Modalidades de radioterapia empregadas para o câncer de cabeça e pescoço / Radiotherapy modalities used for head and neck cancer

O câncer de cabeça e pescoço (CCP) refere-se ao grupo de tumores que atingem a laringe, cavidade nasal, nasofaringe, orofaringe, cavidade oral e glândulas salivares. A radioterapia no paciente com CCP representa uma terapia para manutenção do órgão, através da destruição das células neoplásicas malignas. O objetivo do presente estudo foi identificar estratégias radioterápicas aplicadas ao paciente com CCP e seus respectivos efeitos colaterais em cavidade oral, além de investigar as principais modalidades utilizadas nos sistemas de saúde do Brasil. Tratou-se de uma revisão narrativa da literatura com busca ativa das bases eletrônicas PUBMED, LILACS e SCIELO. Após todas as etapas de refinamento, um total de 58 artigos foram incluídos na presente revisão. A radioterapia possui papel de destaque no tratamento do CCP. No entanto, por não ser um método terapêutico com alta especificidade, resulta em efeitos adversos ao tratamento como mucosite oral, trismo e disfunção salivar, que findam por reduzir a qualidade de vida do paciente. Dentre as principais técnicas radioterapêuticas utilizadas no Brasil, a IMRT e VMAT caracterizam-se como as formas mais avançadas da terapia em 3D, proporcionando doses equivalentes para cada área da lesão tumoral, poupando áreas teciduais circunvizinhas que não necessitam de irradiação. Além da toxicidade reduzida, uma maior sobrevida pode ser observada em pacientes tratados com essas técnicas. Um dos maiores desafios atuais na radioterapia contra o CCP é a proteção de tecidos saudáveis. Nesse sentido, a IMRT e VMAT apresentam superioridade em relação às demais técnicas.

Head and neck cancer (CCP) refers to the group of tumors that affect the larynx, nasal cavity, nasopharynx, oropharynx, oral cavity and salivary glands. Radiotherapy in patients with CCP represents a therapy for organ maintenance, through the destruction of malignant neoplastic cells. The aim of this study was to identify radiotherapy strategies applied to patients with CCP and their respective side effects in the oral cavity, and to investigate the main modalities used in health systems in Brazil. It was a narrative review of the literature with active search of electronic databases PUBMED, LILACS and SCIELO. After all stages of refinement, a total of 58 articles were included in this review. Radiotherapy has a prominent role in the treatment of CCP. However, because it is not a therapeutic method with high specificity, it results in adverse effects to treatment such as oral mucositis, trismus and salivary dysfunction, which end up reducing the quality of life of the patient. Among the main radiotherapeutic techniques used in Brazil, IMRT and VMAT are characterized as the most advanced forms of 3D therapy, providing equivalent doses for each area of the tumor sparing surrounding tissue areas that do not require irradiation. In addition to reduced toxicity, greater survival can be observed in patients treated with these techniques. One of the biggest current challenges in radiation therapy against CCP is the protection of healthy tissues. In this sense, the IMRT and VMAT present superiority in relation to the other techniques.

Evaluación de la experiencia de telemedicina en consulta de Cirugía de cabeza y cuello en un centro de referencia en Manizales / Evaluation of telemedicine experience in head and neck surgery consultation in a referral center in Manizales

Introducción. La infección por COVID-19 afectó drásticamente la atención en salud a nivel mundial, generando retos para la atención primaria. En orden de mitigar y manejar el contagio, la telemedicina se convirtió en una modalidad emergente y efectiva en varias especialidades médicas, incluida la cirugía de cabeza y cuello. Métodos. Estudio de corte transversal con análisis retrospectivo de pacientes atendidos en la consulta virtual durante 18 meses. Se estimaron frecuencias absolutas y relativas, y bivariado con regresión logística binaria. Se incluyeron las variables de diagnóstico primario, poder resolutivo de la consulta, necesidad de cita presencial, plataforma y dificultades de la misma. Resultados. Se incluyeron 2485 pacientes provenientes de 11 departamentos. La patología tiroidea fue la más frecuente (62,9 %), seguida de la aerodigestiva (10,9 %). La consulta fue eficiente en el 99 % de los casos, con una capacidad resolutiva del 96,4 %. El 1,4 % tuvo dificultades en la plataforma y el 8,3 % de los pacientes requirió cita presencial. Cuando hubo dificultad para la revisión de exámenes o una inadecuada inspección funcional, fue 30 veces más probable no poder resolver eficientemente la consulta. Conclusión. La telemedicina provee una alternativa eficiente de atención en cirugía de cabeza y cuello, especialmente en los controles de patología tiroidea, evitando desplazamientos innecesarios. En el tracto aerodigestivo, donde el examen físico es primordial, su utilidad está limitada a la posibilidad de realizar un examen endoscópico posterior que permita una adecuada estadificación y facilite la valoración presencial.

Introduction. The COVID-19 infection drastically affected health care worldwide, creating challenges for primary care. In order to mitigate and manage infection, telemedicine has become an emerging and effective modality in several medical specialties, including head and neck surgery. Methods. Retrospective cross-sectional analysis of patients seen in virtual consultation over 18 months. Absolute and relative frequencies were estimated, univariate analysis was done with chi-square, and bivariate analysis with binary logistic regression. Variables such as primary diagnosis, the resolution power of the consultation, the need for an in-person appointment, the platform, and its difficulties were included. Results. 2485 patients from 11 departments were included. Thyroid pathology was the most frequent (62.9%), followed by aerodigestive tract pathology (10.8%). The consultation was efficient in 99% of cases, with a resolution capacity of 96.4%. 1.4% had difficulties on the platform and 8.3% of patients required an in-person. When there was difficulty in reviewing exams or an inadequate functional inspection, it was 30 times more likely to not be able to efficiently be resolved. Conclusion. Telemedicine provides an efficient alternative for care in head and neck surgery, especially in thyroid pathology controls, avoiding unnecessary travel. In the aerodigestive tract, where the physical examination is essential, its usefulness is limited to the possibility of performing a subsequent endoscopic examination that allows adequate staging and facilitates in-person assessment.

Tumor de cuerpo carotídeo en adolescente. Reporte de un caso / Carotid body tumor in an adolescent. A case report

Introducción. Los paragangliomas del cuerpo carotídeo son neoplasias infrecuentes y representan el 0,6 % de los tumores de cabeza y cuello. La edad de presentación promedio es la quinta década de vida. El objetivo de este artículo fue describir un caso de paraganglioma del cuerpo carotídeo en una adolescente. Caso clínico. Se presenta el caso de una paciente adolescente con paraganglioma de cuerpo carotídeo derecho, de 5x3x3 cm, Shamblin III. Se analizaron la historia clínica, los exámenes diagnósticos, la técnica quirúrgica utilizada y su evolución correspondiente. La información fue obtenida a partir de la ficha clínica, previa autorización por consentimiento de los padres de la paciente. Resultados. Se hizo resección quirúrgica completa y reparo vascular con injerto de vena safena invertida, con evolución favorable y permeabilidad completa del puente vascular, sin secuelas. Conclusión. Este caso podía corresponder a un tumor de etiología familiar, dada su edad temprana de presentación. Se hizo necesario complementar su estudio con imágenes y objetivar el compromiso vascular asociado para la planificación quirúrgica. En estos pacientes, la complejidad de su localización y el compromiso vascular del tumor requiere de un equipo multidisciplinario, con cirujanos de cabeza y cuello y cirujanos vasculares para un resultado exitoso.

Introduction. Carotid body paragangliomas are rare, representing 0.6% of head and neck tumors, with average age of presentation in the fifth decade of life. The objective of this article is to describe a clinical case of carotid body paraganglioma in an adolescent. Clinical case. Review and analysis of the clinical case, reviewing its clinical history, study tests, surgical technique used and its corresponding evolution. Information obtained from the clinical record prior authorization by consent of the patient's parents. Results. Adolescent patient with paraganglioma of the right carotid body, 5x3x3 cm, Shamblin III. With complete surgical resection and inverted saphenous vein graft, favorable evolution, with complete permeability of the vascular bridge, without sequelae. Conclusion. This case could correspond to a tumor of familiar etiology, given its early age of presentation. It is necessary to complement the study with images and to objectively determine the associated vascular involvement for surgical planning. In these patients, the complexity of their location and vascular involvement of the tumor requires a multidisciplinary team with head and neck and vascular surgeons for a successful outcome.

Tratamiento quirúrgico del carcinoma de Merkel facial avanzado. Presentación de un caso / Surgical treatment of advanced facial Merkel cell carcinoma. A case report

Introducción. El carcinoma de Merkel es un tumor maligno poco frecuente, que afecta principalmente a la población caucásica y cuya etiología guarda relación con el poliomavirus de las células de Merkel. Conlleva mal pronóstico, especialmente en estadios finales. Caso clínico. Se expone el caso de una paciente que presentaba un tumor primario facial de grandes dimensiones, con avanzado grado de extensión, afectación linfática cervical y metástasis parotídea derecha. Fue tratada mediante exéresis de la lesión primaria y cobertura con injerto de piel parcial, linfadenectomía cervical y parotidectomía ipsilateral. Resultados. Se logró mejoría importante en la calidad de vida de la paciente y sobrevida de al menos seis meses. Conclusión. Aunque no está claro el manejo óptimo del carcinoma de Merkel avanzado debido a su mal pronóstico, la cirugía favorece una mejoría en la calidad de vida del paciente y puede tener un papel clave en el manejo del carcinoma de Merkel en los estadios avanzados.

Introduction. Merkel carcinoma is a rare malignant tumor that mainly affects the Caucasian population and whose etiology is related to the Merkel cell polyomavirus. It has a poor prognosis, especially in the final stages. Clinical case. The case of a patient who presented a large primary facial tumor, with an advanced degree of extension, cervical lymphatic involvement and right parotid metastasis is described. She was treated surgically by excision of the primary lesion and coverage with partial skin graft, cervical lymphadenectomy, and ipsilateral parotidectomy. Results. A significant improvement was achieved in the patient's quality of life and survival of at least six months.Conclusion. Although the optimal management of advanced Merkel carcinoma is unclear due to its poor prognosis, surgery improves the patient's quality of life and it can play a key role in the management of Merkel carcinoma in advanced stages.

Clinical research progress of boron neutron capture therapy for head and neck cancer / 中华放射肿瘤学杂志

Boron neutron capture therapy is a method based on 10B (n,α) 7Li reaction to achieve malignancy treatment. Upon entry into the human body, the 10B compound carrier can selectively enriched in tumor cells and reacts with external irradiation neutrons. Because 7Li (4 μm) and α particles (7 μm) will be deposited in a cell magnitude (10 μm), the purpose of directional local killing of tumor cells and causing less harm to normal tissue can be achieved successfully. So far, boron neutron capture therapy has been clinically studied in a variety of malignant diseases, including glioblastoma multiforme, meningeoma, head and neck cancer, lung cancer, etc. In this article, the clinical research progress of boron neutron capture treatment in head and neck carcinomas was mainly introduced.

Progress in the pathogenesis and prevention of radiation induced oral mucositis / 中华放射肿瘤学杂志

Radiotherapy is the main treatment for patients with head and neck cancer. Radiation-induced oral mucositis (RIOM) is one of the common complications of patients with head and neck cancer during radiotherapy. It is a mucus injury reaction related to dysphagia and oral pain, which will affect the quality of life and prognosis of patients when it becomes severe. Therefore, prevention and treatment of RIOM are of significance for patients. In this article, the pathogenesis, clinical manifestations, treatment and prevention methods of RIOM were summarized, aiming to provide guidance for the treatment of oral mucositis caused by radiotherapy in patients with head and neck cancer.

Validation of a speech therapy guidelines booklet for dysphagic cancer patients / Validação de cartilha de orientações fonoaudiológicas para pacientes oncológicos disfágicos

ABSTRACT Purpose: to validate the content and appearance of a booklet of speech therapy guidelines on dysphagia for adult oncology patients presented with dysphagia. Methods: a methodological study with a mixed approach, developed for the validation of a guidebook. The validation of the guidebook was made by five expert judges and eleven non-specialist ones. For validation, the Content Validity Index was used: CVI for each item, as well as for the general items. Results: the expert judges assigned the Content Validity Index value above 80% and of 92.20%, and the non-specialist judges attributed values above 90.9% and of 98.0%, which were considered excellent. Conclusion: the proposed guidebook was validated according to content and appearance. It is believed that this material can contribute to the understanding of the health-disease process, promote self-care and arouse the interest of other health professionals in the development of educational technologies in search of better health conditions for the target population.

RESUMO Objetivo: validar conteúdo e aparência de uma cartilha de orientações fonoaudiológicas sobre disfagia para pacientes adultos oncológicos disfágicos. Métodos: trata-se de um estudo metodológico de abordagem mista, desenvolvido para a validação de uma cartilha de orientações. A validação da cartilha, quanto ao conteúdo, foi feita por cinco juízes especialistas e, quanto à aparência, por onze juízes não especialistas. Para a validação utilizou-se o Índice de Validade de Conteúdo para cada item, bem como para todos os itens juntos. Resultados: os juízes especialistas atribuíram valor acima de 80% e de 92,20% para a escala geral de análise. E os juízes não especialistas atribuíram valores acima de 90,9% e de 98,0%, também para a escala geral, sendo considerados excelentes. Conclusão: a cartilha de orientações proposta foi validada segundo conteúdo e aparência. Acredita-se que o referido material possa contribuir para a compreensão do processo saúde-doença, promover o autocuidado e despertar o interesse de outros profissionais da área da saúde para o desenvolvimento de tecnologias educativas em busca de melhores condições de saúde para a população destinada.

Riesgo de osteorradionecrosis de los maxilares según el tipo de radioterapia / Risk of Osteoradionecrosis of the Jaws according to Type of Radiotherapy

Introducción: El cáncer de cabeza y cuello es el séptimo más común a nivel mundial. Las opciones terapéuticas para su manejo incluyen la radioterapia, la cual debe procurar un equilibrio entre la eliminación del tumor y la preservación del tejido sano porque su aplicación implica el riesgo de desarrollar una osteorradionecrosis de los maxilares. Objetivo: Valorar si el riesgo de que se produzca osteorradionecrosis de los maxilares varía en función del tipo de radioterapia. Métodos: Diseño documental, retrospectivo basado en los principios de las revisiones sistemáticas exploratorias según lo establece la lista de chequeo PRISMA Extension for Scoping Reviews (PRISMA-ScR). Se realizaron búsquedas en inglés y español en PubMed, LILACS, ScienceDirect, Tripdatabase y Epistemonikos. Resultados: En total se incluyeron 12 estudios publicados entre 2016 y 2022 con diversos diseños de investigación; el estudio de cohorte retrospectivo fue el que tuvo mayor representación. Se analizaron distintas opciones de radioterapia y sus protocolos, entre ellos, la radioterapia de intensidad modulada, la terapia de protones de intensidad modulada, la radioterapia corporal estereotáctica y la radioterapia tridimensional. La literatura refiere que los protocolos que implican dosis totales más bajas representan un menor riesgo de osteorradionecrosis. Conclusiones: El riesgo de osteorradionecrosis de los maxilares debe atribuirse, en mayor medida, a la dosis total de radiación recibida por el paciente y a la dosis por fracción que al tipo de radioterapia(AU)

Introduction: Head and neck cancer is the seventh most common cancer worldwide. Therapeutic options for its management include radiotherapy, which should seek a balance between tumor elimination and preservation of healthy tissue because its application implies the risk of developing osteoradionecrosis of the jaws. Objective: To assess whether the risk of developing osteoradionecrosis of the jaws varies according to the type of radiotherapy. Methods : Documentary, retrospective design based on the principles of exploratory systematic reviews as established by the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed, LILACS, ScienceDirect, Tripdatabase and Epistemonikos were searched in English and Spanish. Results: In total, 12 studies published between 2016 and 2022 with various research designs were included; the retrospective cohort study had the highest representation. Different radiotherapy options and their protocols were analyzed, including intensity-modulated radiotherapy, intensity-modulated proton therapy, stereotactic body radiotherapy, and three-dimensional radiotherapy. The literature refers that protocols involving lower total doses represent a lower risk of osteoradionecrosis. Conclusions: The risk of osteoradionecrosis of the jaws should be attributed, to a greater extent, to the total radiation dose received by the patient and the dose per fraction than to the type of radiotherapy(AU)

Treatment of osteoradionecrosis of the jaw with injectable platelet-rich fibrin (i-PRF): case series / Tratamento de osteorradionecrose dos maxilares com fibrina rica em plaquetas injetável (i-PRF): série de casos

Objective: This study evaluated the use of autogenous blood concentrate (injectable platelet-rich fibrin) [i-PRF] for promoting soft tissue healing in osteoradionecrosis (ORN) lesions in patients who underwent head and neck radiotherapy. Material and Methods: This study included five ORN lesions in four patients who were treated with i-PRF (applied weekly for 4 weeks to the lesions). Soft tissue features were evaluated through clinical analysis at baseline and at 7, 15, 30, 60, and 90 days after the first session of i-PRF. Extension of the bone lesions was evaluated radiographically. Patient-centered related outcomes were evaluated using quality-of-life questionnaires at baseline and 90 days after the first treatment session. Quality of life data were analyzed using descriptive and frequency statistics and the Wilcoxon test. Results: Of the 5 treated lesions, 1 was completely closed and 3 remained open. The open lesions showed increased necrotic tissue exposure. No changes were observed in the radiographic appearance of the lesions. There was also no impact on the patient's quality of life. Conclusion: The results suggest that the majority of ORN lesions remained stable after the application of i-PRF, with a slight improvement in the quality of the mucosa around the lesions. Furthermore, it was observed that i-PRF did not compromise the quality of life of patients during treatment.(AU)

Objetivo: Este estudo avaliou o uso de concentrado de sangue autógeno (fibrina rica em plaquetas injetável) [i-PRF] para promover a cicatrização de tecidos moles em lesões de osteorradionecrose (ORN) em pacientes submetidos a radioterapia de cabeça e pescoço. Material e Métodos: Este estudo incluiu cinco lesões de ORN em quatro pacientes tratados com i-PRF (aplicado semanalmente por 4 semanas nas lesões). As características do tecido mole foram avaliadas por meio de análises clínicas no início e aos 7, 15, 30, 60 e 90 dias após a primeira sessão de i-PRF. A extensão das lesões ósseas foi avaliada radiograficamente. Os resultados centrados no paciente foram avaliados usando questionários de qualidade de vida no início e 90 dias após a primeira sessão de tratamento. Os dados de qualidade de vida foram analisados usando estatísticas descritivas e de frequência, além do teste de Wilcoxon. Resultados: Das 5 lesões tratadas, 1 foi completamente fechada e 3 permaneceram abertas. As lesões abertas mostraram aumento na exposição de tecido necrótico. Não foram observadas mudanças na aparência radiográfica das lesões. Também não houve impacto na qualidade de vida do paciente. Conclusão: Os resultados sugerem que a maioria das lesões de ORN permaneceu estável após a aplicação de i-PRF, com uma discreta melhora na qualidade da mucosa ao redor das lesões. Além disso, observou-se que a i-PRF não comprometeu a qualidade de vida dos pacientes durante o tratamento.(AU)

Supervivencia y seguimiento de pacientes sometidos a cirugía parcial de laringe

Introducción: El cáncer de cabeza y cuello constituye el 3,8 % de las neoplasias malignas y 2,3 % de las muertes por cáncer; más frecuente entre la sexta y séptima década de la vida. El cáncer laríngeo es el tumor maligno no cutáneo más común (30-40 %) entre los tumores de cabeza y cuello y segundo cáncer más frecuente del aparato respiratorio; razón hombre/mujer de hasta 10:1, reducida con el incremento del tabaquismo en la mujer. La laringectomía parcial y la radioterapia son métodos terapéuticos efectivos en el tratamiento de pacientes con cáncer laríngeo precoz, comparables en tasas de supervivenciay conservación de la laríngea. Objetivo: Evaluar la supervivencia y seguimiento de pacientes que recibieron como tratamiento de elección por persistencia tumoral o recidiva cirugía parcial de laringe en dos hospitales de la provincia Camagüey. Métodos: El universo lo conformaron los pacientes con cáncer laríngeo que acudieron a las consultas y la muestra a criterio de los autores la integraron 70 pacientes que recibieron tratamiento quirúrgico. Se consideraron como variables: edad, sexo, localización topográfica del tumor, técnica quirúrgica parcial realizada y tiempo desupervivencia de los pacientes. Resultados: En la muestra estudiada el 100 % de los pacientes pertenecían al sexo masculino, entre 51 y 60 años de edad y con carcinomas en localización glótica-supraglótica. La técnica quirúrgica más utilizada fue la laringectomía subtotal con cricohioidopexia sin epigotoplastia. Durante la recolección de la información en consulta para el seguimiento de los enfermos, la mayoría se encontraban vivos. Conclusiones: Los pacientes tratados fueron del sexo masculino, quinta y sexta décadas de la vida. Predominó la localización topográfica glótica-supraglótica y la técnica quirúrgica realizada con mayor frecuencia la laringectomía subtotal con cricohioidopexia sin epigotoplastia. Al culminar el estudio la mayor parte de los pacientes de ambos grupos mostraronn buena calidad vida e integración social.

Introduction: Head and neck cancer constitutes 3.8% of malignant neoplasms and 2.3% of cancer deaths; most common between the sixth and seventh decade of life. Laryngeal cancer is the most common non-cutaneous malignant tumor (30-40%) among head and neck tumors and the second most common cancer of the respiratory system; shows a male/female ratio of up to 10:1, which has reduced with the increase in smoking in women. Partial laryngectomy and radiotherapy are effective therapeutic methods in the treatment of patients with early laryngeal cancer, comparable in survival rates and laryngeal preservation. Objective: To evaluate the survival and follow-up of patients who received partial laryngeal surgery as the treatment of choice for tumor persistence or recurrence in two hospitals in the province of Camagüey, Cuba. Methods: The universe was made up of patients with laryngeal cancer who attended the consultations and the sample at the authors' discretion was made up of 70 patients who received surgical treatment. The following variables were considered: age, sex, topographic location of the tumor, partial surgical technique performed and survival time of the patients. Results: In the sample studied, 100% of the patients were male, between 51 and 60 years of age and with carcinomas in a glottic - supraglottic location. The most used surgical technique was subtotal laryngectomy with cricohyoidopexy without epigotoplasty. During the collection of information in consultation for the follow-up of the patients, the majority were alive. Conclusions: The treated patients were male, fifth and sixth decades of life. Glottic-supraglottic topographic location predominated and the most frequently performed surgical technique was subtotal laryngectomy with cricohyoidopexy without epigotoplasty. At the end of the study, most of the patients in both groups showed good quality of life and social integration.

Malignant tumors affecting the head and neck region in ancient times: Comprehensive study of the CRAB Database

Abstract In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.

Electrical Stimulation for Treatment of Dysphagia Post Head Neck Cancer: A Systematic Review and Meta-Analysis

Abstract Introduction Dysphagia induced by radiotherapy in the head and neck region comprises a challenging scenario and sometimes difficult rehabilitation due to the severity of the adverse effects. Some resources such as electrical stimulation have emerged as an alternative to complement the therapeutic process, but there is still no consensus on its use. Objective The purpose of the present study was to evaluate, through a meta-analysis, the effect of electrical stimulation on the rehabilitation of dysphagia generated after head and neck cancer treatment. Data Synthesis Four randomized controlled trials with a total of 146 participants were included. The age of the participants was 58.37 ± 1.8 years old and there was a predominance of males. The time to start the intervention ranged from 50.96 ± 40.12 months after cancer treatment. The intervention showed great heterogeneity regarding the positioning of the electrodes, parameters, duration of the stimulus, number of sessions, and intensity. No difference was identified in the following aspects: oral transit time, hyoid elevation, penetration and/or aspiration after electrostimulation. The quality of the evidence ranged from very low to moderate and high risk of bias. Conclusion In this meta-analysis, we found weak evidence for small and moderate swallowing benefits in patients after radiotherapy for head and neck cancer in short-term clinical trials.

Determinantes Sociais na Sobrevida dos Pacientes com Câncer de Cabeça e Pescoço / Social determinants in the survival of patients with head and neck cancer / Determinantes Sociales en la Supervivencia de Pacientes con Cáncer de Cabeza y Cuello

dos pacientes com câncer de cabeça e pescoço. Métodos: Trata-se de uma revisão integrativa de literatura, realizada em janeiro de 2023 nas bases de dados Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed e com a string de busca ((determinantes sociais de saúde OR condição de vida OR condição sócio-demográfica OR condição socioeconômica OR fatores sociais) AND (análise de sobrevida)). Resultados: Dos 315 artigos encontrados e, após os critérios de elegibilidade e etapas de seleção, apenas 12 correspondiam aos critérios escolhidos. Tais estudos indicam que dentre as pessoas com câncer de cabeça e pescoço o homem, negro, com idade superior a 50 anos, solteiro e/ou divorciado e com baixo nível socioeconômico está propenso a ter uma pior sobrevida. Conclusão: Com base nos artigos selecionados, compreendeu-se que os determinantes sociais em saúde influenciam na melhora ou piora da sobrevida do paciente com câncer de cabeça e pescoço

Objective: Understand how Social Determinants of Health impact the survival of patients with head and neck cancer. Methods: This is an integrative literature review, carried out in January 2023 in the Scientific Electronic Library Online, Latin American and Caribbean Literature in Health Sciences and PubMed databases and with the search string ((social determinants of health OR living condition OR socio-demographic condition OR socioeconomic condition OR social factors) AND (survival analysis)). Results: Of the 315 articles found and, after the eligibility criteria and selection steps, only 12 corresponded to the chosen criteria. Such studies indicate that among people with head and neck cancer, black men, over the age of 50, single and/or divorced and with low socioeconomic status are likely to have a worse survival rate. Conclusion: Based on the selected articles, it was understood that social determinants of health influence the improvement or worsening of survival of patients with head and neck cancer.

Objetivo: Comprender cómo los Determinantes Sociales en Salud impactan en la supervivencia de los pacientes con cáncer de cabeza y cuello. Método: Se trata de una revisión integrativa de la literatura, realizada en enero de 2023 en las bases de datos Scientific Electronic Library Online, Literatura Latinoamericana y del Caribe en Ciencias de la Salud y PubMed, utilizando la cadena de búsqueda ((determinantes sociales de salud OR condición de vida OR condición socio-demográfica OR condición socioeconómica OR factores sociales) AND (análisis de supervivencia)). Resultados:De los 315 artículos encontrados y, después de aplicar los criterios de elegibilidad y etapas de selección, solo 12 cumplían con los criterios elegidos. Estos estudios indican que entre las personas con cáncer de cabeza y cuello, los hombres negros, mayores de 50 años, solteros y/o divorciados y con bajo nivel socioeconómico, tienen una peor supervivencia. Conclusión:Con base en los artículos seleccionados, se comprendió que los determinantes sociales en salud influyen en la mejora o empeoramiento de la supervivencia del paciente con cáncer de cabeza y cuello.

Fractal analysis and assessment of lacunarity in mandibular osteoradionecrosis: a cross-sectional study with control group

Abstract The objective of this study was to evaluate the fractal dimension (FD) and lacunarity of the mandibular bone, comparing patients with and without osteoradionecrosis (ORN). In a cross-sectional study with a control group, 25 patients were included and divided into a case group (with ORN, n = 14) and a control group (without ORN, n = 11). A digital panoramic radiograph taken after the end of radiotherapy (RT) was evaluated for each patient. FD and lacunarity of the mandibular bone were determined using ImageJ software. Descriptive, bivariate, and ROC curve analyses were performed. Cohen's d effect sizes were calculated. Significance was established at p < 0.05. The mean FD and lacunarity values were not significantly different between the groups. The area under the curve for FD and lacunarity were 0.579 and 0.661, respectively. The cut-off point for FD was ≤1.1714 and for lacunarity, > 0.3821, correctly classifying the majority of cases and controls. Most participants in the case group (63.6%) had a FD ≤ 1.1714 and the majority of participants in the control group (63.6%) had a FD >1.1714 (p = 0.395). For lacunarity, most individuals in the case group (72.7%) had a value > 0.3821 and most participants in the control group (63.6%) had a value ≤ 0.3821 (p = 0.198). In conclusion, the FD and lacunarity values did not show statistically significant differences between patients with and without ORN. However, the moderate and large magnitude of the effects seem to indicate that the results may be clinically relevant.

Conocimientos de profesionales de Enfermería sobre autocuidado de personas con cáncer de cabeza y cuello con complejidad clínico asistencial

Introducción: La caracterización de los conocimientos de las enfermeras sobre el autocuidado, se hacen necesario para mejorar la autonomía de personas con cáncer de cabeza y cuello. Objetivo: Caracterizar los conocimientos del profesional de Enfermería sobre el autocuidado de personas con cáncer de cabeza y cuello con complejidad clínico asistencial. Métodos: Estudio descriptivo de corte transversal, realizado en el Instituto Nacional de Oncología y Radiobiología y los Policlínicos Moncada y Vedado, Plaza de la Revolución, La Habana, Cuba, durante el año 2022. La población fueron 14 enfermeras del servicio de cabeza y cuello y 8 que cuidan a personas con cáncer de cabeza y cuello de los policlínicos incluidos en el estudio. Se estudiaron variables socio-laborales y conocimientos sobre autocuidado. Los datos se obtuvieron con una encuesta diseñada por el autor y validada por especialistas. Para el análisis de datos se realizó distribuciones de frecuencias absolutas y relativas (media, porcentaje). Resultados: El 100,00 % de la población estudiada en el servicio de cabeza y cuello presentó adecuado conocimiento sobre la importancia del autocuidado, resultados diferentes obtuvieron el 25,00 % de las enfermeras de los consultorios del médico y la enfermera de la familia. Conclusiones: Los profesionales de Enfermería estudiados presentan características socio-laborales pretendidas, a pasar de su nivel profesional y capacitación recibida, muestran necesidades de conocimientos sobre la teoría del autocuidado de Dorothea Orem y el beneficio de su vinculación con la práctica asistencial para el autocuidado de personas operadas de cáncer de cabeza y cuello con complejidad clínico asistencial.

Introduction: The characterization of nurses' knowledge about self-care is necessary to improve the autonomy of people with head and neck cancer. Objective: To characterize the knowledge of nursing professionals about the self-care of people with head and neck cancer with clinical care complexity. Methods: A descriptive cross-sectional study was conducted at the National Institute of Oncology and Radiobiology and the Moncada and Vedado Polyclinics, Plaza de la Revolución, Havana, Cuba, during 2022. The population consisted of 14 nurses from the head and neck service and 8 who care for people with head and neck cancer from the polyclinics included in the study. Socio-occupational variables and knowledge about self-care were studied. The data were obtained with a survey designed by the author and validated by specialists. For data analysis, absolute and relative frequency distributions (mean, percentage) were performed. Results: 100.00% of the population studied in the head and neck service presented adequate knowledge about the importance of self-care, different results obtained by 25.00% of the nurses in the doctor's offices and the family nurse. Conclusions: The nursing professionals studied present intended socio-occupational characteristics, beyond their professional level and training received, they show knowledge needs about Dorothea Orem's theory of self-care and the benefit of its link with the care practice for the self-care of people operated on for head and neck cancer with clinical care complexity.

Necesidades de autocuidado en personas operadas con cáncer de cabeza y cuello

Introducción: La identificación de las necesidades de autocuidado de las personas operadas con cáncer de cabeza y cuello, se hace necesario para diseñar intervenciones que mejoren su autonomía. Objetivo: Identificar las necesidades de autocuidado en personas operadas con cáncer de cabeza y cuello, con la consideración de las dimensiones físicas, emocionales y sociales relacionadas con la recuperación postoperatoria. Métodos: Estudio descriptivo de corte transversal, realizado en el Instituto Nacional de Oncología y Radiobiología y los Policlínicos Moncada y Vedado del municipio Plaza de la Revolución, La Habana, Cuba, durante el año 2022. La población fueron 12 personas operadas con cáncer de cabeza y cuello, en recuperación en el hogar. Los datos se obtuvieron con un cuestionario diseñado para evaluar capacidades de autocuidado y validado mediante un estudio piloto. Para el análisis de datos se realizó distribuciones de frecuencias absolutas y relativas (porcentaje). Resultados: Se identificaron escasos conocimientos sobre autocuidado, predominaron aspectos del autocuidado relacionado con la alimentación por gastrostomía, la comunicación con la familia y amigos, la higiene, la cura de la traqueotomía y la dependencia de su cuidador. Conclusiones: Se evidencia la necesidad de intervenciones educativas para mejorar las habilidades de autocuidado en personas operadas de cáncer de cabeza y cuello. Esto podría incluir la implementación de programas de formación para enfermos y cuidadores. Es esencial que las políticas de salud consideren estas necesidades para garantizar que los enfermos con cáncer puedan alcanzar niveles óptimos de independencia y calidad de vida postoperatoria.

Introduction: Identifying the self-care needs of people who have undergone surgery for head and neck cancer is necessary to design interventions that improve their autonomy. Objective: To identify self-care needs in people who have undergone surgery for head and neck cancer, taking into account the physical, emotional and social dimensions related to postoperative recovery. Methods: A descriptive cross-sectional study was carried out at the National Institute of Oncology and Radiobiology and the Polyclinics Moncada and Vedado of the Plaza de la Revolución municipality, Havana, Cuba, during 2022. The population consisted of 12 people who had undergone surgery for head and neck cancer, recovering at home. The data were obtained with a questionnaire designed to assess self-care capabilities and validated through a pilot study. For data analysis, absolute and relative frequency distributions (percentage) were performed. Results: There was little knowledge about self-care, with aspects of self-care related to gastrostomy feeding, communication with family and friends, hygiene, tracheostomy care and dependence on caregivers predominating. Conclusions: There is a clear need for educational interventions to improve self-care skills in people who have undergone head and neck cancer surgery. This could include the implementation of training programs for patients and caregivers. It is essential that health policies consider these needs to ensure that cancer patients can achieve optimal levels of independence and quality of life postoperatively.

A experiência de pacientes com câncer de cabeça e pescoço quanto ao autocuidado com a radiodermite / The experience of patients with head and neck cancer regarding self-care for radiodermatitis / Experiencia de pacientes con cáncer de cabeza y cuello sobre el autocuidado de la radiodermitis

RESUMO Objetivo: Analisar a experiência de pacientes com câncer de cabeça e pescoço quanto ao autocuidado com a radiodermite associado aos fatores sociodemográficos e clínico-patológicos. Método: Estudo descritivo com abordagem qualitativa, desenvolvido em um Centro de Referência de Alta Complexidade em Oncologia em Belém - Pará - Brasil. Realizado com entrevistas e análise de prontuário. Os dados foram coletados de fevereiro a abril de 2022, e tratados por análise de conteúdo de Bardin subsidiada pelo software IRAMUTEQ. Resultados: Emergiram três subcategorias: importância do conhecimento do paciente quanto a radioterapia; identificação dos efeitos adversos relacionados ao tratamento; e, orientação do enfermeiro quanto ao autocuidado. Considerações Finais: O conhecimento dos pacientes foi incipiente sobre o tratamento, efeitos adversos foram identificados pelo impacto negativo em sua autoestima e autoimagem e a orientação do autocuidado foi efetiva com a reprodução do cuidado. O estudo oportuniza a elaboração de estratégia de ensino adequada em pesquisas futuras.

ABSTRACT Objective: To analyze the experience of patients with head and neck cancer regarding self-care for radiodermatitis associated with sociodemographic and clinical-pathological factors. Method: A descriptive study with a qualitative approach, carried out at a High Complexity Oncology Reference Center in Belém - Pará - Brazil. It was conducted through interviews and analysis of medical records. The data were collected from February to April 2022 and processed using Bardin's content analysis supported by the IRAMUTEQ software. Results: Three subcategories emerged: The importance of the patient's knowledge about radiotherapy; Identification of adverse effects related to the treatment; and Nurses' guidance on self-care. Final Considerations: The patients' knowledge about the treatment was incipient, adverse effects were identified by the negative impact on their self-esteem and self-image, and self-care guidance was effective in reproducing care. The study provides an opportunity to develop an appropriate teaching strategy in future research.

RESUMEN Objetivo: Analizar la experiencia de pacientes con cáncer de cabeza y cuello sobre el autocuidado de la radiodermatitis asociado a factores sociodemográficos y clínico-patológicos. Método: Estudio descriptivo con enfoque cualitativo, desarrollado en un Centro de Referencia de Alta Complejidad en Oncología en Belém, Pará, Brasil. Realizado por medio de entrevistas y análisis de historias clínicas. Los datos se recopilaron de febrero a abril de 2022 y se procesaron mediante análisis de contenido de Bardin con ayuda del software IRAMUTEQ. Resultados: Surgieron tres subcategorías: importancia del conocimiento del paciente sobre radioterapia; identificación de los efectos adversos relacionados con el tratamiento; y orientación del enfermero sobre el autocuidado. Consideraciones finales: El conocimiento de los pacientes sobre el tratamiento era incipiente, ellos identificaron los efectos adversos debido al impacto negativo en su autoestima y autoimagen y la orientación de autocuidado fue efectiva dado que lograron reproducir el cuidado. El estudio contribuye a que se desarrollen estrategias de enseñanza adecuada en futuras investigaciones.

Programa de acompañamiento a personas diagnosticadas con cáncer de cabeza y cuello, liderado por la enfermera de práctica avanzada con mención en oncología / Support program for people with head and neck cancer, led by an oncology advanced practice nurse

Se presenta una propuesta de intervención de enfermería de práctica avanzada (EPA) en oncología. OBJETIVO: Implementar un programa de acompañamiento para pacientes con cáncer de cabeza y cuello. PROPUESTA: Realizar un levantamiento del proceso y descripción del flujo que debe transitar el paciente oncológico desde la sospecha, diagnóstico, tratamiento, seguimiento y derivación a cuidados paliativos. En segunda instancia, crear e implementar una consulta de enfermería que pueda responder a las necesidades de atención de salud en forma holística de la persona con diagnóstico oncológico de cáncer de cabeza y cuello, tanto en las personas que se encuentran en fase sospecha y confirmación diagnóstica (consulta de ingreso) y en el proceso de seguimiento del sobreviviente (después de finalizado el tratamiento oncológico), a través de una puesta en marcha escalonada, con períodos de evaluación en cada uno de ellos. CONCLUSIONES: La heterogeneidad de la persona diagnosticada con cáncer de cabeza y cuello representa un desafío y se considera a la EPA un profesional para manejar casos complejos. El camino hacia este nuevo rol será paulatino, y requiere una transición tanto por el equipo de salud, los pacientes y las propias enfermeras dentro del marco legal vigente.

This paper presents a proposal for an advanced practice nursing intervention (APN) in oncology. OBJECTIVE: To implement a support program for patients with head and neck cancer. PROPOSAL: To carry out a survey of the process and description of the flow that the oncology patient must go through from suspicion, diagnosis, treatment, follow-up and referral to palliative care. Secondly, to create and implement a nursing consultation that can respond to the health care needs in a holistic manner of the person with an oncological diagnosis of head and neck cancer, both in people who are in the suspicion and diagnostic confirmation phase (admission consultation) and in the follow-up process of the survivor (after the end of oncological treatment), through a staggered implementation, with evaluation periods in each of them. CONCLUSIONS: The heterogeneity of the person diagnosed with head and neck cancer represents a challenge and the APN is considered a professional to manage complex cases. The journey towards this new role will be gradual, and requires a transition both by the health team, the patients and the nurses themselves within the current legal framework.

Retalho supraclavicular para reconstrução oncológica em cabeça e pescoço: Uma série de 62 casos / Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases

Introdução: A reconstrução oncológica de defeitos extensos em cabeça e pescoço impõe ao cirurgião plástico a difícil decisão entre o uso de retalhos livres e retalhos pediculados. O retalho supraclavicular é um dos principais exemplos de retalho pediculado, sendo versátil, com espessura delgada e cor semelhante à região a ser reconstruída. Método: Um estudo retrospectivo foi realizado através da coleta de dados de prontuário de pacientes internados no Instituto do Câncer do Estado de São Paulo, entre dezembro de 2010 e março de 2020. Resultados: Dentre os 62 pacientes reconstruídos com retalho supraclavicular, 37 eram do sexo masculino e 25 do sexo feminino. Cinquenta e oito pacientes (93,5%) possuíam alguma comorbidade associada. Ao todo, 27 complicações relacionadas ao retalho (43,5%) foram registradas, sendo 5 necroses totais (8%). Conclusão: O retalho supraclavicular possui importante papel nas reconstruções oncológicas de cabeça e pescoço e deve ser considerado como opção em pacientes maus candidatos a retalhos microcirúrgicos.

Introduction: The oncological reconstruction of extensive defects in the head and neck requires the plastic surgeon to make a difficult decision between the use of free flaps and pedicled flaps. The supraclavicular flap is one of the main examples of a pedicled flap, being versatile, with a thin thickness and similar color to the region to be reconstructed. Method: A retrospective study was carried out by collecting data from medical records of patients admitted to the Cancer Institute of the State of São Paulo between December 2010 and March 2020. Results: Among the 62 patients reconstructed with a supraclavicular flap, 37 were male and 25 female. Fifty-eight patients (93.5%) had some associated comorbidity. In total, 27 complications related to the flap (43.5%) were recorded, 5 of which were total necrosis (8%). Conclusion: The supraclavicular flap plays an important role in head and neck oncological reconstructions and should be considered as an option in patients who are poor candidates for microsurgical flaps.