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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2021.tde-07022022-164348
Document
Author
Full name
Ana Raphaela Maia Dezan Couto Curvo
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Ricz, Hilton Marcos Alves (President)
Arruda, Gustavo Viani
Pieroni, Karina Alessandra Michelão Grecca
Title in Portuguese
Avaliação dos fatores de risco para as complicações bucais crônicas após radioterapia em região de cabeça e pescoço
Keywords in Portuguese
Hipossalivação
Neoplasia de cabeça e pescoço
Qualidade de vida
Radioterapia
Xerostomia
Abstract in Portuguese
A radioterapia (RT) consiste em modalidade de terapia antineoplásica estabelecida para o tratamento de carcinoma espinocelular (CEC) na região de cabeça e pescoço (CP). No entanto, existem diversas complicações crônicas que envolvem a cavidade oral e comprometem diretamente a qualidade de vida (QV) dos pacientes, das quais se pode destacar, xerostomia, hipossalivação, cárie de radiação, trismo, infecções oportunistas e osteorradionecrose. Objetivos: Identificar a incidência das complicações crônicas na população estudada, avaliar o impacto da xerostomia, hipossalivação e QV em pacientes adultos submetidos a RT por IMRT para tratamento de CEC na região de CP. Materiais e Métodos: Este estudo prospectivo e observacional ocorreu com pacientes maiores de 18 anos, diagnosticados com CEC de CP e indicação de RT. Os pacientes foram avaliados em três tempos: T1- diagnóstico, T2-imediatamente antes da RT e T3-a partir de 3 meses até um ano após o término da RT. As seguintes variáveis foram coletadas: sexo, idade, comorbidades, hábitos de tabagismo e etilismo, presença de foco infeccioso em cavidade oral, CPO-D (índice de dentes cariados, perdidos e obturados), condição periodontal, índice gengival, índice de placa, fluxo salivar, abertura bucal, estadiamento clínico da doença, área tumoral, dose total de radiação, quimioterapia, dano cirúrgico de glândula salivar maior e QV. Foi realizada análise descritiva dos efeitos colaterais crônicos após a RT, condições contribuintes para perda de salivação e análise da QV. Resultados: Foram avaliados 61 pacientes em T3 para análise descritiva dos efeitos colaterais tardios e QV. Destes, 34 pacientes foram submetidos a análise de comparação entre variáveis antes e após a RT, na qual houve associação entre fluxo salivar (p<0,001), hipossalivação (p<0,001), questionário de xerostomia (p<0,001), LENT-SOMA (p=0,005) e queixa de xerostomia (p=0,003). O fluxo salivar apresentou correlação com dose de RT (p=0,039) e dose entregue em glândulas parótidas (p=0,012). A queixa de xerostomia esteve correlacionada a diminuição do fluxo salivar (p=0,029) e a QV foi diminuída nos pacientes que apresentaram xerostomia (p=0,049). Conclusão: Os efeitos colaterais crônicos da RT em CP estiveram presentes no grupo estudado, conforme já descrito na literatura. Os parâmetros de xerostomia, hipossalivação e QV foram afetados pela RT.
Title in English
Assesment of risk factors for chronic oral complications after radiotherapy treament in the head and neck region
Keywords in English
Head and neck neoplasm
Hyposalivation
Quality of life
Radiotherapy
Xerostomia
Abstract in English
Radiotherapy (RT) consists of an established antineoplastic therapy modality for the treatment of squamous cell carcinoma (SCC) in the head and neck (H&N) region. However, there are several chronic complications that involve the oral cavity and directly compromise the Quality of Life (QoL) of patients, such as: xerostomia, hyposalivation, radiation caries, trismus, opportunistic infections, and osteoradionecrosis. Objectives: To identify the incidence of chronic complications in the studied population, evaluate the impact of xerostomia, hyposalivation and QoL in adult patients undergoing RT by IMRT for the treatment of SCC in the H&N region. Materials and Methods: This prospective and observational study was carried out with patients older than 18 years, diagnosed with H&N SCC and indication for RT. Patients were evaluated in three stages: T1-diagnostic, T2-immediately before RT and T3-from 3 months to one year after the end of RT. The following variables were collected: sex, age, comorbidities, smoking and alcoholism, presence of an infectious focus in the oral cavity, DMFT (decayed, missing and filled teeth index), periodontal condition, gingival index, plaque index, salivary flow, mouth opening, clinical stage of the disease, tumor area, total radiation dose, chemotherapy, major salivary gland surgical damage and QoL. A descriptive analysis of chronic side effects after RT, conditions contributing to salivation loss and QoL was performed. Results: 61 of the T3 patients were evaluated for descriptive analysis of late side effects and QoL. Among them, 34 patients underwent a comparison analysis between variables before and after RT, in which there was a correlation between salivary flow (p<0.001), hyposalivation (p<0.001), xerostomia questionnaire (p<0.001), LENT-SOMA (p=0.005) and complaint of xerostomia (p=0.003). The salivary flow presented a correlation with the RT dose (p = 0.039) and the delivered dose in the parotid glands (p = 0.012). Complaints of xerostomia were correlated with decreased salivary flow (p=0.029) and QoL was reduced in patients with xerostomia (p=0.049). Conclusion: The chronic side effects of H&N RT were present in the studied group, as described in the literature. The parameters of xerostomia, hyposalivation and QoL were affected by RT.
 
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Publishing Date
2022-02-15
 
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