Predictors of functional decline in locally advanced head and neck cancer patients from south Brazil.

BACKGROUND: Functional decline in Brazilian patients with head and neck squamous cell carcinoma (HNSCC) is associated with impaired recovery, quality of life, and health care costs. METHODS: Sixty patients enrolled at the regional oncology center in Curitiba, Brazil, were assessed over 6 months for toxicities, nutritional status, anthropometry, fatigue, stress, and functionality. RESULTS: Severe mid-arm and mid-calf circumference depletion accompanied weight loss. Total fatigue score increased 64% (p < .001), as did perceived stress and serum cortisol (p = .01). Instrumental activities of daily living (IADL) dependence doubled, and activities of daily living (ADL) dependence quadrupled (p < .001). Difficulty chewing or swallowing, weight loss, fatigue, perceived stress, and IADL dependence accounted for 48.2% of ADL dependence. CONCLUSIONS: The physical and psychological impact of HNSCC and its treatment are universally experienced; yet, screening and intervention for symptoms such as fatigue and stress are not typical clinical practice. Moreover, assessment of functional status is usually limited to chewing and swallowing. This study identified symptoms that require systematic intervention and randomized trials with functional independence as the outcome.

Accuracy, sensitivity and specificity of fine needle aspiration biopsyin salivary gland tumours: A retrospective study

Objective: The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needleaspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the courseof a four year period. Study design: A retrospective study was carried out between 2001-2005 to review thecases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosedduring post-operative histopathology examination. Results: A total of 106 cases of salivary gland tumours wereconsidered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. Thesensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in whichFNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22),specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negativepredictive value was 87.7% (50/57). Conclusions: Despite the high rate of inadequate samples obtained in theFNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity (AU)

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Accuracy, sensitivity and specificity of fine needle aspiration biopsy in salivary gland tumours: a retrospective study.

OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needle aspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the course of a four year period. STUDY DESIGN: A retrospective study was carried out between 2001-2005 to review the cases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosed during post-operative histopathology examination. RESULTS: A total of 106 cases of salivary gland tumours were considered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. The sensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in which FNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22), specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negative predictive value was 87.7% (50/57). CONCLUSIONS: Despite the high rate of inadequate samples obtained in the FNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity.

Endoscopia de contato (microestomatoscopia) nas lesões da boca e do lábio: avaliação do método / Contact endoscopy (microstomatoscopy) in oral lesions: evaluation of the method

OBJETIVO: Descrever as dificuldades da endoscopia de contato aplicada à boca e ao lábio (microestomatoscopia de contato) e aplicar nas lesões do lábio os critérios usados na endoscopia de contato de outras topografias. MÉTODO: Estudo prospectivo utilizando o endoscópio de contato Storz 8715A e o corante azul de toluidina. Vinte exames foram feitos para aprendizado da técnica e depois mais 31 (21 lesões do lábio e 10 da boca), todos exames in vivo. Os critérios avaliados foram: Celularidade, Arquitetura, Estratificação e Morfologia. RESULTADOS: A falta de nitidez, os tremores finos e o deslizamento do aparelho dificultaram o procedimento em 100 por cento dos casos, mas permitiram um exame adequado. Os 13 diagnósticos de malignidade das lesões do lábio apresentaram todos os critérios alterados. CONCLUSÃO: as dificuldades encontradas foram o contato do aparelho com a superfície anatômica, o deslizamento do aparelho, os tremores finos e a falta de nitidez da imagem, que não inviabilizaram a realização e a interpretação do exame. Os critérios são aplicáveis às lesões da boca e do lábio inferior.

BACKGROUND: 1- To describe difficulties of contact endoscopy related to mouth and lip (contact microstomatoscopy) and 2- apply the criteria used in contact endoscopy of other topographies when lip lesions are diagnosed. METHODS: A prospective study was performed with the contact endoscope Storz 8715A and toluidine blue was used. Twenty examinations were accomplished in order to learn the technique; after that, other 31 were included (21 lip lesions and 10 oral lesions), all in vivo examinations. The criteria assessed were: cellularity, architecture, stratification and morphology. RESULTS: Lack of image clearness, slight tremors and sliding of the equipment made the procedure difficult in 100 percent of the cases; even though, accomplishment of proper examination was obtained. The 13 cases of lip malignancy lesions had the criteria altered as a whole. CoNCLUSION: Difficulties found were the contact of the equipment with anatomic surface, the sliding of the equipment, the slight tremors, and the lack of image clearness. Nevertheless, such elements did not interrupt the accomplishment and the examination analysis. The criteria are applied to oral and lower lip lesions.

Analysis of prognostic factors in patients with oropharyngeal squamous cell carcinoma treated with radiotherapy alone or in combination with systemic chemotherapy.

OBJECTIVE: To assess the prognostic significance of several factors in oropharyngeal squamous cell carcinoma treated with radiotherapy alone or in combination with chemotherapy. DESIGN: Retrospective study. SETTING: Erasto Gaertner Hospital, Curitiba, Brazil, and A. C. Camargo Hospital, São Paulo, Brazil. PATIENTS: A total of 361 patients treated for squamous cell carcinoma from January 1, 1990, to December 31, 2001. INTERVENTIONS: Radiotherapy alone or with chemotherapy. MAIN OUTCOME MEASURES: Disease-free survival, overall survival, and treatment response. RESULTS: Most tumors were located at the tonsil (46.8%) or base of the tongue (28.0%) and were at clinical stage III or IV (92.8%). Treatment response was associated with Zubrod scale score, weight loss, number of comorbidities, symptom-severity and Piccirillo stages, hemoglobin level, tumor site, macroscopic appearance of the tumor, and clinical stage. The 5-year overall survival rate was 17.6% and disease-free survival rate was 16.2%. The significant prognostic variables were age; Zubrod scale score; weight loss; comorbidities; Berg, Piccirillo, and symptom-severity staging; involvement of adjacent soft-tissue areas and bone; lymph node mobility; clinical stage; and radiotherapy doses. The multivariate analysis showed Zubrod scale score, symptom-severity staging system, Berg staging system, comorbidities, and radiotherapy dose as independent prognostic factors. CONCLUSION: A combination of clinical factors, such as symptoms, patients' general status, weight loss, and comorbidities, leads to a relevant stage of clinical severity that can be associated with the TNM stage as predictors of survival in oropharyngeal carcinoma.

Looking Beyond Tobacco and Alcohol: The Role of Lifestyle and Other Environmental Risk Factors for Laryngeal Cancer

Laryngeal cancer incidence in São Paulo, Brazil, is one of the highest in the world. OBJECTIVE: This hospitalbasedcase-control study was designed to investigate exposure-disease relationship between larynx cancer andsmoking and drinking history, diet, occupational exposures and other characteristics. MATERIAL ANDMETHODS: The study was conducted in 3 metropolitan areas in Brazil: São Paulo (South-east), Curitiba (South)and Goiânia (Central-west). We have analyzed information on demographics, occupational history, environmental exposures, tobacco smoking and alcoholdrinking habits obtained from interviews with 194 cases and 804 controls (non-cancer inpatients) matched on 5-year age group, gender, hospital catchments area, and trimester of admission. RESULTS: Tobacco and alcohol consumption were the most important factors for prediction of laryngeal cancer. Other important riskfactors were indoor exposure to wood stove fumes (RR=2.6), woodworking (RR=1.9), family history of cancer(RR=2.1), and high consumption of coffee and “chimarrão”(a kind of maté tea ). There was a protective effect for the consumption of citric fruits and forcarotene-rich vegetables. CONCLUSION: regionally specific lifestyle (“chimarrão”, high consumption of woodworking, and family history of cancer may be responsible for a substantial proportion of incidentlaryngeal cancer cases.

Predictive factors for diagnosis of advanced-stage squamous cell carcinoma of the head and neck.

OBJECTIVE: To identify the predictive factors (with emphasis on diagnostic delay) associated with the diagnosis of an advanced-clinical stage head and neck cancer. DESIGN: Cross-sectional study of patients with head and neck cancer originally recruited for a case-control study. SETTING: Three referral oncological centers in metropolitan areas in southern Brazil: São Paulo, Curitiba, and Goiânia. PATIENTS: The study population comprised 679 patients recently diagnosed as having a previously untreated head and neck squamous cell carcinoma. MAIN OUTCOME MEASURE: Diagnosis of advanced disease (clinical stage III-IV) head and neck cancer. RESULTS: Patients with laryngeal and hypopharyngeal cancers were more likely to be diagnosed as having advanced disease than those with lip, oral, and oropharyngeal cancers (88.0% vs 74.6%) (P<.001). Patient delay was inversely associated with clinical stage at diagnosis in patients with the same cancers, while professional delay was directly associated with a higher risk of advanced clinical stage at diagnosis (P =.001 and P =.006, respectively). In the analysis of laryngeal and hypopharyngeal cancer, both patient and professional delays were associated with advanced disease, with patient delay being a stronger predictive factor than professional delay. CONCLUSIONS: Clinical stage at diagnosis was associated with sociodemographic characteristics, patient delay, and professional delay. Our results indicate that continued educational programs for the population and health care professionals regarding the identification of early symptoms of head and neck cancers are warranted.

Centro de diagnóstico de lesöes bucais: potencial impacto na epidemiologia do câncer de boca em Curitiba / Oral cavity lesions diagnostic center: potential impact in oral cancer epidemiology in Curitiba

Devido à importância do câncer de boca na regiäo de Curitiba, correspondendo ao sexto tumor de maior freqüência nos homens e oitavo nas mulheres, associado ao fato de que 60 por cento de todos os casos säo diagnosticados em estágios avançacos, foi criado o Centro de Diagnóstico de Lesöes Bucais - CDLB pela Secretaria Municipal da Saúde (SMS) de Curitiba. Este estudo apresenta os resultados iniciais das atividades deste centro

Ameloblastomas: análise de 43 casos / Ameloblastomas: analysis of 43 cases

Foi revisada a experiência multi-institucional dos autores nessa doença rara, enfatizando seu tratamento e resultado

Tratamento conservador do câncer de mama / Conservative treatment of cancer of the breast

Ha muito tempo vem-se tantando encontrar uma alternativa para o tratamento do cancer de mama diferente da cirurgia radical proposta por Halsted em 1890. Muitas formas de cirurgia conservadora foram desenvolvidas com esta finalidade. A eficacia de seu emprego ainda tem sido muito discutida,porem ha estudos que demonstram inexistir diferenca de sobrevida entre as pacientes com tratamento conservador e radical. Parece haver, contudo, maior incidencia de recidiva local nas pacientes tratadas conservadoramente