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Master's Dissertation
DOI
Document
Author
Full name
Rejane Carolina de Oliveira Franco
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Marta, Gustavo Nader (President)
Castro Junior, Gilberto de
Ferrigno, Robson
Linck, Rudinei Diogo Marques
Title in Portuguese
Influência do intervalo entre a cirurgia e a radioterapia adjuvante nos desfechos clínicos dos pacientes com câncer de cabeça e pescoço
Keywords in Portuguese
Neoplasias de cabeça e pescoço/cirurgia
Neoplasias de cabeça e pescoço/terapia
Prognóstico
Quimiorradioterapia adjuvante
Abstract in Portuguese
Introdução e objetivos: A radioterapia (RT) tem importante papel no tratamento dos pacientes com neoplasia de cabeça e pescoço, sendo frequentemente utilizada como terapia adjuvante a fim de diminuir a probabilidade de recorrência local. Além dos fatores clínicos, variáveis como a duração total do tratamento e o intervalo entre o diagnóstico e início da terapêutica também podem impactar sobre o resultado clínico. É incerto qual o limiar de tempo seguro para aguardar o início da RT adjuvante após a cirurgia com intenção curativa sem que haja comprometimento dos resultados oncológicos. O presente estudo tem o objetivo de avaliar o efeito do intervalo de tempo para iniciar a RT adjuvante sobre o desfecho clínico de controle locorregional dos pacientes com neoplasia de cabeça e pescoço. Materiais e métodos: Estudo de coorte retrospectivo, no qual foram incluídos pacientes com diagnóstico de carcinoma de células escamosas de cabeça e pescoço submetidos à ressecção cirúrgica com intenção curativa seguida de RT, com ou sem quimioterapia adjuvante, no período de janeiro de 2009 à janeiro de 2015. Os dados foram coletados a partir de prontuário eletrônico. O intervalo de tempo entre a cirurgia e a RT adjuvante considerado foi dicotomizado por meio do método de curva Receiver Operating Characteristics (ROC) aos 92 dias. Também foram exploradas possíveis fontes de heterogeneidade por meio da análise regressa, levando em consideração o efeito potencial de outros fatores sobre o desfecho de controle locorregional. Resultados: Foram avaliados 168 pacientes. A maioria deles (n = 132; 78,6%) do sexo masculino, com tumor de cavidade oral (n = 95; 56,5%) e idade média de 62 anos (variação 41-92 anos). Aproximadamente 93% dos pacientes apresentavam doença localmente avançada estádios clínicos III ou IV. A análise univariada demonstrou que os fatores que apresentaram significância estatística em relação ao controle locorregional foram: presença de invasão perineural (p < 0,001), linfonodos comprometidos (p < 0,001), extravasamento extracapsular em linfonodos (p = 0,014), duração do tratamento radioterápico < 30 dias (p = 0,001), RT em leito tumoral com dose < 60 Gy (p = 0,03) e KPS antes da RT < 70 (p = 0,001). Na análise multivariada, KPS menor que 70 (HR = 2,058; IC95%: 1,060-3,992; p = 0,033), dose no leito inferior a 60 Gy (HR = 6,523; IC95%: 2,266-18,777; p = 0,001), presença de linfonodos comprometidos no pescoço (HR = 3,339; IC95%: 1,350-8,255; p = 0,009) e presença de invasão perineural (HR = 3,529; IC95%: 1,236-10,074; p = 0,018) foram as variáveis independentes relacionadas à menor controle locorregional. A taxa de sobrevida acumulada livre de recidiva foi de 66,4% para os pacientes que iniciaram a RT com mais de 92 dias pós-operatórios versus 75,4% para aqueles que iniciaram a RT dentro de 92 dias (p=0,397). Os pacientes cujo tempo total de tratamento (período entre a data da cirurgia até o último dia da RT) foi superior a 150 dias apresentaram taxa de recidiva locorregional de 41,8%, enquanto nenhum paciente com duração do tratamento inferior a 150 dias apresentou recidiva (p <= 0,001). Conclusão: O intervalo de tempo entre a cirurgia e a RT não demonstrou impacto sobre as taxas de controle locorregional em pacientes com câncer de cabeça e pescoço. Outros fatores como a dose de tratamento mínima de 60 Gy e o tempo total de tratamento inferior a 150 dias foram determinantes sobre o desfecho de controle locorregional
Title in English
Influence of time between surgery and adjuvant radiotherapy in clinical outcomes of patients with head and neck cancer
Keywords in English
Chemoradiotherapy Adjuvant
Head and neck neoplasms/surgery
Head and neck neoplasms/therapy
Prognosis
Abstract in English
Purpose: Radiation therapy (RT) has an important role at the treatment of patients with head and neck tumors, being frequently used as adjuvant therapy with the purpose to decrease locoregional recurrence rates. Beyond clinical tumor factors, the prognoses could be also affected by therapeutic variables such as the total treatment time and the interval time between surgery and adjuvant RT. It is not clear the optimal time to start RT after curative intent surgery without compromising the oncological outcomes. This study aimed to evaluate the effect of the delay in initiating adjuvant RT on the locoregional outcome of patients with head and neck cancer. Material/methods: This is a retrospective cohort study that included patients diagnosed with squamous cell carcinoma of head and neck submitted to surgical resection with curative intent followed by RT, with or without adjuvant chemotherapy, from January 2009 to January 2015. Data were collected from medical records. The time interval was considered from the date of surgery to the date of starting RT and dichotomized by the ROC curve method at 92th day. Possible sources of heterogeneity were also assessed through regression analysis, considering the potential effects of other variables on the locoregional outcome. Results: A total of 168 patients were evaluated. The majority of them were male (n = 132; 78.6%), diagnosed with oral cavity cancer (n = 95; 56.5%) with median age of 62 years (range 41-92 years). About 93% of them had locally advanced disease clinical stage III/IV. The univariate analysis showed the following statistically significant factors were related to locoregional control: angiolymphatic invasion (p = 0.055), perineural invasion (p < 0.001), positive lymph nodes (p <= 0.001), extracapsular nodal extension (p = 0.014), length of RT < 30 days (p = 0.001), radiation dose to tumor bed < 60 Gy (p = 0.03) and KPS before RT < 70 (p = 0.001). The multivariate analysis showed KPS < 70 (HR = 2.058; CI95%: 1.060-3.992; p = 0.033), radiation dose to tumor bed < 60 Gy (HR = 6.523; CI95%: 2.266-18.777; p = 0.001), positive lymph nodes (HR = 3.339; CI95%: 1.350-8.255; p = 0.009) and perineural invasion (HR = 3.529; CI95%: 1.236- 10.074; p = 0.018) as independent variables of lower locoregional control. The relapse-free survival rate was 66.4% for patients who initiated RT with more than 92 postoperative days versus 75.4% for those who initiated RT within 92 days (p=0.377). Patients whose total treatment time (period between the date of the surgery until the last day of RT) was longer than 150 days had a locoregional recurrence rate of 41.8%, whereas no patient with treatment duration inferior to 150 days had relapses (p = 0.001). Conclusion: The interval between surgery and RT did not show influence on locoregional control rates in patients with head and neck cancer. However, doses < 60 Gy, and the total treatment time < 150 days were associated with lower locoregional control rates
 
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Publishing Date
2019-10-29
 
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