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Master's Dissertation
DOI
https://doi.org/10.11606/D.23.2021.tde-27102021-174526
Document
Author
Full name
Renata Maria Mamprin Stopiglia
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Moreira, Maria Stella Nunes Araujo (President)
Alves, Fábio de Abreu
Jaguar, Graziella Chagas
Morimoto, Susana
Title in Portuguese
Osteorradionecrose dos maxilares em pacientes portadores de câncer de cabeça e pescoço - Overview de revisões sistemáticas
Keywords in Portuguese
Câncer de cabeça e pescoço
Osteorradionecrose
Overview
Radioterapia
Revisão sistemática
Abstract in Portuguese
Os pacientes portadores de câncer de cabeça e pescoço realizam tratamento, de radioterapia podendo ou não estar associados à quimioterapia e/ou cirurgias. A qualidade de vida dos mesmos é afetada em função dos efeitos colaterais causados pelos tratamentos. Mucosite, hiposalivação, perda do paladar, trismo e osteorradionecrose são os efeitos colaterais que mais acomentem os pacientes em tratamento para câncer de cabeça e pescoço. A osteorradionecrose é considerada um evento tardio e a maior complicação pós tratamento de radioterapia. Foi realizada uma busca sistemática nas bases de dados eletrônicas MEDLINE / PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Open Gray e busca manual, sem restrição de idioma e tempo. Os critérios de elegibilidade foram os seguintes: 1) ser revisão sistemática; 2) abordar sobre os efeitos orais e complicações após quimioterapia e/ou radioterapia em pacientes adultos portadores de câncer de cabeça e pescoço e 3) RS baseadas em estudos clínicos prospectivos/ retrospectivos e ECR (estudo clínico randomizado). A elegibilidade foi determinada de acordo com os critérios de exclusão para:1) RS que descrevessem a o tratamento para as sequelas da ORN; 2) as RS baseadas em relatos de casos ou estudos in vitro sobre ORN; 3) ORN em ossos não gnáticos (temporal); 4) não abordarem sobre incidência, tratamento ou prevenção da ORN e 5) revisão da classificação da ORN. Foram identificados 1321 artigos, mas apenas 13 foram considerados elegíveis. A fase de elegibilidade, qualidade metodológica (AMSTAR 2) foi conduzida por dois examinadores independentes e calibrados (RMS e GS), e um terceiro examinador (MSANM) foi consultado para a resolução de incongruências. O número de pacientes avaliados para o desenvolvimento de ORN ao longo do tratamento foi 33.762 sendo que desses, 2.094 desenvolveram a lesão, representando uma incidência de 6,2%. Quanto a localização a mandíbula é o local de maior acometimento. A exodontia após a radioterapia foi apontada como o maior fator causal para o desenvolvimento de ORN. A abordagem de tratamento para a ORN com pentoxifilina e tocoferol demonstrou eficácia superior em relação ao uso de antibioticoterapia e câmera hiperbárica. Baseado no risco de viés, é baixo o nível atual de evidência para as abordagens preventivas e curativas da ORN.
Title in English
Osteoradionecrosis and its treatment protocols in patients with head and neck cancer - overview of systematic reviews
Keywords in English
Head and neck cancer
Oral cancer
Osteoradionecrosis
Radiotherapy
Systematic reviews
Abstract in English
Patients with head and neck cancer undergo treatment, radiation therapy, which may or may not be associated with chemotherapy and/ or surgery. Their quality of life is affected due to the side effects caused by the treatments. Mucositis, hyposalivation, loss of taste, trismus and osteoradionecrosis are the side effects that most affect patients undergoing treatment for head and neck cancer. Osteoradionecrosis is considered a late and highly complicating event after radiotherapy and chemotherapy treatment. A systematic search was performed in the electronic databases MEDLINE/ PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Open Gray and manual search, without restriction of language. The eligibility criteria were: 1) to be a systematic review; 2) to address the oral effects and complications after chemotherapy and/or radiotherapy in adult patients with head and neck cancer and 3) SR based on prospective studies and RCT (randomized clinical trial). Eligibility was determined according to the exclusion criteria for: 1) SR who described rehabilitation to repair ORN sequelae; 2) SR based on case reports or in vitro studies on ORN; 3) ORN in non-gnathic (temporal) bone; 4) do not address the incidence, treatment or prevention of ORN and 5) review of the ORN classification. The Systematic review identified 1321 articles, but only 13 were eligible. The eligibility phase, methodological quality (AMSTAR 2) was conducted by two independent and calibrated examiners, and a third examiner was consulted to resolve inconsistencies. The number of patients treated for the development of ORN during the treatment was 33,762 of which 2,094 developed a lesion, representing an occurrence of 6.2%. As for the location of the ORN the mandible is the site of greatest involvement and, single lesions were more observed than multiple. Extraction after radiotherapy was identified as the major causa factor for the development of ORN. Prevention, based on the studies evaluated is achieved through hyperbaric oxygenation (HBO), being more effective when compared to the use of antibiotic therapy (ATB). The treatment of ORN showed greater effectiveness with the use of PENTO (Pentoxifylline and Tocopherol) in relation to antibiotic therapy in the studies evaluated in the review. This study concluded that for the treatment of ORN, PENTO was considered more effective comparable to antibiotic therapy or hyperbaric oxygenation. Although, there is no evidence as to which period is best for extractions in patients undergoing treatment for head and neck cancer, the risk of developing ORN is increased in the face of the procedure.
 
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Publishing Date
2023-01-16
 
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