Impact of COVID-19 pandemic among patients with lung and head and neck cancer assisted in a public cancer center in Brazil.

BACKGROUND: There is no updated national data regarding the real impact of the COVID-19 pandemic on delaying diagnosis and treatment among patients with lung, and head, and neck cancers in Brazil. This study aimed to analyze the COVID-19 pandemic impact on cancer diagnosis and clinical outcomes among lung, head, and neck cancer patients assisted in a tertiary cancer center in Southeastern Brazil, as well as to analyze these patients' pretreatment clinical features. METHODS: Retrospective cohort of patients with lung or head and neck cancer assisted in a tertiary cancer center in southeastern Brazil between January/2019 and December/2021. To assess statistical differences among groups [i.e., cohort 2019 versus (vs.) 2020 and 2019 vs. 2021] chi-square test was used with a 5% significance level and 90% power for sample size calculation. Differences among baseline clinical features and sociodemographic characteristics were evaluated either by T-test for two samples or Fisher's or Pearson's chi-square test (for quantitative or qualitative variables). All utilized tests had a 5% significance level. RESULTS: Six hundred fifty-two patients were included, 332 with lung and 320 with head and neck cancer; it was observed a significant decrease in oncologic treatment recommendations and increase in palliative care recommendation for patients with lung cancer, despite similar stages at diagnosis. During the COVID-19 pandemic, more pain symptoms were reported at the first Oncology assessment for patients with head and neck cancer (p < 0.05). Compared to 2019, head and neck cancer patients diagnosed in 2021 presented a worse initial performance status (p = 0.008). There was a statistically significant increase in survival for patients diagnosed with head and neck cancer in 2021 when compared to 2019 (p = 0.003). CONCLUSIONS: This research highlights low survival rates for patients with lung and head and neck cancer in Brazil, even before the pandemic started, as consequence of advanced diseases at diagnosis at the public health system and clinical degrading features. Additionally, there was an increase incidence in both lung cancer and head and neck cancer despite no differences in clinical stage. This reflects how fragile is the public healthcare system even before facing an acute public health crisis such as the COVID-19 pandemic. Yet, the total impact on public health may follow for many years.

The Fundamental Role of Multidisciplinary Approach in Complex Head and Neck Pathology: A Case Report of Maxillary Adenoid Cystic Carcinoma.

Adenoid cystic carcinoma (ACC) is a rare tumor, with a documented annual incidence ranging from 3 to 4.5 cases per million. It constitutes approximately 1% of all head and neck malignancies and around 10% of salivary gland tumors. It is imperative to adopt a multidisciplinary approach to ensure the most appropriate therapeutic outcome. Treatment strategies usually involve a multidisciplinary approach and may include surgery, radiotherapy, chemotherapy, or various combinations of these. In this context, we present a clinical case of ACC originating in the palate of a woman. Throughout this article, we will detail the diagnostic challenges and multidisciplinary treatment strategies implemented, emphasizing the importance of a comprehensive approach in cases of palatal ACC. In addition, we will discuss the rehabilitation process and the outcomes observed during the follow-up of this case.

Repurposing NFκB and HDAC inhibitors to individually target cancer stem cells and non-cancer stem cells from mucoepidermoid carcinomas.

Drug resistance remains a major obstacle in the treatment of mucoepidermoid carcinomas (MEC) leading to tumor recurrence, disease progression, and metastasis. Emerging evidence suggests that drug resistance is mediated by the presence of a highly adaptative subpopulation of cancer cells known as cancer stem cells (CSC). We have previously reported that solid tumors use NFkB signaling as a chemotherapy-resistant mechanism. We have also shown that interfering with the epigenome of solid tumors is an effective strategy to control the population of CSC. Here, we sought to investigate the effects of the NFkB inhibitor emetine and the HDAC inhibitor SAHA on the biology of MEC CSC and assessed whether this combination therapy would favor the standard of care therapy comprised of the administration of Cisplatin (CDDP). Our findings suggested that the administration of low concentrations of emetine and SAHA is more effective in disrupting CSC in MEC, while the administration of emetine in combination with CDDP constitutes an effective therapy to target non-CSC MEC tumor cells.

Seguridad y factibilidad de la reconstrucción microquirúrgica en tumores de cabeza y cuello en pacientes mayores de 70 años / Safety and feasibility of free-flap reconstruction in head and neck tumors in patients aged 70 years or older

RESUMEN Antecedentes: debido al aumento en la expectativa de vida, se ha incrementado la incidencia de tumores de cabeza y cuello en pacientes añosos. Objetivo: evaluar los resultados de la reconstrucción con colgajos microquirúrgicos luego de la resección radical (RRMC) de tumores de cabeza y cuello en pacientes de 70 años o mayores. Material y métodos: se analizó una serie de pacientes sometidos a RRCM por tumores de cabeza y cuello en el período 2000-2020. Se dividió la muestra en dos grupos: G1: ≥ de 70 años y G2: < de 70 años. Se analizaron variables demográficas, quirúrgicas, posoperatorias y factores de riesgo de trombosis del colgajo en los pacientes ≥ de 70 años. Resultados: se incluyó un total de 178 pacientes, 61 en G1 y 117 en G2. Ambos grupos fueron homogéneos respecto del sexo, IMC (índice de masa corporal), alcoholismo, tabaquismo, tratamiento neoadyuvante e incidencia de HPV (virus del papiloma humano). Hubo mayor cantidad de pacientes con riesgo ASA ≥ III en G1 vs. G2; (p: 0,005). En G1, 33 (54%) correspondieron a estadio oncológico ≥ III vs. 99 (87%) en G2 (p: 0,001). Cuarenta y dos (69%) pacientes en G1 recibieron adyuvancia vs. 94 (83%) en G2 (p: 0,02) y no hubo diferencias en la morbimortalidad global y en fallas del colgajo. El sexo femenino fue el único factor de riesgo de trombosis del pedículo vascular (p: 0,05). Conclusión: la RRCM para tumores de cabeza y cuello es factible y segura en pacientes añosos, con una incidencia de morbimortalidad similar a la del resto de la población.

ABSTRACT Background: The higher life expectancy has increased the incidence of head and neck tumors in elder patients. Objective: the aim of this study was to evaluate the outcomes of free flap reconstructions after radical resection (FFRR) of head and neck tumors in patients aged 70 years or older. Material and methods: We analyzed a series of patients undergoing FFR due to head and neck tumors between 2000-2020. The patients were divided into two groups: G1: ≥ 70 years, and G2: < 70 years. The demographic, operative and postoperative variables and the risk factors for flap thrombosis in patients ≥ 70 years were analyzed. Results: A total of 178 patients were included, 61 in G1 and 117 in G2. Both groups were homogeneous regarding sex, BMI (body mass index), alcohol consumption, smoking habits, neoadjuvant treatment, and incidence of HPV (human papillomavirus). The incidence of ASA grade ≥ III was significantly higher in G1 vs. G2; (p: 0,005). In G1, 33 patients (54%) corresponded to cancer stage ≥ III vs. 99 (87%) in G2 (p: 0.001). Forty-two (69%) patients in G1 received adjuvant therapy vs. 94 (83%) in G2 (p = 0.02) and there were no differences in overall morbidity and mortality and in flap failure. Female sex was the only predictor of vascular flap thrombosis (p = 0.05). Conclusion: FFRR in head and neck tumors is feasible and safe in elderly patients, with morbidity and mortality rates similar to those of the general population.

Oral squamous cell carcinoma cancer stem cells have different drug sensitive to pharmacological NFκB and histone deacetylation inhibition.

Despite many progresses in the development of new systemic therapies for oral squamous cell carcinoma (OSCC), the five-year survival rate of OSCC is low. The traditional chemotherapies approach (cisplatin - CDDP) shows some limitations like drug toxicity, limited efficacy, and drug resistance. Promising studies suggested OSCC cancer stem cells (CSC) presented resistance to CDDP. We have previously studied many targets, and we extensively showed the efficacy of the NFκB signaling and the role of histones acetylation, on different malignant tumors, including adenoid cystic carcinoma and mucoepidermoid carcinoma, but until then the effects of the NFkB inhibitor and histone deacetylase (HDAC) inhibitor on the biology of OSCC were not evaluated. Here we assessed the pharmacological inhibitor of NFκB emetine and HDAC inhibitor SAHA on the behavior of CSC derived from OSCC. Our data suggested that CDDP administration resulted in reduced viability of bulk OSCC cells and increased CSC. A single and isolated shot of emetine and SAHA were able to disrupt CSC by inhibiting the NFκB pathway and increasing the histone acetylation levels, respectively. Further, the combined administration of emetine and SAHA presented the same CSC disruption as seen in emetine alone.

Comprehensive Molecular Landscape of Cetuximab Resistance in Head and Neck Cancer Cell Lines.

Cetuximab is the sole anti-EGFR monoclonal antibody that is FDA approved to treat head and neck squamous cell carcinoma (HNSCC). However, no predictive biomarkers of cetuximab response are known for HNSCC. Herein, we address the molecular mechanisms underlying cetuximab resistance in an in vitro model. We established a cetuximab resistant model (FaDu), using increased cetuximab concentrations for more than eight months. The resistance and parental cells were evaluated for cell viability and functional assays. Protein expression was analyzed by Western blot and human cell surface panel by lyoplate. The mutational profile and copy number alterations (CNA) were analyzed using whole-exome sequencing (WES) and the NanoString platform. FaDu resistant clones exhibited at least two-fold higher IC50 compared to the parental cell line. WES showed relevant mutations in several cancer-related genes, and the comparative mRNA expression analysis showed 36 differentially expressed genes associated with EGFR tyrosine kinase inhibitors resistance, RAS, MAPK, and mTOR signaling. Importantly, we observed that overexpression of KRAS, RhoA, and CD44 was associated with cetuximab resistance. Protein analysis revealed EGFR phosphorylation inhibition and mTOR increase in resistant cells. Moreover, the resistant cell line demonstrated an aggressive phenotype with a significant increase in adhesion, the number of colonies, and migration rates. Overall, we identified several molecular alterations in the cetuximab resistant cell line that may constitute novel biomarkers of cetuximab response such as mTOR and RhoA overexpression. These findings indicate new strategies to overcome anti-EGFR resistance in HNSCC.

Cephaeline is an inductor of histone H3 acetylation and inhibitor of mucoepidermoid carcinoma cancer stem cells.

AIM: To evaluate the potential use of Cephaeline as a therapeutic strategy to manage mucoepidermoid carcinomas (MEC) of the salivary glands. MATERIAL AND METHODS: UM-HMC-1, UM-HMC-2, and UM-HMC-3A MEC cell lines were used to establish the effects of Cephaeline over tumor viability determined by MTT assay. In vitro wound healing scratch assays were performed to address cellular migration while immunofluorescence staining for histone H3 lysine 9 (H3k9ac) was used to identify the acetylation status of tumor cells upon Cephaeline administration. The presence of cancer stem cells was evaluated by the identification of ALDH enzymatic activity by flow cytometry and through functional assays using in vitro tumorsphere formation. RESULTS: A single administration of Cephaeline resulted in reduced viability of MEC cells along with the halt on tumor growth and cellular migration potential. Administration of Cephaeline resulted in chromatin histone acetylation as judged by the increased levels of H3K9ac and disruption of tumorspheres formation. Interestingly, ALDH levels were increased in UM-HMC-1 and UM-HMC-3A cell lines, while UM-HMC-2 showed a reduced enzymatic activity. CONCLUSION: Cephaeline has shown anti-cancer properties in all MEC cell lines tested by regulating tumor cells' viability, migration, proliferation, and disrupting the ability of cancer cells to generate tumorspheres.

Tumores malignos de cabeza y cuello en pacientes pediátricos / Malignant head and neck tumors in pediatric patients

Introducción: Los tumores malignos de cabeza y cuello incluyen varios subtipos histológicos y el pronóstico depende de su ubicación anatómica. Objetivo: Describir las características clínicas y el tratamiento de pacientes pediátricos con tumores malignos de cabeza y cuello. Métodos: Estudio descriptivo, longitudinal y retrospectivo realizado en el servicio de Oncopediatría del Instituto Nacional de Oncología y Radiobiología, desde el 1ro. de enero de 2005 al 31 de diciembre de 2017. Se registraron variables demográficas, clínicas y terapéuticas. Se identificaron los pacientes a partir de las bases de datos del registro hospitalario del citado instituto. Se seleccionaron todos los pacientes con tumores de cabeza y cuello que tuvieron diagnóstico histológico. Resultados: Se identificaron 73 pacientes, con ligero predominio del sexo femenino (60,3 por ciento), con una edad media de 12 años (rango entre 0 y 18 años). El tipo histológico más frecuente fue el carcinoma tiroideo (35,6 por ciento), seguido de los rabdomiosarcomas (27,3 por ciento). El tratamiento más utilizado fue la cirugía (38,3 por ciento) seguido de la combinación de cirugía más radioterapia y quimioterapia (22,0 por ciento). Conclusiones: El tumor maligno de cabeza y cuello más frecuente en pacientes pediátricos es el carcinoma tiroideo. El tratamiento de elección es la resección total, acompañado de radioterapia y quimioterapia, dependiendo del tipo histológico y la etapa clínica(AU)

Introduction: Malignant tumors of the head and neck include several histological subtypes and the prognosis depends on their anatomical location. Objective: To describe the clinical characteristics and treatment of patients diagnosed with malignant head and neck tumors. Methods: A descriptive, longitudinal and retrospective study was carried out from January 1, 2005 to December 31, 2017 at the Oncopediatrics service in the National Institute of Oncology and Radiobiology, according to demographic, clinical and therapeutic variables. Patients were identified from the databases of the hospital registry of the above mentioned institute. All patients with head and neck tumors that had a histological diagnosis were selected. Results: 73 patients were identified, with a slight predominance of females (60.3 percent), with a mean age of 12 years (range between 0 and 18 years). The most frequent histological type was thyroid carcinoma (35.6 percent), followed by rhabdomyosarcomas (27.3 percent). The most used treatment was surgery (38.3 percent) followed by the combination of surgery plus radiotherapy and chemotherapy (22 percent). Conclusions: Tumors of the head and neck are infrequent. The treatment of choice is total resection, accompanied by radiotherapy and chemotherapy, depending on the histological type and the clinical stage(AU)

Respuesta al tratamiento radioterápico en pacientes con tumores malignos de cabeza y cuello / Response to radiotherapy treatment in patients with head and neck malignant tumors

Introducción: La radioterapia es una de las variantes de tratamiento más antiguas con que contamos hoy día para curar los pacientes afectos de neoplasias malignas, pero debe ser cuidadosamente seleccionada en pacientes pediátricos. Objetivo: Evaluar la respuesta al tratamiento radiante en niños con tumores de cabeza y cuello. Métodos: Se realizó un estudio descriptivo, retrospectivo lineal, donde se incluyeron 26 pacientes ingresados en el Servicio de Oncocirugía del hospital William Soler desde enero de 2000 a enero de 2013, con diferentes tipos de tumores malignos de cabeza y cuello y edades comprendidas entre 1 y 18 años. Se tuvieron en cuenta los efectos tóxicos a largo plazo del tratamiento radiante, asociado o no a tratamiento quimioterápico adyuvante o concurrente y a la cirugía. Resultados: Todos los pacientes recibieron radioterapia corporal externa, el 73,1 por ciento de los casos recibió quimioterapia adyuvante en su mayoría con diagnóstico de linfomas y 7,7 por ciento recibió quimioterapia concurrente. Esta última en dos pacientes: uno con sarcoma facial y otro con carcinoma de parótida. Cinco pacientes (19,2 por ciento) solo recibieron cirugía y radioterapia como tratamiento: dos casos con neuroblastoma, un caso con sarcoma facial y dos con hemangiopericitomas. Conclusión: El estudio demostró la gran utilidad del empleo de la radioterapia en el control de las enfermedades malignas de la infancia localizadas en cabeza y cuello(AU)

Introduction: Radiotherapy is one of the oldest treatments used nowadays for curing patients suffering from malignant neoplasias, but it must be carefully selected in pediatric patients. Objective: To evaluate the response of radiotherapy treatments in children with head and neck tumors. Methods: A descriptive, lineal retrospective study was carried out, in which were included 26 patients admitted in the Service of Oncosurgery of William Soler Hospital from January, 2000 to January, 2013. These patients presented different kinds of head and neck malignant tumors; their ages were among 1 and 18 years. The long term toxic effects of radiotherapy were taken into account, being those associated or not to concurrent or adyuvant chemotherapy, and to surgery. Results: All the patients received physical external radiotherapy. 73,1 percent of the cases (most of them with a diagnosis of lymphoma) received adyuvant chemotherapy and 7,7 percent had concurrent chemotherapy. This last one in two patients: one with facial sarcoma and the other one with parotid carcinoma. Just five patients (19.2 percent) had surgery and radiotherapy as treatment: two cases with neuroblastoma, one case with facial sarcoma, and two cases of hemangiopericytomas. Conclusions: This study has demonstrated the usefulness of radiotherapy in the control of head and neck malignant diseases in children(AU)

Gastrostomía endoscópica: técnicas básicas, técnicas nuevas, errores semánticos y sugerencias para una clasificación coherente / Endoscopic gastrostomy: basic techniques, new techniques, semantic errors and suggestions for a coherent classification

The use of the term “direct technique” to refer to a modified introducer-type technique; to call the “introducer technique” “push technique”, or the “push technique” “Seldinger technique” are the most common semantic errors we make when classifying endoscopic gastrostomy techniques. The sole criterion we consider appropriate for the classification of these techniques is the access used for the gastrostomy tube, which can be transoral or transabdominal. Gauderer transoral technique (pull-technique) is the most popular globally because it simple, successful, the procedure is shorter, less traumatic and less expensive. Transabdominal techniques, such as “introducer” and “combined techniques” help to prevent wound contamination, tumour spreedingin patients with head and neck tumors, and esophageal tear in low weight newborn babies. These techniques shall be implemented and taught in Endoscopy Centers. The other techniques described are just variations of the basic techniques.

Usar el término “direct technique” para referirse a una técnica “introducer modificada”, llamar técnica “push” a la técnica “introducer” o “Seldingertechnique” a la técnica “push” son los errores semánticos que se cometen con más frecuencia cuando se intenta clasificar las técnicas de la gastrostomía endoscópica. El único criterio que nos parece adecuado para clasificar las técnicas es la vía de acceso de la sonda que puede ser transoral y transabdominal. La técnica transoral por tracción de Gauderer (pull-technique) es la más popular en el mundo por ser simple, exitosa, más breve, menos traumática y menos costosa. Las técnicas transabdominales como “introducer” y las “técnicas combinadas” ayudan a prevenir la contaminación de la herida, la siembra tumoral en pacientes con tumores de cabeza y cuello, y el desgarro esofágico en recién nacidos de bajo peso. Estas técnicas debieran implementarse y enseñarse en los centros de endoscopia. Las otras técnicas descritas son sólo variaciones de las técnicas básicas.

Estratégias em reconstruções complexas do couro cabeludo e da fronte: uma série de 22 casos / Strategies in complex reconstructions of the scalp and forehead: a series of 22 cases

INTRODUÇÃO: A região cefálica está exposta a insultos de ordem variada por parte do meio ambiente. As lesões extensas no couro cabeludo representam um grande desafio ao cirurgião plástico devido à pouca mobilidade da pele nesta região, o que dificulta o seu fechamento. Uma grande variedade de técnicas tem sido utilizada para o fechamento de defeitos no couro cabeludo e na fronte. A técnica ideal deve visar o melhor resultado funcional, estético e baixa morbidade do sítio doador. MÉTODOS: Foi realizado um estudo clínico retrospectivo no período de janeiro de 2006 a dezembro de 2014, de uma série de 22 casos com tumores avançados do couro cabeludo e da fronte e perda cutânea extensa pós-trauma. RESULTADOS: Foram realizados 11 retalhos locais de couro cabeludo (bi ou tripediculados), três retalhos coronais da fronte e oito retalhos livres. Houve um caso de perda parcial tardia de um retalho livre pós-radioterapia. CONCLUSÃO: Diferentes técnicas para a reconstrução do couro cabeludo e da fronte são possíveis, cada caso deve ser avaliado individualmente. Os retalhos apresentados foram considerados seguros e com pouca morbidade da área doadora. Os resultados obtidos foram satisfatórios e estão de acordo com a literatura analisada.

INTRODUCTION: The cephalic region is exposed to various insults from the environment. Extensive lesions in the scalp are a great challenge for plastic surgeons, because the low mobility of the skin in this region hampers its closure. A great variety of techniques have been used to close defects on the scalp and forehead. Ideally, scalp closure should provide a better functional and aesthetic outcome, as well as low morbidity at the donor site. METHODS: From January 2006 to December 2014, we performed a retrospective clinical study involving a series of 22 patients with advanced tumors of the scalp or forehead, or with extensive post-trauma skin loss. RESULTS: Reconstructive surgeries with 11 local scalp flaps (bi- or tri-pedicled), three coronal forehead flaps, and eight free flaps were performed. One patient experienced late partial loss of a free flap after radiotherapy. CONCLUSION: Various techniques can be used to reconstruct the scalp and forehead; each case should be assessed individually. The present study indicated that flaps are safe and that they confer low morbidity at the donor area. These results were satisfactory and in agreement with the literature analyzed.

Cirugía Robótica Transoral (TORS), en el manejo de lesiones neoplásicas de cabeza y cuello / Transoral Robotic Surgery (TORS), in the management of head and neck tumors

El cáncer de cabeza y cuello es una enfermedad muy complicada cuya incidencia ha venido incrementando en la última década y está relacionada con la infección del virus del papiloma humano. La base del tratamiento es la cirugía, que debe hacerse con intervenciones extensas y mutilantes a través del cuello, son acompañadas de quimioterapia y radioterapia, dejando secuelas funcionales difíciles de manejar. Desde 2009 se aprobó el uso del robot Da Vinci® para resecar tumores de la orofaringe y supraglotis, con la cirugía robótica transoral. Las bondades de esta técnica, que inciden en la pronta recuperación del paciente, y que están derivadas de la excelente visión tridimensional y la versatilidad de movimientos del instrumental articulado (EndoWrist®), han hecho que las recomendaciones de su uso estén redefiniéndose continuamente. Este artículo resume las ventajas, las desventajas, las indicaciones de manejo actual, el cuidado posoperatorio, la rehabilitación y la terapia adyuvante de este novedoso tratamiento.

Head and neck cancer is a complicated disease, with an increasing incidence in the last decade, and is associated with the human papilloma virus infection. The basic treatment is surgery, which should be done with interventions through the neck, which are extensive and crippling, supplemented by chemotherapy and radiotherapy, leaving hard-to-manage functional sequels. The use of the Da Vinci® robot was approved in 2009 for the resection of tumors of the oropharynx and supraglotis, using transoral robotic surgery. The benefits of this technique, leading to an early recovery of the patient, arise from the excellent three-dimensional views and exceptional movements of the automated instrument (EndoWrist®). This has led to the recommendations for its use being continuously redefined. This article summarizes the indications, advantages, disadvantages, postoperative care, management, rehabilitation, and adjuvant therapy of this new treatment.

Use of prototyping in preoperative planning for patients with head and neck tumors.

BACKGROUND: Prototyping technologies for reconstructions consist of obtaining a 3-dimensional model of the object of interest. Solid models are constructed by the deposition of materials in successive layers. The purpose of this study was to perform a double-blind, randomized, prospective study to evaluate the efficacy of prototype use in head and neck surgeries. METHODS: Thirty-seven cases were randomized into prototype and nonprototype groups. The following factors were recorded: the time of plate and locking screw apposition, flap size, time for reconstruction, and an aesthetic evaluation. RESULTS: The prototype group exhibited a reduced surgical time (43.7 minutes vs 127.7 minutes, respectively; p = .001), a tendency to reduce the size of the bone flap taken for reconstruction, and better aesthetic results than the group that was not prototyped. CONCLUSION: The use of prototyping demonstrated a trend toward a reduced surgical time, smaller bone flaps, and better aesthetic results.

Necessidades de autocuidado à qualidade de vida de clientes com câncer de cabeça e pescoço: contribuição da enfermagem / Self-care needs and quality of life patients with head and neck cancer: contribution of Nursing

Aborda-se a consulta de enfermagem como estratégia de pesquisa, visando identificar necessidades de autocuidado (AC) em clientes com câncer de cabeça e pescoço em tratamento paliativo ambulatorial. Tem-se como objetivos: identificar o perfil sociodemográfico e nosológico dos clientes com câncer de cabeça e pescoço atendidos no ambulatório para cuidados paliativos; identificar a qualidade de vida (QV) dessas pessoas através da consulta de enfermagem; avaliar as mudanças no sistema de autocuidado, considerando a intervenção de enfermagem. O estudo fundamenta-se nos conceitos, protocolos e instrumentos específicos da temática escolhida, e na Teoria do Déficit de Autocuidado de Orem. Escolheu-se o método quantitativo, descritivo, com delineamento pré-experimental tempo-série anterior e posterior em grupo único, que recebeu orientações para o autocuidado na consulta de enfermagem (CE). Foram sujeitos do estudo 77 clientes cadastrados no ambulatório especializado em tratamento paliativo, do INCA do Rio de Janeiro, no período de março a agosto de 2011. Variáveis sociodemográficas e nosológicas compõem o instrumento de produção de dados; enquanto as etapas da sistematização da assistência de enfermagem compõem o formulário para a implementação da CE. Para avaliar a QV aplicou-se o formulário QLQ30-H&N45, sendo os dados produzidos tratados mediante a estatística descritiva. Constatou-se, que a maioria dos 77 (100%) sujeitos do estudo é do sexo masculino e situam-se na faixa etária de 50 a 60 anos. Predominam os residentes na Baixada Fluminense, com ensino fundamental e aposentados. Têm união estável, cuidador informal e referem pouca realização de lazer. A maioria possuía hábito de tabagismo e alcoolismo. Quanto ao perfil nosológico, a maioria possui lesão tumoral inodora, sendo a cavidade oral o sítio mais acometido por câncer, e a metástase local a mais frequente...

The approach in on the nursing appointment as a research strategy, aiming at identifying the self-care (SC) needs in outpatients with head and neck cancer under palliative treatment. The aims are: to identify the socio-demographic and nosological profile of outpatients with head and neck cancer assisted for palliative care; to identify the quality of live (QL) of those people through nursing appointment; to assess the changes in the self-care system, considering the nursing intervention. The study is based on concepts, protocols and specific instruments of the chosen theme and on Orem's Self-care Deficit Theory. A quantitative and descriptive method was chosen with before-and-after time-series quasi-experimental design in sole group, which received self-care guidance at nursing appointment (NA). The subjects were 77 clients registered in the specialized palliative treatment outpatient’s clinic at the National Cancer Institute in Rio de Janeiro, from March to August, 2011. Socio-demographic and nosological variables comprise the data production instrument,while the nursing assistance systematization steps comprise the form for NA implementation. In order to asses QL, the form QLQ30-H&N45 was applied, with data produced being treated upon descriptive statistics. It was observed that most of the 77 (100%) subjects of the study is male and between 50 and 60 years of age. There is a predominance of residents in Baixada Fluminense (Lowlands in Rio de Janeiro), who hold fundamental education and are retired. They live under common-law marriage, have informal caregivers and report low practice of leisure activities. Most of them routinely consume tobacco and alcohol. As for the nosological profile, most bear odorless tumor injury, being the oral cavity the site most affected by cancer and being local metastasis the most frequent one. As for the self-care capacity, most of them feed themselves, get dressed and move around without assistance...

Repercussões da radioterapia na região orofacial e seu tratamento / Impact of radiotherapy on the orofacial region and management of related conditions

A radioterapia em região de cabeça e pescoço provoca inúmeras sequelas ao paciente irradiado, afetando o sistema estomatognático e com repercussões sistêmicas importantes. As sequelas da radiação ionizante podem ser extensas e, algumas vezes, permanentes, em especial nas glândulas salivares e no tecido ósseo. É relevante que o cirurgião dentista tenha conhecimento das reações adversas e das formas adequadas de prevenção e tratamento para amenizar o desconforto e melhorar a condição de vida do paciente irradiado. Portanto, a conscientização e motivação deste paciente, com a promoção de saúde oral através da adequação do meio bucal e orientações sobre ações preventivas, são essenciais para se obter o melhor prognóstico.

Head and neck radiotherapy causes countless sequelae in irradiated patients, affecting the stomatognathic system, with significant systemic implications. Sequelae of exposure to ionizing radiation may be extensive and sometimes permanent, particularly in the salivary glands and bone tissue. It is of utmost importance that the surgeon dentist be aware of adverse reactions and appropriate forms of treatment to alleviate discomfort and improve the quality of life of the irradiated patient. Therefore, awareness and motivation of the patient, with promotion of oral health through the adaptation of the oral environment and guidance on preventive measures are essential to get a better prognosis.

Impacto da nutrição enteral na toxicidade aguda e na continuidade do tratamento dos pacientes com tumores de cabeça e pescoço submetidos a radioterapia com intensidade modulada / Impact of enteral nutrition on acute toxicity and treatment continuity in head and neck cancer patients submitted to intensity-modulated radiotherapy

OBJETIVO: Analisar o impacto da terapia nutricional enteral na manutenção do peso corpóreo e na necessidade de replanejamento e/ou interrupção da radioterapia em pacientes com câncer de cabeça e pescoço submetidos a radioterapia de intensidade modulada (IMRT). MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os pacientes submetidos a IMRT entre janeiro de 2005 e outubro de 2008, com a inclusão de 83 casos. RESULTADOS: A idade mediana foi de 58,6 anos. Em apenas em cinco pacientes (6 por cento) houve interrupção do tratamento, que variou de 4 a 18 dias, e em 19 casos (23 por cento) houve necessidade de replanejamento. A terapia nutricional enteral foi instituída antes do início da radioterapia em 16 pacientes (19 por cento). Perda de peso > 5 por cento ocorreu em 58 casos (70 por cento), sendo mais prevalente no grupo de pacientes em que a terapia nutricional enteral não foi instituída pré-radioterapia. Na comparação entre os grupos não houve diferença significativa na realização de replanejamento (25 por cento versus 21 por cento; p = 0,741) ou na ocorrência e duração da interrupção da radioterapia. CONCLUSÃO: A terapia nutricional enteral tem um claro ganho na manutenção do peso corporal, porém, não houve um benefício na realização da gastrostomia percutânea endoscópica ou da sonda nasoenteral em relação à interrupção e ao replanejamento da radioterapia.

OBJECTIVE: The present study was aimed at analyzing the impact of enteral nutrition on the maintenance of body weight and on the necessity of replanning and/or interruption of treatment of head and neck cancer patients undergoing intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: Cases of patients submitted to IMRT in the period from January 2005 to October 2008 were retrospectively reviewed, and 83 of them were included in the study. RESULTS: Median patients' age was 58.6 years. Only five patients (6 percent) had their treatment interrupted for a period ranging from 4 to 18 days, and in 19 cases (23 percent) required replanning. Enteral nutrition was initiated before the radiotherapy in 16 patients (19 percent). Weight loss of > 5 percent was observed in 58 patients (70 percent), with a higher prevalence in the group of patients who had not received pre-radiotherapy enteral nutrition. No significant difference was observed between the groups regarding the necessity of radiotherapy replanning (25 percent versus 21 percent; p = 0.741) and necessity and duration of treatment interruption. CONCLUSION: Enteral nutrition is of a great value in the body weight maintenance, but no benefit was observed with the performance of endoscopic percutaneous gastrostomy as compared with radiotherapy interruption/replanning.

Faringocoloplastia como reconstrução tardia pós-faringolaringectomia total por carcinoma espinocelular de hipofaringe: relato de caso e revisão da literatura / Pharyngocoloplasty as late reconstruction post-pharyngolaryngectomy by hypopharynx

Introdução: O carcinoma espinocelular de cabeça e pescoço representa cerca de 5% de todas as neoplasias malignas. A localização dessa neoplasia no trato aerodigestivo superior é um fator prognóstico importante, sendo que, na maioria dos casos de hipofaringe, apresentam-se já avançados no momento do diagnóstico. A ressecção cirúrgica, quimioterapia e radioterapia adjuvantes têm grande importância no seu tratamento. Muitos pacientes, com controle loco-regional da doença, beneficiam-se de procedimentos cirúrgicos reparadores e de reconstrução do trânsito intestinal. Relato de caso: Homem, 38 anos, ex-etilista e ex-tabagista, com queixa de disfagia e dispneia rapidamente progressivas, submetido à traqueostomia de urgência por insuficiência respiratória aguda. À investigação, foi diagnosticado um carcinoma espinocelular de supraglote, com extensão para a parede medial do recesso piriforme esquerdo. O paciente foi, então, submetido à faringolaringectomia total, seguida de quimiorradiação. Sem sinais de recidiva tumoral após 12 meses de acompanhamento, foi realizada faringocoloplastia como reconstrução do trânsito intestinal. Encontrase atualmente em acompanhamento ambulatorial sem evidência de recidiva tumoral e satisfeito com o resultado cirúrgico final. Discussão: A reconstrução do trânsito intestinal em pacientes submetidos à faringolaringectomias é indicada para pacientes com controle local da doença e que aceitem o procedimento cirúrgico. A técnica mais utilizada é a interposição de alça de delgado. Porém, o cólon também é utilizado como substituto do esôfago. A escolha da técnica depende fundamentalmente da acurácia técnica do cirurgião e da necessidade de uma longa alça para anastomose entre a faringe e o estômago, com resultados satisfatórios.

Introduction: Head and neck squamous cell carcinoma represents about 5% of all malignant tumors. Localization of this neoplasia at the upper aerodigestive tract is an important prognostic factor. In most cases, hypopharynx tumors are at an advanced stage when diagnosed. Surgical resection, as well as alongside chemotherapy and radiotherapy, are essential to the treatment. Many patients with locoregional control of the disease benefit from reparative and reconstructive surgeries of the intestinal transit. Case report: Man, 38 years old, former user of alcohol and tobaco, complaining of rapid progressive dysphagia and dyspnea, submitted to urgent tracheotomy due to acute respiratory failure. At examination, we diagnosed supraglottic squamous cell carcinoma, involving the left pyriform fossa medial wall. The patient underwent a pharyngolaryngectomy, followed by chemoradiation. Without signs of tumor recurrence after a 12-month follow-up, we performed a pharyngocoloplasty with reconstruction of the intestinal transit. At the moment, he is attending for an outpatient follow-up, with no evidences of tumor recurrence, and satisfied with the final surgical outcome. Discussion: The reconstruction of intestinal transit in pharyngolaryngectomy patients is indicated for those with local control of the disease and that accept this surgicalprocedure. The most used technique is the loop interposition of small intestine, but the colon is also used for esophageal replacement. Its choice depends mainly on the technical accuracy of the surgeon, but also on the requirement of a lengthy loop for the anastomosis between pharynx and the stomach, with suitable results.