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Doctoral Thesis
Full name
Genival Barbosa de Carvalho
Knowledge Area
Date of Defense
São Paulo, 2020
Kowalski, Luiz Paulo (President)
Dedivitis, Rogério Aparecido
Goncalves, Antonio Jose
Marta, Gustavo Nader
Title in Portuguese
Fatores prognósticos em pacientes com carcinoma epidermoide  de laringe estádios I ou II e preservação de órgão de acordo com a modalidade terapêutica inicial: cirurgia ou radioterapia
Keywords in Portuguese
Neoplasias laríngeas/cirurgia
Neoplasias laríngeas/preservação de órgão
Neoplasias laríngeas/radioterapia
Abstract in Portuguese
Introdução: A preservação do órgão em pacientes com carcinoma epidermoide de laringe em estádio clínico inicial de acordo com a modalidade terapêutica ainda é controversa. Este estudo analisa as taxas de preservação laríngea e sobrevida em pacientes com carcinoma epidermoide em estádios I ou II submetidos a tratamento com cirurgia ou radioterapia pareados pelo escore de propensão por estágio clínico. Metodologia: É um estudo de coorte retrospectivo com pacientes tratados consecutivamente de janeiro de 1995 a dezembro de 2014. Dos 151 pacientes que atenderam aos critérios de inclusão, 112 (74,%) eram portadores de tumores glóticos, 92 (60,9%) com estádio clínico I e 103 (68,2%) foram tratados com radioterapia, 96 foram selecionados pelo escore de propensão, pareados pelo estádio clínico, para cada paciente tratado com cirurgia, outro paciente com o mesmo estádio tratado com radioterapia foi selecionado. Resultados: O tempo de seguimento variou de 2 dias a 276 meses com mediana de 55 meses. A taxa de perda de seguimento foi 15,2%. Em relação à sobrevida global e câncer específica, não foram observadas diferenças entre as modalidades terapêuticas, mas os pacientes submetidos à radioterapia apresentaram maior taxa de recorrência local (37,5% x 12,5%, p = 0,021). A taxa de preservação laríngea foi de 78,5%. Não houve correlação entre a probabilidade de preservação da laringe e as variáveis estudadas, embora os pacientes classificados como ASA III ou IV e os submetidos à radioterapia apresentaram uma tendência a maior risco de perda da laringe, mas sem significância estatística. Entre os pacientes submetidos à radioterapia e que evoluíram com recorrência local, 22% foram submetidos à laringectomia parcial de resgate. Conclusão: pacientes portadores de tumores de laringe em estádios iniciais podem ser tratados com cirurgia ou radioterapia com taxas de sobrevida global, câncer específica e taxas de preservação laríngea semelhantes, mas é necessário acompanhamento adequado para o diagnóstico oportuno de recorrências, em fases que o paciente possa ser candidato a laringectomia parcial de resgate parcial, pois os pacientes submetidos à radioterapia apresentam maiores taxas de recidiva
Title in English
Prognostic factors in patients with stage I or II laryngeal squamous cell carcinoma and organ preservation according to the initial therapeutic modality: surgery or radiotherapy
Keywords in English
Laryngeal neoplasms/radiotherapy, Laryngeal neoplasms/organ preservation
Laryngeal neoplasms/surgery
Abstract in English
Introduction: Organ preservation in patients with squamous cell carcinoma in the initial clinical stage according to the initial therapeutic modality is still controversial. This study analyzes the rates of laryngeal preservation and survival in patients with stage I or II squamous cell carcinoma underwent treatment with surgery or radiotherapy matched by the propensity score by clinical stage in relation to the therapeutic option. Methodology: It is a retrospective cohort study with patients treated consecutively from January 1995 to December 2014. Of the 151 patients who met the inclusion criteria, 112 (74,%) had glottic tumors, 92 (60.9%) with clinical stage I and 103 (68.2%) were treated with radiotherapy, 96 were selected by the propensity score, matched by the clinical stage, for each patient treated with surgery, another patient with the same stage treated with radiotherapy was selected. Results: The time of follow-up ranged from 2 days to 276 months with a median of 55 months. The rate of loss to follow-up was 15.2%. Regarding overall and cancer specific survival, no differences were observed between the therapeutic modalities, but patients underwent to radiotherapy had a higher rate of local recurrence (37.5% x 12.5%, p = 0.021). The laryngeal preservation rate was 78.5%. There was no correlation between the probability of larynx preservation and the variables studied, although patients classified as ASA III or IV and those underwent to radiotherapy had a tendency to a higher risk of loss of the larynx, but without statistical significance. Among patients undergoing radiotherapy who had local recurrence, 22% underwent salvage partial laryngectomy. Conclusion: Patients with initial laryngeal tumors may be submitted to surgery or radiotherapy with similar overall, cancer specific survival and laryngeal preservation rates, but adequate follow-up aiming to perform and partial laryngectomy to treat the local recurrence is necessary, because patients undergoing radiotherapy have higher risk of recurrence
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