O tratamento das recidivas loco-regionais no carcinoma epidermoide de laringe / The treatment of loco-regional relapses of the larynx squamous cell carcinoma

RESUMO

Introdução: O carcinoma epidermoide de laringe apresentou aumento da indicação de tratamento radioterápico nos tumores de estádios clínicos avançados (III e IV), especialmente a partir de 1990. Objetivo: Avaliar as recidivas e a sobrevida livre de doença dos tumores de laringe submetidos a cirurgia de resgate. Métodos: Estudo de 78 recidivas loco-regionais no período de 1996 a 2004, sendo o tratamento inicial com cirurgia e radioterapia em 14 (21,8%) casos, cirurgia exclusiva em 17 (18%) e radioterapia e/ou quimiorradioterapia em 47 (60,2%). Quanto ao estádio clínico, quatro eram I, cinco II, 15 III e 47 IV. Sete pacientes com diagnóstico de recidiva peritraqueostoma exclusiva foram excluídos da classificação TNM. Em relação ao gênero, 71 (89,9%) eram masculinos e sete (10,1%) femininos, com idade média de 57,5 anos. Resultados: Das 78 recidivas, 21 foram submetidos à cirurgia de resgate. O intervalo de mediana do diagnóstico das 52 recidivas loco-regionais, com exclusão dos 26 pacientes com persistência da doença ao final da radioterapia, foi de 456 dias. Das recidivas submetidas à cirurgia de resgate, 13 foram locais, sete regionais, incluindo dois casos de peritraqueostomas isoladas e uma loco-regional. Nas 13 recidivas locais, 10 pacientes foram irradiados previamente e nas recidivas regionais, dois foram irradiados previamente e cinco operados. A sobrevida global foi de 54% e a sobrevida livre de doença a cinco anos de 55%. Conclusões: O diagnóstico das recidivas foi realizado mais precocemente em pacientes submetidos a cirurgia previamente. Um número limitado de recidivas foram passíveis de cirurgia de resgate com índice de sobrevida livre de doença a cinco anos promissor, especialmente nos pacientes irradiados previamente.

ABSTRACT

Introduction: The squamous cell carcinoma of the larynx had an increased for radiotherapy indication in advanced stages (III and IV) specially after 1990. Objective: To evaluate the recurrences and free disease survival on patients who underwent to salvage surgery for recurrent larynx carcinoma. Methods: Study of the charts of 78 cases with larynx carcinoma recurrences from 1996 to 2004. The initial treatment was surgery with postoperative radiotherapy in 14 cases (21.8%); surgery alone in 17 cases (18%) and chemoradiation of isolated radiation therapy in 47 cases (60.2%). The clinical stage of the cases was I in four cases, II in five cases, III in 15 cases and IV in 47 cases. Seven patients with diagnosis of peritracheostomal recurrences. Most of cases 89.9% were male and the mean age was 57.7 years. Results: 21 underwent salvage surgery. The mean interval of diagnosis interval of 52 locoregional recurrences (excludingthe 26 cases with persistent/residual disease) was 456 days. Among the recurrences submitted to salvage surgery, 13 were local, seven regional (including two cases of isolated peritracheostomal recurrences) and one was locoregional. Of the 13 local recurrences, 10 were previously irradiated and in regional recurrences, two were irradiated and five submitted to previous surgery. The overall survival in salvaged cases was 54% and the free disease rate in five years was 55%. Conclusions: The diagnosis of recurrence was reached earlier in patients who underwent surgery than in patients submitted to radiation therapy. A limited number of patients can be successfully submitted to salvage surgery, especially among the irradiated ones.