ABSTRACT
Introdução: O tratamento do câncer de laringe ébastante controverso. Neste trabalho, o objetivo é avaliar astendências brasileiras no tratamento do câncer de laringe.Material e Métodos: Pesquisa realizada através deresposta a questionário de múltipla escolha idealizado peloINCa-MS-RJ e aplicado a cirurgiões de cabeça e pescoço.Resultados: Os cirurgiões entrevistados tiveramcomo principais indicações: para tumores T1a glóticos 48,3%indicaram radioterapia, em tumores glóticos estágio T1b43,7% indicaram laringectomia fronto-anterior ou frontolaterale 21,9% laringectomia supracricóidea. Em tumoresglóticos T2 48,3% indicaram laringectomia supracricóidea.Nos pacientes com tumores T1 e T2 supraglóticos54,1% indicaram radioterapia e 79,41% laringectomiasupraglótica, respectivamente. Em tumores T3 glóticos(aritenóide móvel, com prega vocal fixa), 64,4% indicaramlaringectomia supracricóidea. Nos casos de tumores T3glóticos (aritenóide fixa, com corda vocal fixa), 45,4%responderam que indicariam a laringectomia near-total. Emcasos de tumores T4, 88,5% dos entrevistados indicaramlaringectomia total associada à radioterapia adjuvante. Notratamento das cadeias linfáticas, 84,8% indicaramlinfadenectomia dos níveis II, III e IV em pacientes N0 eapenas 46% esvaziam bilateralmente ao realizarlaringectomia total. Para tumores T1N0 supraglóticos 63,2%indicam esvaziamento cervical e 78,2% fazem-nobilateralmente. Conclusão: O tratamento preferencial para o câncerde laringe no Brasil segue o que se considera o padrão ouro,ou seja, pacientes com tumores iniciais têm como principalindicação a radioterapia ou a cirurgia endoscópica e, noscasos de tumores avançados, a laringectomia total associadoà radioterapia. Há uma tendência de maior indicação decirurgias parciais/subtotais para o tratamento de pacientescom tumores de laringe avançados selecionados.
Introduction: The treatment of laryngeal cancer is still a matter of controversy. In this work, our aim is to evaluate the Brazilian trends on the treatment of those patients. Methods: A multiple choice questionnaire made by Inca-MS-RJ, was applied to Brazilian Head and Neck Surgeons. Questions were made regarding the treatment options for laryngeal squamous cell carcinoma. Results: Surgeons who were interviewed had the following main indications: for T1a glottic tumors, 48.3% of surgeons indicated radiotherapy and for T1b glottic tumors treatment, 43.7% indicated frontoanterior laryngectomy or frontolateral laryngectomy, and 21.9% supracricoid laryngectomy. For T2 glottic tumors 48.3% of surgeons indicated supracricoid laryngectomy. For supraglottic tumors, the main treatment was radiotherapy for T1 stage (54.1% of surgeons) and supraglottic laryngectomy for T2 stage (79.41% of surgeons). The majority of surgeons (64.4%) indicated supracricoid laryngectomy for T3 glottic tumors (mobile arytenoid, with fixed vocal cord) and when the T3 glottic tumors had fixed arytenoid, with fixed vocal cord, the main option was the near-total laryngectomy (45.4%). For T4 tumors, 88.5% of surgeons indicated total laryngectomy plus adjuvant radiotherapy. For the neck treatment, 84.8% of surgeons indicated neck dissection in levels II, III and IV in N0 patients and only 46% indicated bilateral neck dissection when total laryngectomy was indicated. More than 60% of surgeons indicated neck dissection to T1N0 supraglottic tumors, and 78.2% of them indicated bilateral neck dissection in these cases. Conclusion: The preferencial treatment of larynx cancer in Brazil follows what we consider gold standard, that is, patients with inicial tumors have as main indication radiotherapy or endoscopic surgery with or without laser. In the cases of advanced tumors total laryngectomy plus adjuvant radiotherapy is the most commonly used in Brazil. There is a tendency of a higher indication of partial/subtotal surgeries for the treatment of patients with selected advanced larynx tumors.
