Background and aim: In society there is a growing awareness that a vital factor for patientswith chronic diseases, such as head and neck cancer (HNC), is how well they are able to function in their every day lives – a common, but often overlooked, public health issue. The overall aim of this thesis is to reach a deeper understanding of living with HNC and to identify the experiences that patients felt promoted their health and well-being. It also explores the patients' experiences of contact and care from health professionals and whether these encounters could increase their feelings of health and well-being; salutogenic approach. Methods: This thesis engages a qualitative data design. On three occasions, 35 purposivelyselected patients were interviewed (31 from Sweden and one from Denmark, Finland, Island, and Norway). The first study was conducted in the Nordic counties (I), and the remainingstudies were conducted in Sweden (II, III, IV). Interviews were performed on a single basis(I, II, III) and then repeated (IV). The individual, semi-structured qualitative interviews usedopen-ended questions (n=53). Three different forms of analyses were used: critical incident technique (I), thematic content analysis (II), latent content analysis (III), and interpretativedescriptive analysis (paper IV). Findings: Living with head and neck cancer was expressed as living in captivity, in the sensethat patients' sometimes life-threatening symptoms were constant reminders of the disease. The patients experienced a threat against identity and existence. Patients struggled to find power and control over everyday life, and if successful this appeared to offer them better health and well-being along with spiritual growth. The general understanding was that these patients had strong beliefs in the future despite living on a virtual rollercoaster. The patients went through a process of interplay of internal and external enabling that helped them acquire strength and feelings of better health and well-being. Consequently, they found power and control from inner strength and other health resources, e.g. social networks, nature, hobbies, activity, and health professionals. However, the findings also revealed the opposite; that some patients were more vulnerable and felt powerless and faced everyday life with emotional and existential loneliness. They were dependent on next of kin and health professionals. Having good interpersonal relationships and emotional support 24 hours a day from next of kin were crucial, as were health promoting contacts and care from health professionals. This health promoting contact and care built on working relationships with competent health professionals that were available, engaged, respectful, validating, and, above all experienced in the treatment phase. But many patients experienced not health promoting contact and care – and a sense of not being respected, or even believed. Added were the patients' experiences of inadequate coordination between phases of their lengthy illness trajectory. They felt lost and abandoned by health services, especially before and after treatment. Conclusions: Inner strength, good relationships with next of kin, nature, hobbies, andactivities could create strength and a sense of better health and well-being. Patients experienced a mutual working relationship during dialoguing and sensed co-operation and equality in encounters with competent health professionals. This could lead to enhanced power and control i.e. empowerment in a patient's everyday life. The findings highlight psychosocial rehabilitation in a patient-centred organisation when health professionals supportpatients' inner strength and health resources , and also offer long-term support to next of kin.Finally, this research suggests that if health professionals could gain a deeper understanding of the psychosocial, existential, social, and economic questions on patients' minds, they could better sense how patients feel and would be better equipped not only to offer greater support, but to raise their voices to improve health policy and health care for these patients. / Syfte och bakgrund: Avhandlingens övergripande syfte var att få en djupare förståelse för personer med huvud – halscancer vardagsliv samt vad som främjar deras hälsa och välbefinnande d v s ett salutogent synsätt. Kroniska sjukdomstillstånd såsom cancer räknas numera till de stora folksjukdomarna och vid huvud – halscancer är vikten av ett fungerande vardagsliv emellertid ett ofta förbisett folkhälsoproblem. Metod: Avhandlingen omfattar fyra delarbeten baserade på kvalitativa data. Resultaten baseras på semistrukturerade individuella intervjuer (n=53) som riktades till 35 utvalda personer. Den första studien (I) genomfördes i Danmark, Finland, Island, Norge och Sverige och de övriga i Sverige (II, III, IV). Intervjuerna genomfördes vid ett tillfälle (I, II, III) och vid upprepade tillfälle (IV). Tre olika textanalyser användes, kritisk händelse teknik (I), tematisk innehålls analys (II), latent innehållsanalys (III) och tolkande beskrivande analys (IV). Resultat: Att leva med huvud - halscancer beskrevs som ett liv i fångenskap och upplevdes som att åka i berg och dalbana mellan hopp och förtvivlan. De ofta livshotande symtomen påminde ständigt om sjukdomen och upplevdes som hot både mot existensen och mot identiteten. Detta till trots kom ibland en stark optimism och tro på framtiden till uttryck. Några av de intervjuades vardagsliv präglades dock av känslomässig och existentiell ensamhet och upplevelser av sårbarhet och maktlöshet. Att ha makt och kontroll över den egna livssituationen liksom närståendes känslomässiga stöd, ibland dygnet runt, främjade hälsan. Hälsofrämjande kontakter med vårdpersonalen upplevdes främst under sjukhusvistelsen. Avgörande var en god och bekräftande patient vårdar relation samt att personalen hade hög kompetens och visade engagemang och respekt i vårdsituationen. Flera av de intervjuade beskrev dock allvarliga brister i kontakten med sjukvården. Upplevelser av brist på respekt och att inte bli trodd i sin sjukdomsupplevelse beskrevs, vilket vanligast i perioderna före och efter sjukhusvistelsen. Samordningen mellan hälso- och sjukvårdens olika funktioner upplevdes som bristfällig under hela sjukdomsförloppet. Konklusion: Inre styrka, goda relationer med närstående, nära kontakt med naturen, hobbyer och andra aktiviteter skapade upplevelser av hälsa och välbefinnande hos personer med huvud - halscancer. I dialog med kompetent vårdpersonal, där samverkan och jämlikhet var tydlig, upplevdes ömsesidiga, vänliga relationer som en hjälp för dem att få ökad egenmakt och kontroll i vardagslivet. Resultatet visar på patienternas långvariga kamp med ett vardagsliv med ständig känslomässig, psykosocial, existentiell, social och ekonomisk oro. Resultatet pekar också på en brist på patientcentrerad organisation och psykosocial rehabilitering, där vårdpersonal stödjer patienters inre styrka och hälsoresurser. Förhoppningen är att resultatet kan leda till en ökad förståelse hos vårdpersonal för hur vardagslivet kan upplevas då man har en huvud- hals cancer, för att på så vis ge adekvat hjälp till dessa patienter och deras närstående.

Head and neck cancer is a heterogeneous group of tumours, of which certain subgroups such as cancer of the mobile tongue frequently are associated with a relatively poor prognosis due to the high risk of regional failure and mortality rates that haven’t improved in a significant way over the last 3 decades, despite advancements in both diagnostics and treatment. Today we lack means to assess the biological aggressiveness of each individual tumour, which varies largely. Treatment comprises of surgery with additional radiotherapy and medical therapies in more advanced tumours. The focus in this thesis is on molecular biomarker expression in head and neck cancer and especially in association with radiotherapy. Increased knowledge paves the way to a more individualized cancer treatment aiming for better outcome and less overtreatment and sequelae. The aims of this thesis was: To map the effects of radiotherapy in both tumour and adjacent tissue for the possible markers hyaluronan, EGFR and mast cells. To investigate whether the expression of hyaluronan in the epithelium and connective tissue stroma and EGFR in the tumour correlates with the risk for developing cervical metastasis in N0 patients, and to find out whether the 3-year tumour-specific survival rates correlates with the expression of HA in the epithelium and EGFR in the tumour. To establish an animal model for radiation-induced mucositis and to use that model to examine the pattern of invading inflammatory cells. To investigate whether the expression of podoplanin in tongue cancer correlates with the risk for cervical metastasis and to determine whether the total amount of lymph vessels in the diagnostic biopsy has any impact on the clinical outcome. To investigate the differences in the metabolome of tongue cancer cell lines with different radiosensitivity. The most important findings of this thesis were: The expression of EGFR and hyaluronan hade the same pattern of expression in both tumour and adjacent tissues before radiotherapy. The expression of EGFR was increased in the epithelium of the adjacent tissue close to the tumour after radiotherapy. The intensity of the staining of hyaluronan was correlated to the 3-year survival rates in patients with tongue cancer. An experimental model for radiation-induced oral mucositis in rat was established and in this model a temporal pattern of macrophage invasion with two different subtypes of macrophages was found. There were no correlation between the expression of podoplanin in the tumour tissue and the cervical metastasis rate in patients with tongue cancer, but the younger patients were more likely to have a higher expression of podoplanin in their tumour than elder patients. Tongue cancer cell lines with different radiosensitivity respond to irradiation with different patterns of metabolic expressions.

Objectifs: réaliser une étude anatomique et anthropologique de l’os hyoïde en utilisant les moyens modernes de reconstruction 3D et discuter les applications cliniques potentielles notamment en cancérologie. Méthode : L’étude a été réalisée à partir d’une analyse de 180 os hyoïdes dont 88 ont été prélevés sur cadavres (groupe 1) et 92 analysés à partir d’examens tomodensitométriques pratiqués sur des sujets vivants (groupe 2). Une analyse métrique ainsi qu’une analyse de morphométrie géométrique ont été réalisées pour chaque groupe. Les 2 groupes ont ensuite été comparés afin d’évaluer l’influence des muscles sur la morphologie de l’os hyoïde. Dans un second temps, nous avons appliqué cette méthodologie à une série de 24 patients opérés de laryngectomie partielle. Résultats : Nous avons montré qu’il existait une importante hétérogénéité morphologique entre les os hyoïdes et que celle-ci était étroitement liée au sexe, à la taille et au poids des individus. En effet, la longueur et la largeur de l’os hyoïde étaient significativement plus importantes chez les hommes que chez les femmes (39,08 vs. 32,50 mm, p=0,033 et 42,29 vs. 38,61 mm, p=0,003). Par ailleurs, l’angle formé par les deux grandes cornes (angle alpha) était plus large chez les femmes (44,09 vs. 38,78 p=0,007). De plus, la longueur de l’os hyoïde était corrélée de façon positive avec la taille (coefficient de corrélation de Pearson r=0,533, p=0,01) et le poids des sujets (r=0,497, p=0,01). Des différences métriques significatives ont aussi été retrouvées entre les os hyoïdes secs et les os des sujets vivants. / Objectives: To perform an anatomical and anthropological study of the hyoid bone using modern 3D reconstruction tools and to discuss potential applications in clinical practice. Methods: The study was conducted on 88 intact hyoid bones taken from cadavers during forensic autopsies (group 1) and on 92 from CT-scan images of living adult subjects (group 2). Three-dimensional reconstructions were created from CT-scan images using Amira 5.3.3® software. An anatomical and anthropological study of hyoid bones was carried out using metric and morphologic analysis. A comparison was performed between groups 1 and 2 in order to evaluate the influence of muscle traction on hyoid bone shape. In a second step, this methodology was applied to 24 patients operated on for partial laryngectomy. Results: Characteristics of the hyoid bone were highly heterogeneous and were closely linked with the sex, height and weight of individuals. Length and width were significantly greater in men than in women (39.08 vs. 32.50 mm, p=0.033 and 42.29 vs. 38.61 mm, p=0.003) whereas the angle between the greater horns was larger in females (44.09 vs. 38.78 p=0.007). There was a significant positive correlation between the height (Pearson coefficient correlation r=0.533, p=0.01) and weight (r=0.497, p=0.01) of subjects and the length of the hyoid bone. Significant metric differences were shown between group 1 and group 2. In patients operated on for partial laryngectomy, hyoid bones could be classified into 3 types (A, B and C) according to their morphology. Conclusion: This very reproducible methodology is of importance because it may lead to clinical studies, particularly in head and neck cancer.

No description available.

Introdução: A metástase linfonodal tem impacto significativo não somente no prognóstico do carcinoma espinocelular (CEC) de laringe, como também na sobrevivência. O índice de densidade linfonodal (IDL) combina a análise da extensão e a qualidade do esvaziamento cervical, com a habilidade na análise anatomopatológica. Objetivo: Avaliar o IDL como fator prognóstico no CEC de laringe. Métodos: Foi realizado um estudo retrospectivo com 186 pacientes submetidos a tratamento cirúrgico da laringe com esvaziamento cervical entre janeiro de 2009 a dezembro de 2016. Variáveis clínico-patológicas foram avaliadas, assim como o ponto de corte de IDL para determinar fatores prognósticos. Resultados: Foram calculados dois valores de IDL no estudo: considerando os pacientes N0 (IDL= 0,018) e considerando pN+ (IDL= 0,06). A curva de Kaplan-Meier (log-rank) em relação à sobrevivência acumulada mostrou que tanto os pacientes com IDL > 0,018 quanto considerando o IDL >= 0,06 tiveram maior taxa de mortalidade do que os pacientes com IDL <= 0,018 ou IDL < 0,06, mostrando uma forma mais agressiva da doença, com recidiva mais precoce. Entretanto, apenas o IDL > 0,06 mostrou impacto tanto no intervalo livre de doença quanto na sobrevivência global. Conclusão: O IDL mostrou ser um índice importante na avaliação prognóstica dos pacientes com CEC de laringe, tendo relação direta com recidiva da doença. Pacientes com IDL > 0,060 provavelmente têm doença mais agressiva e devem ser candidatos à terapia adjuvante / Introduction: Lymph node metastasis has a significant impact not only on the prognosis for laryngeal squamous cell carcinoma (SCC), but also on survival. The index of lymph node density (LND) combines the analysis of the extension and quality of the neck dissection with the skill in analyzing the pathology. Objective: To evaluate LND as a prognostic factor in patients with laryngeal SCC. Methods: A retrospective study was carried out with 186 patients submitted to laryngeal surgical treatment with neck dissection between January 2009 and December 2016. Clinical-pathological variables were assessed, as well as the cut-off point for LND, to determine prognostic factors. Results: Two LND values were calculated in the study: one considering N0 patients (LND=0.018) and the other considering pN+ (LND=0.060). The Kaplan-Meier curve (log-rank) related to cumulative survival demonstrated that not only patients with LND > 0.018 but also those with LND >= 0.060 had a higher mortality rate than those with LND <= 0.018 or LND < 0.060, presenting a more aggressive form of the disease, with earlier recurrence. However, only the LND >= 0.060 group had impact on both disease-free survival, and overall survival. Conclusion: The LND proved to be an important index in the prognostic evaluation of larynx SCC patients, having a direct relationship with disease recurrence. Patients with LND >= 0.060 are likely to have a more aggressive form of the disease and should be considered for adjuvant therapy

Les Papillomavirus Humains (HPV) sont responsables de près de 100% des cancers du col utérin. Récemment, ces HPV sont apparus comme étant aussi la cause de certaines tumeurs des voies aérodigestives supérieures, et particulièrement des carcinomes épidermoïdes de l’oropharynx. En France, la proportion des tumeurs oropharyngées HPV-induites est mal connue, notamment parce que le dépistage viral n’est pas recommandé. De plus, il est difficile d’évaluer la proportion de tumeurs HPV positives dans les tumorothèques car les échantillons tumoraux sont fixés dans du formol puis inclus en paraffine (FFIP), ce qui complexifie les techniques de détection. Nous avons, au cours de nos travaux, testé une méthode de détection des HPV à haut risque oncogène indiquée pour le traitement des frottis en phase liquide. Nous l’avons mise à l’épreuve sur des prélèvements FFIP et comparée à la technique de référence qu’est la PCR (Polymerase Chain Reaction) suivie d’une électrophorèse sur gel. Nos résultats indiquent que cette technique est applicable aux prélèvements tissulaires et apparaît même comme étant plus sensible. En France, deux tiers des patients atteints de tumeurs des VADS sont pris en charge à des stades tardifs. Ceci s’explique en partie par l’absence de dépistage organisé de ces cancers. Nous avons donc mené une étude prospective sur des patients atteints d’une tumeur des VADS afin de tester le frottis oral comme technique de dépistage des cancers mais également des infections par les HPV. Nos résultats indiquent que le frottis a une spécificité proche de celle de la biopsie (94,4%) pour le dépistage des cancers des VADS, mais une moindre sensibilité (66,7%). Cette étude nous a permis de mettre en évidence une tumeur HPV-induite dans 12,2% des cas. Parmi eux, nous avons détecté grâce à un frottis buccal (en zone saine) une infection par un HPV à haut risque oncogène dans 53,3% des cas. L’OMS a classé les HPV comme agents carcinogènes depuis 1995, et a établi que les patientes ayant développé un cancer du col utérin avaient un risque 6 fois plus élevé de développer une autre tumeur HPV-induite. Dans ce contexte, nous avons prévu une étude prospective multi-centrique visant à dépister une infection orale par un HPV oncogène chez des patientes porteuses d’une lésion pré-néoplasique ou néoplasique du col utérin. Le taux de co-infection des deux sites anatomiques est inconnu chez les femmes infectées au niveau génital. Dans la mesure où l’infection orale pourrait être à l’origine d’une seconde localisation tumorale, il semble important d’en connaître la proportion afin de proposer par la suite un suivi particulier aux populations « à risque ». Au-delà des traitements des cancers avérés se pose la question de la vaccination préventive, qui existe contre les HPV 16 et 18 dans la prévention des cancers du col utérin. Le type 16 étant retrouvé dans 90% des tumeurs épidermoïdes de l’oropharynx HPV-induites, l’extension des recommandations vaccinales apparaît comme une nouvelle question de santé publique / The Human Papillomavirus (HPV) are involved in almost 100% of cervical cancers. Recently, HPVs have been recognized as the cause of tumors of the upper aerodigestive tract, especially of squamous cell carcinoma of the oropharynx. In France, the proportion of oropharyngeal HPV-related tumors is unknown, partly because viral testing is not in guidelines. Moreover, assess the proportion of HPV-positive tumors in tumor banks is difficult because the tumor samples were fixed in formalin and embedded in paraffin (FFPE), which complicates detection techniques. We tested a high risk HPV detection method, indicated for liquid based pap smear, on FFPE samples. We compared this technique to the gold-standard : PCR (Polymerase Chain Reaction) followed by electrophoresis. Our results indicate that this technique is applicable to FFPE samples and even appears to be more sensitive. The majority of French patients (2/3) with head and neck consult with an advanced stage of disease. This is explained in part by the lack of organized screening of these cancers, contrary to breast, prostate, cervical, or colorectal cancers. But an early treatment is essential to increase the survival rate. We therefore conducted a prospective study on patients with head and neck tumors to test the oral brushing as screening cancer and HPV detection. We found tumor and/or dystrophic cells in 97.8% of patients with biopsy, and in 88.9% of patients by brushing. Compared with biopsy, our results suggested that smear has similar specificity for HPV detection in tumors (94.4%), but lower sensitivity (66.7%). This study has shown an HPV-related tumor in 12.2% of cases. Among them, we detected by brushing (in healthy area) an oral infection by high-risk HPV in 53.3% of cases. WHO has classified HPV as carcinogenic agents since 1995, and determined that patients who developed cervical cancer are six-times more likely to develop another HPV-related tumor. In this context, we have planned a multicenter prospective study to detect oral HPV infection in patients with a pre-neoplastic or neoplastic lesion of the cervix. Co-infection rate of the two anatomical sites is unknown in women infected with genital level. Insofar oral infection could be the cause of a second tumor location, it seems important to know how much women are co-infected to propose thereafter a special monitoring. The preventive vaccination, which exists against HPV 16 and 18 in the prevention of cervical cancer, is a future perspective. Because HPV 16 is found in 90% of HPV-related squamous cell carcinoma of the oropharynx, extending vaccine recommendations emerge as a new public health issue

Ziel der Habilarbeit war die molekulargenetische und -zytogenetische Charakterisierung von Kopf-Hals-Karzinomen, um das biologische Verhalten dieser Tumoren besser einschätzen zu können als mit Hilfe der bekannten klinisch-pathologischen Tumorklassifikation. Dazu wurden 100 primäre Plattenepithelkarzinome des Kopf-Hals-Bereiches, 27 Fälle syn- oder metachroner Metastasen und 10 Fälle von Zweitkarzinomen mit Hilfe der Comparativen Genomischen Hybridisierung (CGH) analysiert. Alle untersuchten Tumoren stammten von Patienten, die primär im Zeitraum zwischen 1994 und 1998 in der HNO-Klinik der Charité operiert wurden. Die Auswertung der analysierten Tumoren brachte die nachfolgenden wesentlichen Ergebnisse: Plattenepithelkarzinome des Kopf-Hals-Bereiches sind durch Deletionen der Chromosomen 3p, 4p/q, 5q, 6q, 8p, 9p, 11p/q, 13q, 18q und 21q sowie DNA-Gewinne im Bereich von 1p, 3q, 5p, 8q, 9q, 11q13, 16p, 17q, 19, 20q und 22q. Gut differenzierte Tumoren sind durch Deletionen auf Chromosom 3p und 9p kombiniert mit einem DNA-Gewinn auf 3q gekennzeichnet. Die schlecht differenzierten Malignome zeigen zusätzlich die Deletionen von Chromosom 4, 5q, 8p, 11, 13q, 18q sowie 21q und die DNA-Gewinne von 8q, 11q13 sowie 20q.Der metastatische Phänotyp ist bei Kopf-Hals-Karzinomen durch Deletionen im Bereich der Chromosomen 10q und 11 charakterisiert.Als wichtigstes Ergebnis konnten zwei unabhängige genetische Prognosemarker für Kopf-Hals-Karzinome charakterisiert werden - die 11q13- und 3q-Amplifikation. In der multivariaten Cox-Regression zeigte sich, daß der Einfluß beider Parameter, besonders aber der 11q13-Amplifikation für die Einschätzung des rezidiv- und metastasenfreien sowie des Gesamtüberlebens der Patienten größer ist als der aller klinisch-pathologischen Parameter, insbesondere der TNM-Klassifikation. / Comparative Genomic Hybridization (CGH) was performed on 100 primary head and neck squamous cell carcinomas, 27 cases of lymph node metastases and 10 second primaries. The main results are summarized as follows: The entity of head and neck squamous cell carcinomas is characterized by a pattern of chromosomal alterations involving deletions chromosomes 3p, 4p/q, 5q, 6q, 8p, 9p, 11p/q, 13q, 18q and 21q combined with overrepresentations of chromosomes 1p, 3q, 5p, 8q, 9q, 11q13, 16p, 17q, 19, 20q and 22q.Well differentiated carcinomas (G1) carry deletions on chromosomes 3p and 9p together with the overrepresentation of 3q indicating early tumor development. Accordingly, the undifferentiated tumors (G3) were charaterized by addtional deletions on chromosomes 4, 5q, 8p, 11, 13q, 18q, 21q and overrepresentations on 8q, 11q13 and 20q suggesting that these changes are preferentially associated with tumor progression.The metastatic phenotype of head and neck suqamous cell carcinomas is significantly associated with deletions of chromosomes 10q and 11.The overall survival time as well as the recurrence free survival time were significantly lower in patients who's tumors showed amplifications of the chromosomal region 11q13 and/or overrepresentations of chromosome 3q (tested for significance by the log rank test p=0.0008 / p=0.0299). Multivariate analysis (Cox's proportional hazards model) revealed both chromosomal alterations as most important independent prognostic factors in HNSCC prior to the established TNM staging system.

Made available in DSpace on 2016-08-10T10:55:04Z (GMT). No. of bitstreams: 1 REBECCA FEILENBERGER DE OLIVEIRA MARTINS.pdf: 257286 bytes, checksum: 6e70b855d3a684a4e0a5686321976b67 (MD5) Previous issue date: 2006-08-08 / The present study had the objective of verifying if the treatment with ionizing rays given to patients with head and neck cancer could provoke medium-term changes in bone density of jaws. The sample covered twelve patients in treatment at the Radioteraphy Service of Araújo Jorge Hospital, in Goiânia city, Goiás, in the period of April of 2005 to January of 2006. To evaluate the risk factors associated to bone changes, the amostral population answered partly open questionnaires about their medical and oral health. The patients were submitted to oral clinic examinations and then directed to computerized tomography in the region of maxilla and mandible. All of them had malignant tumors of orophaynx and, after tomographies, were treated from injuries and lymphatic nodules with association of radio and chemotherapy. The radiation doses of the external beam ranged from 5000 to 7000 rad, in accordance with the staging of injury. After 127 to 266 days of the therapy with ionizing radiation, the sample was sent to a second computerized tomography exam in the region of jaws. The results of this inquiry had demonstrated that, in this interval of time, radiotherapy did not unchain qualitative alterations in the jaw bones that could be identificated. So, dental procedures or orthopedic and traumatologic surgeries, in mediumterm, are not contraindicated to patients treated with radiotherapy. / O presente estudo teve como objetivo verificar se o tratamento com raios ionizantes ministrado a pacientes com câncer de cabeça e pescoço poderia desencadear alterações na densidade óssea dos maxilares, a médio prazo. A amostra incluiu doze pacientes em tratamento junto ao Serviço de Radioterapia do Hospital Araújo Jorge, na cidade de Goiânia, Goiás, no período de abril de 2005 a janeiro de 2006. Para avaliar os fatores de risco associados às alterações ósseas, a população amostral respondeu a questionários semi-abertos sobre sua saúde médica e odontológica. Os pacientes foram submetidos a exames clínicos bucais e então encaminhados para exames de tomografia computadorizada na região de maxila e mandíbula. Todos possuíam tumores malignos de orofaringe e, após as tomografias, foram tratados das lesões e dos nódulos linfáticos com associação de rádio e quimioterapia. A dose de radiação do feixe externo oscilou entre 5000 e 7000 rads, de acordo com o estadiamento da lesão. Transcorridos de 127 a 266 dias da terapia por radiação ionizante, a amostra foi encaminhada para um segundo exame de tomografia computadorizada na região dos maxilares. Os resultados desta investigação demonstraram que, nesse intervalo de tempo, a radioterapia não desencadeou alterações qualitativas nos ossos maxilares passíveis de identificação. Nesse sentido, procedimentos odontológicos ou cirurgias ortopédicas e traumatológicas, a médio prazo, não estão contra-indicados a pacientes tratados com radioterapia.

O tratamento do câncer de cabeça e pescoço e a dificuldade de comunicação decorrente da laringectomia interferem de maneira significativa na qualidade de vida das pessoas acometidas, principalmente quanto aos aspectos funcionais, psicológicos e sociais. Este estudo teve como o objetivo avaliar a qualidade de vida relacionada à saúde (QVRS) de pessoas com câncer de cabeça e pescoço. Trata-se de um estudo exploratório com metodologia quantitativa, do tipo transversal. A coleta de dados foi realizada no período de maio a setembro de 2015, com 100 pessoas com câncer de cabeça e pescoço, divididas em dois grupos: G1: pessoas laringectomizadas, G2: pessoas não laringectomizadas. Para isto, foi utilizado um aplicativo de comunicação alternativa instalado em tablet e foram aplicados o Critério de Classificação Econômica Brasil (CCEB) e a escala Functional Assessment Cancer Therapy (FACT-H&N). Para a análise dos dados foram utilizados o teste exato de Fisher, teste de Kruskal-Wallis, Ancova e estatística descritiva. Como resultados observou-se a prevalência de pessoas do sexo masculino, com faixa etária entre 59 e 74 anos , casadas, aposentadas não ativas, com baixa escolaridade e baixo nível socioeconômico. Os sujeitos participantes de ambos os grupos avaliaram sua qualidade de vida global, de um modo geral, como satisfatória sendo que as funções mais acometidas foram: bem estar emocional e bem estar funcional. Quanto às comparações dos escores finais da escala, observa-se que os participantes do G1 apresentaram melhor QVRS do que os do G2 no escore FACT-G total score, o G1 apresentou melhor QVRS do que o G2, enquanto no FACT-H&N Total score e TOI o G2 apresentou resultados ligeiramente melhores, porém sem significância estatística. Quanto ao uso do LIVOX, todos os participantes que apresentaram alguma dificuldade no seu uso tinham mais de 58 anos e se declararam aposentados não ativos (p=0,04). Conclui-se que é importante o oferecimento, tanto no pré quanto no pós operatório, de cuidados que possam avaliar e melhorar a qualidade de vida relacionada à saúde das pessoas com câncer de cabeça e pescoço / The treatment of head and neck cancer and the communication difficulties resulting from laryngectomy significantly interfere in the quality of life of the affected people, especially regarding the functional, psychological and social aspects. This study aimed to assess the health-related quality of life (HRQoL) of people with head and neck cancer. This paper is an exploratory cross-sectional study with quantitative methodology. The data collection, which occurred between May and September of 2015, was carried out with 100 people with head and neck cancer, who were divided into two groups: G1: laryngectomized people, G2: non- laryngectomized people. To this end, an alternative communication application (LIVOX), installed on a tablet, was used, and the Brazilian Economic Classification Criteria (CCEB) and the Functional Assessment of Cancer Therapy (FAC-H&N) scale were applied. For the data analysis, the Fisher\'s exact test was used, as well as the Kruskal-Wallis test, the analysis of covariance (ANCOVA) and descriptive statistics. The observed results were the prevalence of people of the male sex, with ages between 59 and 74, married, inactive and retired, and with low education and socioeconomic status. The participant subjects of both groups evaluated their global quality of life as generally satisfactory, with the most affected functions being those of emotional and functional well-being. Regarding the scale\'s final scores comparison, it was observed that the G1 participants presented better HRQoL on the FACT-G total score than those of the G2, whereas the G2 presented slightly better results on the FACT-H&N and TOI, although with no statistical significance. As for the use of the LIVOX app, all participants who presented some sort of difficulty when using it were over 58 years old and declared themselves as inactive (p=0,04). It is therefore concluded that the illness and treatment process interferes in the subject\'s life, and that it is important to offer, at both preoperative and post-operative stages, the means for assessing and improving the health- related quality of life of people with head and neck cancer

Made available in DSpace on 2016-01-26T12:51:29Z (GMT). No. of bitstreams: 1 aneliserusso_dissert.pdf: 4806118 bytes, checksum: 0ae19d04c260950faf6788fde7ad65a0 (MD5) Previous issue date: 2011-05-24 / Some individuals may be present increased risk of developing cancer due to differences in biometabolism. Polymorphisms in xenobiotic metabolizing genes, such as family members of Cytochrome P450 (CYP), of Glutathione-S-Transferases (GSTs) and Microsomal Epoxide Hydrolase (mEH) show association with the carcinogenesis of head and neck. Objective: Identify the frequency of genes polymorphisms CYP1A1 (CYP1A1*2A and CYP1A1*2C), CYP2E1 (CYP2E1*5B and CYP2E*6), GSTT1 (null genotype), GSTM1 (null genotype), GSTP1 (A313G and C341T) and mEH (Tyr113His and His139Arg) in patients with head and neck cancer and in individuals with no cancer history (controls), to identify susceptibility biomarkers of this type of cancer. Methods: included 1,100 individuals, 375 patients with pathological diagnosis of squamous cell carcinoma of head and neck cancer and 725 controls. The variables analyzed were: age, sex, alcohol and tobacco, the occurrence primary site and progression of tumor. Genotyping of polymorphisms was performed by Polymerase Chain Reaction - Length Polymorphism, Restriction Fragment (PCR-RFLP), Real-Time PCR (RT-PCR) and multiplex PCR. Datas were evaluated by chi-square, univariate and multiple logistic regression. Results: Advanced age, smoking habits and alcohol consumption were predictors for the development of the head and neck tumors. The polymorphisms CYP2E1*5B (CYP2E1-PstI) and GSTP1 A313G were associated with this disease in univariable analysis. In multirariable analysis the interaction among CYP1A1*2C polymorphism with the female gender (OR= 0.10; 95% CI=0.01-0.72; p< 0.05) and alcohol no-habit (OR= 0.21; 95% CI=0.07-0.67; p< 0.05), mEH His139Arg and alcohol habit (OR= 0.49; 95% CI=0.27-0.90; p< 0.05), CYP2E1* 5B and habits tobacco and alcohol and &#8805;49 age (OR = 4.10; CI 95% 2.44-6.89; p < 0.001; OR = 1.93; CI 95% 1.18-3.16; p=0.0084; OR=9,10; CI 95% 5,86-14,14; p< 0,001, respectively) and GSTP1 A313G and tobacco and alcohol habits, &#8805;48 agea and male gender (OR=4.21; IC 95% 2.71-6.55; p<0.0001; OR=1.65; IC 95% 1.07-2.55; p=0.023; OR=12.37; IC 95% 7.89-19.38; p<0.0001, respectively); decrease the head and neck cancer risk; while CYP1A1*2A and tobacco and alcohol no-habits (OR= 2.84; 95% CI=1.01-7.97; p< 0.05; OR= 2.43; 95% CI=1.00-5.87; p< 0.05, respectively) increase this risk. The CYP2E1*5B polymorphism and tobacco no-habit (OR= 3.75; 95% CI=1.25-11.23; p< 0.05) also increases the risk for this disease. Showed high frequency of the polymorphisms CYP1A1*2C (OR= 2.48; 95% CI=1.00-6.20; p < 0.05) GSTT1 (OR= 3.35; 95% CI=1.67-6.72; p < 0.05) in patients group with primary tumors of larynx; while those who have the pharynx as the primary site GSTT1 (OR=0.29; 95% CI=0.12-0.71; p < 0.05) was less frequent. CYP1A1*2A (CYP1A1-MspI) polymorphism was associated with lymph node involvement and increased risk for cancer (OR =2.45; 95% CI= 1.07-5.64). Conclusion: Our data demonstrate that the interaction between polymorphisms in genes that encode enzymes involved in xenobiotic metabolism and the demographic and risk factors may modulate the development of head and neck cancer. / Alguns indivíduos podem apresentar risco aumentado de desenvolver o câncer devido às diferenças no biometabolismo. Polimorfismos em genes metabolizadores de xenobióticos, tais como os membros da família do Cytocromo P450 (CYP), das Glutatião-S-Transferases (GSTs) e Epóxido Hidrolase Microssomal (mEH) mostram associação com a carcinogênese de cabeça e pescoço. Objetivo: Identificar a frequência de polimorfismos dos genes CYP1A1 (CYP1A1*2A e CYP1A1*2C), CYP2E1 (CYP2E1*5B e CYP2E*6), GSTT1 (genótipo nulo), GSTM1 (genótipo nulo), GSTP1 (A313G e C341T) e mEH (Tyr113His e His139Arg) em pacientes com câncer de cabeça e pescoço e em indivíduos sem história de neoplasia (controles), visando identificar biomarcadores de suscetibilidade para este tipo de câncer. Casuística e Métodos: Foram incluídos no estudo 1.100 indivíduos, 375 pacientes com diagnóstico patológico de carcinoma de células escamosas de cabeça e pescoço e 725 controles. As variáveis analisadas foram: idade, sexo, consumo de álcool e tabaco, sítio primário de ocorrência de tumor e evolução da doença. A genotipagem dos polimorfismos foi realizada por Reação em Cadeia da Polimerase Polimorfismos de Comprimentos de Fragmento de Restrição (PCR-RFLP), PCR em Tempo Real (PCR-RT) e PCR multiplex. Os dados foram avaliados por Qui-quadrado e Regressão logística univariada e múltipla. Resultados: Idade acima de 49 anos, hábitos tabagista e etilista foram preditores para o desenvolvimento de neoplasias de cabeça e pescoço. Os polimorfismos CYP2E1*6 (CYP2E1-DraI) e GSTP1 A313G foram associados com esta doença na análise univariada. Na análise múltipla, a interação entre polimorfismo CYP1A1*2C com o gênero feminino (OR= 0,10; 95% CI=0,01-0,72; p< 0,05) e hábito não etilista (OR= 0,21; 95% CI=0,07-0,67; p< 0,05), mEH His139Arg e hábito etitlista (OR= 0,49; 95% CI=0,27-0,90; p< 0,05), CYP2E1* 5B e hábitos tabagista e etilista e idade &#8805;49 (OR = 4,10; CI 95% 2,44-6,89; p < 0,001; OR = 1,93; CI 95% 1,18-3,16; p = 0,0084; OR = 9,10; CI 95% 5,86-14,14; p < 0,001, respectivamente) e GSTP1 A313G e hábitos tabagista e etilista, idade &#8805;48 anos e gênero masculino (OR=4,21; IC 95% 2,71-6,55; p<0,0001; OR=1,65; IC 95% 1,07-2,55; p=0,023; OR=12,37; IC 95% 7,89-19,38; p<0,0001, respectivamente); diminui o risco de câncer de cabeça e pescoço; enquanto CYP1A1*2A e hábitos não tabagista e não etilista (OR= 2,84; 95% CI=1,01-7,97; p< 0,05; OR= 2,43; 95% CI=1,00-5,87; p< 0,05, respectivamente) aumentam este risco. O polimorfismo CYP2E1*5B e hábito não tabagista (OR= 3,75; 95% CI=1,25-11,23; p< 0,05) também aumenta o risco para esta doença. Foi observada uma alta frequência dos polimorfismos CYP1A1*2C (OR= 2,48; 95% CI=1,00-6,20; p < 0,05) GSTT1 (OR= 3,35; 95% CI=1,67-6,72; p < 0,05) no grupo de pacientes com tumores primários de laringe; enquanto naqueles que tem a faringe como sítio primário o polimorfismo GSTT1 (OR=0,29; 95% CI=0,12-0,71; p < 0,05) foi menos freqüente. O polimorfismo CYP1A1*2A foi associado com o envolvimento de linfonodo e risco aumentado para o câncer (OR=2,45; 95% CI=1,07-5,64). Conclusão: Nossos dados demonstram que a interação entre os polimorfismos em genes que codificam enzimas envolvidas no metabolismo de xenobióticos e os fatores demográficos e de risco podem modular o desenvolvimento do câncer de cabeça e pescoço.