a 60 anos. Predominam os residentes na Baixada Fluminense, com ensino fundamental e aposentados. Têm união estável, cuidador informal e referem pouca realização de lazer. A maioria possuía hábito de tabagismo e alcoolismo. Quanto ao perfil nosológico, a maioria possui lesão tumoral inodora, sendo a cavidade oral o sítio mais acometido por câncer, e a metástase local a mais frequente...

The approach in on the nursing appointment as a research strategy, aiming at identifying the self-care (SC) needs in outpatients with head and neck cancer under palliative treatment. The aims are: to identify the socio-demographic and nosological profile of outpatients with head and neck cancer assisted for palliative care; to identify the quality of live (QL) of those people through nursing appointment; to assess the changes in the self-care system, considering the nursing intervention. The study is based on concepts, protocols and specific instruments of the chosen theme and on Orem's Self-care Deficit Theory. A quantitative and descriptive method was chosen with before-and-after time-series quasi-experimental design in sole group, which received self-care guidance at nursing appointment (NA). The subjects were 77 clients registered in the specialized palliative treatment outpatient’s clinic at the National Cancer Institute in Rio de Janeiro, from March to August, 2011. Socio-demographic and nosological variables comprise the data production instrument,while the nursing assistance systematization steps comprise the form for NA implementation. In order to asses QL, the form QLQ30-H&N45 was applied, with data produced being treated upon descriptive statistics. It was observed that most of the 77 (100%) subjects of the study is male and between 50 and 60 years of age. There is a predominance of residents in Baixada Fluminense (Lowlands in Rio de Janeiro), who hold fundamental education and are retired. They live under common-law marriage, have informal caregivers and report low practice of leisure activities. Most of them routinely consume tobacco and alcohol. As for the nosological profile, most bear odorless tumor injury, being the oral cavity the site most affected by cancer and being local metastasis the most frequent one. As for the self-care capacity, most of them feed themselves, get dressed and move around without assistance...

Repercussões da radioterapia na região orofacial e seu tratamento / Impact of radiotherapy on the orofacial region and management of related conditions

A radioterapia em região de cabeça e pescoço provoca inúmeras sequelas ao paciente irradiado, afetando o sistema estomatognático e com repercussões sistêmicas importantes. As sequelas da radiação ionizante podem ser extensas e, algumas vezes, permanentes, em especial nas glândulas salivares e no tecido ósseo. É relevante que o cirurgião dentista tenha conhecimento das reações adversas e das formas adequadas de prevenção e tratamento para amenizar o desconforto e melhorar a condição de vida do paciente irradiado. Portanto, a conscientização e motivação deste paciente, com a promoção de saúde oral através da adequação do meio bucal e orientações sobre ações preventivas, são essenciais para se obter o melhor prognóstico.

Head and neck radiotherapy causes countless sequelae in irradiated patients, affecting the stomatognathic system, with significant systemic implications. Sequelae of exposure to ionizing radiation may be extensive and sometimes permanent, particularly in the salivary glands and bone tissue. It is of utmost importance that the surgeon dentist be aware of adverse reactions and appropriate forms of treatment to alleviate discomfort and improve the quality of life of the irradiated patient. Therefore, awareness and motivation of the patient, with promotion of oral health through the adaptation of the oral environment and guidance on preventive measures are essential to get a better prognosis.

Impacto da nutrição enteral na toxicidade aguda e na continuidade do tratamento dos pacientes com tumores de cabeça e pescoço submetidos a radioterapia com intensidade modulada / Impact of enteral nutrition on acute toxicity and treatment continuity in head and neck cancer patients submitted to intensity-modulated radiotherapy

OBJETIVO: Analisar o impacto da terapia nutricional enteral na manutenção do peso corpóreo e na necessidade de replanejamento e/ou interrupção da radioterapia em pacientes com câncer de cabeça e pescoço submetidos a radioterapia de intensidade modulada (IMRT). MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os pacientes submetidos a IMRT entre janeiro de 2005 e outubro de 2008, com a inclusão de 83 casos. RESULTADOS: A idade mediana foi de 58,6 anos. Em apenas em cinco pacientes (6 por cento) houve interrupção do tratamento, que variou de 4 a 18 dias, e em 19 casos (23 por cento) houve necessidade de replanejamento. A terapia nutricional enteral foi instituída antes do início da radioterapia em 16 pacientes (19 por cento). Perda de peso > 5 por cento ocorreu em 58 casos (70 por cento), sendo mais prevalente no grupo de pacientes em que a terapia nutricional enteral não foi instituída pré-radioterapia. Na comparação entre os grupos não houve diferença significativa na realização de replanejamento (25 por cento versus 21 por cento; p = 0,741) ou na ocorrência e duração da interrupção da radioterapia. CONCLUSÃO: A terapia nutricional enteral tem um claro ganho na manutenção do peso corporal, porém, não houve um benefício na realização da gastrostomia percutânea endoscópica ou da sonda nasoenteral em relação à interrupção e ao replanejamento da radioterapia.

OBJECTIVE: The present study was aimed at analyzing the impact of enteral nutrition on the maintenance of body weight and on the necessity of replanning and/or interruption of treatment of head and neck cancer patients undergoing intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: Cases of patients submitted to IMRT in the period from January 2005 to October 2008 were retrospectively reviewed, and 83 of them were included in the study. RESULTS: Median patients' age was 58.6 years. Only five patients (6 percent) had their treatment interrupted for a period ranging from 4 to 18 days, and in 19 cases (23 percent) required replanning. Enteral nutrition was initiated before the radiotherapy in 16 patients (19 percent). Weight loss of > 5 percent was observed in 58 patients (70 percent), with a higher prevalence in the group of patients who had not received pre-radiotherapy enteral nutrition. No significant difference was observed between the groups regarding the necessity of radiotherapy replanning (25 percent versus 21 percent; p = 0.741) and necessity and duration of treatment interruption. CONCLUSION: Enteral nutrition is of a great value in the body weight maintenance, but no benefit was observed with the performance of endoscopic percutaneous gastrostomy as compared with radiotherapy interruption/replanning.

Faringocoloplastia como reconstrução tardia pós-faringolaringectomia total por carcinoma espinocelular de hipofaringe: relato de caso e revisão da literatura / Pharyngocoloplasty as late reconstruction post-pharyngolaryngectomy by hypopharynx

Introdução: O carcinoma espinocelular de cabeça e pescoço representa cerca de 5% de todas as neoplasias malignas. A localização dessa neoplasia no trato aerodigestivo superior é um fator prognóstico importante, sendo que, na maioria dos casos de hipofaringe, apresentam-se já avançados no momento do diagnóstico. A ressecção cirúrgica, quimioterapia e radioterapia adjuvantes têm grande importância no seu tratamento. Muitos pacientes, com controle loco-regional da doença, beneficiam-se de procedimentos cirúrgicos reparadores e de reconstrução do trânsito intestinal. Relato de caso: Homem, 38 anos, ex-etilista e ex-tabagista, com queixa de disfagia e dispneia rapidamente progressivas, submetido à traqueostomia de urgência por insuficiência respiratória aguda. À investigação, foi diagnosticado um carcinoma espinocelular de supraglote, com extensão para a parede medial do recesso piriforme esquerdo. O paciente foi, então, submetido à faringolaringectomia total, seguida de quimiorradiação. Sem sinais de recidiva tumoral após 12 meses de acompanhamento, foi realizada faringocoloplastia como reconstrução do trânsito intestinal. Encontrase atualmente em acompanhamento ambulatorial sem evidência de recidiva tumoral e satisfeito com o resultado cirúrgico final. Discussão: A reconstrução do trânsito intestinal em pacientes submetidos à faringolaringectomias é indicada para pacientes com controle local da doença e que aceitem o procedimento cirúrgico. A técnica mais utilizada é a interposição de alça de delgado. Porém, o cólon também é utilizado como substituto do esôfago. A escolha da técnica depende fundamentalmente da acurácia técnica do cirurgião e da necessidade de uma longa alça para anastomose entre a faringe e o estômago, com resultados satisfatórios.

Introduction: Head and neck squamous cell carcinoma represents about 5% of all malignant tumors. Localization of this neoplasia at the upper aerodigestive tract is an important prognostic factor. In most cases, hypopharynx tumors are at an advanced stage when diagnosed. Surgical resection, as well as alongside chemotherapy and radiotherapy, are essential to the treatment. Many patients with locoregional control of the disease benefit from reparative and reconstructive surgeries of the intestinal transit. Case report: Man, 38 years old, former user of alcohol and tobaco, complaining of rapid progressive dysphagia and dyspnea, submitted to urgent tracheotomy due to acute respiratory failure. At examination, we diagnosed supraglottic squamous cell carcinoma, involving the left pyriform fossa medial wall. The patient underwent a pharyngolaryngectomy, followed by chemoradiation. Without signs of tumor recurrence after a 12-month follow-up, we performed a pharyngocoloplasty with reconstruction of the intestinal transit. At the moment, he is attending for an outpatient follow-up, with no evidences of tumor recurrence, and satisfied with the final surgical outcome. Discussion: The reconstruction of intestinal transit in pharyngolaryngectomy patients is indicated for those with local control of the disease and that accept this surgicalprocedure. The most used technique is the loop interposition of small intestine, but the colon is also used for esophageal replacement. Its choice depends mainly on the technical accuracy of the surgeon, but also on the requirement of a lengthy loop for the anastomosis between pharynx and the stomach, with suitable results.

Research progress on photodynamic therapy in dentistry / 国际生物医学工程杂志

As a new technique, photedynamic therapy was introduced in the end of 1970s and has been put into clinical application from experimental tests in recent years. Its mechanisms was established on the basis that a series of special typed cells and tissues could selectively absorb photosensitive drugs and generate photore-sponsive effects by light irradiation of definite wavelengths. Currently, the photodynamic theraputics is applied mainly in non surgical treatment of tumor betided in body superfacial and hollow viscus. Its application area has been expanded unceasingly in modern clinic due to the discovery of the selective aggregation of photoresponsive drugs to many pathological tissues and pathogenic microorganisms other than tumors, and the development of new photoresensitizer. In this paper, review is given on the effect mechanisms, the light sources and photosensitizer, as well as the application of photodynamic treatment of tumors in head and neck and its treatments of mucosal dis-ease and oral pathogenic microorganism infected diseases.