Malignant neoplasms of the oral cavity and oropharynx treated in Brazil: what do hospital cancer records reveal? / Neoplasias malignas da cavidade oral e orofaringe tratadas no Brasil: o que revelam os registros hospitalares de câncer?

Abstract Introduction: Head and neck cancer has an impact on the global burden of diseases, representing an important cause of morbidity and mortality in Brazil, as well as worldwide. Objective: To learn and describe the clinical, epidemiological and care configuration provided to patients with cancer of the oral cavity and oropharynx recorded in Brazil, diagnosed from 2007 to 2016. Methods: This is a cross-sectional study, carried out using secondary hospital-based data, using the indirect documentation technique. Results: There were 52,799 hospital records of oral cavity cancer and 34,516 cases of oropharyngeal cancer in the assessed period. There was a predominance of male patients, aged 50-59 years, mostly Caucasians, and with a low level of schooling. Throughout the period there was a significant reduction in the positive history of alcohol and tobacco consumption, except for alcoholic beverages in oral cavity cancer. Most patients were diagnosed at an advanced stage of the disease (III or IV). Most patients with oral cavity cancer had no evidence of the disease on follow-up, while most patients with oropharyngeal cancer died. The first most frequent treatment offered to patients with oral cavity cancer was surgery, while for patients with oropharyngeal cancer it chemoradiotherapy predominated. Conclusion: Despite the fact that, in general, there was a reduction in the records of patient alcohol and tobacco consumption, the increase in the number of medical consultations, the predominantly late diagnosis and the patients' low level of schooling indicate the need for health education, primary prevention and early diagnosis of cancer of the oral cavity and oropharynx.

Resumo Introdução: O câncer de cabeça e pescoço impacta a carga global de doenças, representa importante causa de morbimortalidade no Brasil e no mundo. Objetivo: Conhecer e descrever a compleição clínica, epidemiológica e assistencial dos atendimentos a pacientes com câncer de cavidade oral e orofaringe registrados no Brasil, diagnosticados de 2007 a 2016. Método: Estudo transversal, feito a partir de dados secundários de base hospitalar, por meio de técnica de documentação indireta. Resultados: Houve 52.799 registros hospitalares de câncer de cavidade oral e 34.516 casos de câncer de orofaringe no período considerado. Predominaram pacientes do sexo masculino, da faixa etária de 50-59 anos, predominantemente branca, e de baixo nível de escolaridade. Ao longo do período houve redução expressiva do histórico positivo de consumo de bebida alcoólica e tabaco, exceto para bebida alcoólica no câncer de cavidade oral. A maioria dos pacientes foi diagnosticada em estágio avançado da doença (III ou IV). A maior parte dos pacientes de câncer de cavidade oral apresentava-se sem evidência da doença, enquanto que grande parte dos pacientes com câncer de orofaringe evoluiu a óbito. O primeiro tratamento mais frequente oferecido aos pacientes com câncer de cavidade oral foi cirurgia, enquanto para os pacientes com câncer de orofaringe foi a quimioradioterapia. Conclusão: Apesar de se observar, de maneira geral, redução dos registros do consumo de bebida e tabaco, o aumento do número de atendimentos, o diagnóstico tardio predominante e o baixo nível de escolaridade dos pacientes apontam para a necessidade da educação em saúde, de prevenção primária e do diagnóstico precoce do câncer de cavidade oral e orofaringe.

Cáncer avanzado de orofaringe. Nuevo paradigma de tratamiento / ADVANCED OROPHARYNGEAL CANCER TREATED WITH SEQUENTIAL CHEMORADIATION PRESERVING THE ORGAN

Antecedentes: Hasta la década del 80 los pacientes con esta patología eran intervenidos quirúrgicamente. A partir de 1997 la Cleveland Clinic publica un estudio basado en la quimioradioterapia en el cáncer avanzado de orofaringe con resultados similares a los de la época anterior, pero con preservación del órgano. En nuestro medio no existe bibliografía que analice estadísticamente los resultados y los factores que lo condicionaron. Objetivo: Evaluar los resultados con quimioradioterapia secuencial en el cáncer avanzado de la región orofaríngea. Lugar de aplicación: Hospital de atención terciaria Diseño: Prospectivo no randomizado Material y metodo: Desde Enero del 2002 al 30 de diciembre del 2004 se estudiaron 60 pacientes, 55 pertenecían al sexo masculino, con edad media de 60 años, el 76.7% eran T III y los restantes T IV con tumores malignos de la región orofaríngea mediante quimioradioterapia secuencial. Resultados: La supervivencia a 152 meses fue del 30.1%. El análisis univariado, demostró que el estadío, con p<0,001, la reducción con p=0,010 y la cirugía de rescate con p=0,028 fueron las únicas variables estadísticamente significativas, mientras la edad, el sexo y la localización no tuvieron los mismos resultados. En el análisis multivariado, el estadío con una p< 0.001, el sexo con una p=0.016 y la reducción con una p=0.024 resultaron ser estadisticamente significativos. Conclusiones: El tratamiento de los tumores de la región orofaríngea, en estadíos III y IV, mediante quimioradioterapia secuencial alcanzaron resultados similares a los tratados con cirugía seguida de radioterapia, pero con preservación del órgano

Background: Until the 80th decade, patients with advanced oropharyngeal cancer were surgically treated. In 1997 the Cleveland Clinic published similar results with chemoradiotherapy but preserving the organ. In our country there are not papers analyzing those results and conditional factors. Objective: Evaluation of sequential chemoradiation results in advanced oropharyngeal cancer Setting: Public tertiary care Hospital of tumours Design: Prospective not randomized. Population and methods: From January 2002 to December 2008, 60 patients were analysed, 55 of them were male with a mean age of 60, 76.7% TIII/IV oropharyngeal carcinomas treated with sequential chemoradiation. Results: The overall 152 months of survival was 30.1%. Univariate analize showed stage p<001, reduce of lesion p:0.010 and rescue surgery p:0.028 were statiscally significative. Age, gender and subsite had not similar results. In multivariate analize only stage p:0.001, gender p: 0.016 and reduce of lesion p:0.024 resulted statiscally significative. Conclusions: Sequential chemoradiation of III and IV stage tumours of oropharyngeal area have similar long terms results than those treated with surgery plus radiation but with organ preservation

Advanced carcinoma of the oropharynx: survival analysis comparing two treatment modalities

Abstract About 92,000 new cases of oropharynx carcinoma are expected to occur annually worldwide. There is no consensus about the best therapy for these advanced tumors. The objective of the present study was to evaluate overall and disease-free survival rates of patients with advanced oropharynx squamous cell carcinoma, comparing surgery + radiotherapy with chemotherapy + radiotherapy. Medical records of patients were reviewed. Previously treated tumors were excluded. Clinical, demographic and microscopic information was collected, and p16 staining was performed. Kaplan-Meier survival curves were plotted. Forty-seven cases were included, 41 men and 6 women, having a mean age of 56.3 years. Most patients were smokers (85.1%) and consumed alcohol (74.5%). Patients were stage III (21.3%) or IV (78.7%). Most lesions affected the base of the tongue (36.2%). Of the 23 cases available for p16 testing, 3 were positive (13.0%). There was no difference between the overall and the disease-free survival rates for the two treatment modalities (p>0.05), even when only resectable tumors were compared. Seventeen cases experienced recurrence (36.2%); 16 (34.0%) patients remained alive without disease; 15 (31.9%) died due to disease; 9 (19.2%) were recurrent at the last follow-up. The two treatment protocols were equally efficient in treating advanced oropharynx squamous cell carcinoma, since both promoted similar overall and disease-free survival rates. The results and interpretations related herein mostly regard "conventional" oropharyngeal squamous cell carcinomas, as opposed to HPV-associated tumors.

Neoplasias de orofaringe / Oropharyngeal neoplasms

Objetivos: O presente estudo tem como principal objetivo revisar os importantes aspectos acerca das neoplasias de orofaringe, com o intuito de atentarmos aos pontos relevantes quanto à epidemiologia, clínica e tratamento existentes atualmente, alertando ao público médico. Métodos: Como método, fez-se uma revisão na literatura acerca do tema, usando-se o banco de dados do PubMed e da SciELO, no período de 2012 a 2017. Os critérios de inclusão para os estudos utilizados como referência foram a abordagem terapêutica das neoplasias orofaríngeas e os dados referentes à epidemiologia da patologia. Resultados: Como resultado da presente revisão, viu-se que as neoplasias de orofaringe se caracterizam pelo acometimento das regiões compreendidas na base da língua, tonsilas palatinas, palato mole, paredes laterais e posteriores da orofaringe e valécula, sendo as localizadas nas amígdalas as mais frequentes. Atualmente, a infecção pelo papilomavírus humano (HPV), associada aos fatores de risco mais conhecidos como o tabaco e o álcool, têm contribuído na incidência destes cânceres. O diagnóstico precoce influencia diretamente no prognóstico, sendo fundamental, para tanto, adequados anamnese e exame físico em consultório médico. Conclusões: Concluiu-se que o sexo masculino ainda representa o gênero mais acometido, a despeito de estar aumentando a incidência nas mulheres, e que os tratamentos propostos para as neoplasias de orofaringe estão em constante aperfeiçoamento no que tange a técnicas cirúrgicas e a tecnologias de combate a infecções virais, responsáveis pelo surgimento da doença.

Aims: The present study has as main objective to review the most important aspects concerning the neoplasms of the oropharynx, with the intent of listening to the relevant points regarding the epidemiology, clinical aspects and treatment that currently exist, alerting the physicians about its characteristics. Methods: As a method, it was made a literature review about the topic, using the database Pubmed and SciELO, between 2012 and 2017. The inclusion criteria for the studies used as reference were the therapeutic approach of oropharyngeal neoplasms and the data referring to the epidemiology. Results: As a result, we were able to confirm that the neoplasms of the oropharynx are basically characterized by the involvement of the regions included in the base of the tongue, tonsils, soft palate, lateral and posterior oropharynx walls and vallecula, being significantly more frequent the ones located in the tonsils. Currently, the infection by the human papillomavirus (HPV), as others more known risk factors as tobacco and alcohol, contribute in the incidence of these cancers. Early diagnosis directly influences the prognosis and, for this reason, adequate history and physical examination in the doctor's office are essential. Conclusions: It was concluded that the male gender is still the most affected gender, despite the increasing incidence in women, and that the proposed treatments for the malignancies of the oropharynx are in constant improvement which regards to surgical techniques and technologies that combat viral infections, which are responsible for the disease.

Oropharyngeal cancer: an emergent disease? / Cáncer de orofaringe: ¿una enfermedad emergente?

Abstract Oropharyngeal cancer incidence has recently increased, thereby attracting public attention. Akin to other malignancies of the upper aerodigestive tract, it has been attributed to the carcinogenic effects of tobacco and alcohol use. However, recent evidence shows that a substantial increase in the disease is attributable to the effects of human papillomavirus (HPV). Marked progress has been made in relation to the knowledge of molecular and genetic mechanisms involved in the genesis and progression of these cancers. This has led to the development of new and promising therapies of a more specific and less toxic nature that have prolonged life and improved its quality. However, these therapies have failed to significantly increase the proportion of patients who are cured. To decrease the mortality associated with these neoplasms, it is necessary to adopt public health measures aimed at prevention and early diagnosis.

Resumen El cáncer de orofarínge recientemente ha incrementado su incidencia, por lo que ha atraído la atención pública. Como en otras neoplasias malignas de las vías aerodigestivas superiores se atribuye a los efectos carcinogénicos del tabaco y alcohol, sin embargo evidencia reciente señala un incremento substancial atribuible a los efectos del virus del papiloma humano. Mucho se ha avanzado en relación a los conocimientos de los mecanismos moleculares y genéticos implicados en la génesis y progresión de estas neoplasias, lo que ha conducido al desarrollo de nuevas y prometedoras terapias, mas especificas y menos tóxicas, que han prolongado la vida y mejorado su calidad, pero no han logrado incrementar significativamente la proporción de pacientes curados. Si se desea abatir la mortalidad por estas neoplasias es necesario emprender medidas de salud publica dirigidas a su prevención y diagnóstico temprano.

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

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

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

Squamous cell carcinoma of the oro- and hypopharynx

One hundred and forty three patients with inoperable squamous cell carcinoma of the oro- and hypopharynx were seen in the Radiotherapy and Oncology department, Faculty of Medicine, University of Alexandria from January 1985 to December 1989. The median age was 51 years, and the male to female ratio was 1.38: 1. Patients with hypopharyngeal carcinomas constituted 74% of the series. The overall response to radiotherapy was 82%, with 47% complete responders. The clinical stage and radiation dose had a prognostic value in determining the response to radiation. Chemotherapy was used in 45 cases after failure of radiotherapy with partial response in 8 cases. The responses were of short duration. The median survival was 6 months in the whole series. Late stages, poorly differentiated tumors, and inadequate doses of irradiation were associated with a worse prognosis and short survival

What has changed in the management of oropharyngeal cancer in the past twenty years?

Novas técnicas de diagnóstico que permitem delimitaçäo mais precisa do tumor primátrio e das metástases regionais, exame sob anestesia e pan-endoscopia de rotina säo essenciais no planejamento terapêutico. Lesöes precoces podem ser tratadas com sucesso tanto pela cirurgia quanto pela radioterapia . Todavia lesäo avançadas requerem combinaçäo de trtamentos agressivos, para oferecer alguma esperança de cura. Com o objetivo de melhorar a resposta terapêutica as irradiaçöes, novas alternativas, tais como hiperfracionamento e hipertermia, têm sido investigadas. Todas essas técnicas permanecem näo comprovadas e controversas. Indubitavelmente, os avanços mais importantes ocorreram no tratamento cirúrgico destes cânceres. Além disso, as técnicas de reconstruçäo tornaram-se mais sofisticadas. O uso de agentes quimioterápicos como adjuvantes a cirurgia e radioterapia continua a ser objetivo de interesse, embora näo existam evidências definitivas de que possa influenciar os resultados a longo prazo. O estabelecimento de clínicas multidisciplinares foi o mais significante avanço obtido nas duas últimas décadas