RESUMEN
UNLABELLED: The main goals of the larynx preservation protocol are eradication of cancer and preservation of a functional larynx with maintenance of respiration, phonation and swallowing. Few studies, however have addressed functional outcomes. OBJECTIVE: Functional evaluation of oropharyngeal swallowing in patients enrolled in a larynx preservation protocol at the Hospital do Câncer AC Camargo. METHODS: Evaluation of swallowing was performed by videofluoroscopy in 31 patients, focusing on: oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration and severity of dysphagia. RESULTS: Swallowing analysis: 5 patients showed inefficient bolus preparation, 14 had changes in the bolus propulsion; 23 patients had a reduced laryngeal elevation, 26 presented with stasis in the vallecula and 14 with stasis in hypopharynx. Nine patients presented silent aspiration. We detected functional swallowing in 11 patients; mild dysphagia in 7; mild/moderate in 7; moderate in 3 and severe dysphagia in 3. CONCLUSION: Larynx preservation results in changes of swallowing, ranging in their majority from discrete to moderate. Some patients, however, developed severe dysphagia, and oral feeding was not possible.
Asunto(s)
Carcinoma de Células Escamosas/fisiopatología , Trastornos de Deglución/fisiopatología , Neoplasias Hipofaríngeas/fisiopatología , Neoplasias Laríngeas/fisiopatología , Adulto , Anciano , Antineoplásicos/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Cisplatino/uso terapéutico , Terapia Combinada , Trastornos de Deglución/etiología , Dispepsia/etiología , Femenino , Fluoroscopía , Humanos , Neoplasias Hipofaríngeas/complicaciones , Neoplasias Hipofaríngeas/tratamiento farmacológico , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Laríngeas/tratamiento farmacológico , Neoplasias Laríngeas/radioterapia , Masculino , Persona de Mediana Edad , Paclitaxel/análogos & derivados , Paclitaxel/uso terapéutico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Grabación en VideoRESUMEN
OBJETIVO: Avaliar a deglutição orofaríngea de pacientes submetidos a protocolo de preservação de laringe no Hospital do Câncer AC Camargo. MÉTODOS: De 43 pacientes com carcinoma epidermóide de laringe e hipofaringe tratados com quimioterapia semanal (paclitaxel 30 mg/m² e cisplatina 20 mg/m²) concomitante à radioterapia externa fracionada (180 cGy/dia, dose total 7040 cGy), foram avaliados 31 pacientes. A avaliação consistiu de videofluoroscopia. Os resultados foram classificados de acordo com alterações de motilidade orofaríngea, estases, aspiração e severidade da disfagia. RESULTADOS: alterações de fase preparatória e oral: estase em cavidade oral (58 por cento) e aumento do tempo de trânsito oral (32,3 por cento); fase faríngea: estase em valécula (83,9 por cento), redução da elevação laríngea (74,2 por cento), atraso no início da deglutição faríngea (51,6 por cento) e estase em hipofaringe (45,2 por cento). A deglutição funcional foi observada em 35,5 por cento dos pacientes, 54,8 por cento tinham disfagias discretas ou moderadas e 9,6 por cento disfagias severas. CONCLUSÃO: A associação de quimioterapia e radioterapia para preservação laríngea resulta em alterações da deglutição, na maior parte discretas a moderadas. Alguns pacientes, entretanto, evoluem com disfagia severa, em que a alimentação por via oral não é possível.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas/fisiopatología , Trastornos de Deglución/fisiopatología , Neoplasias Hipofaríngeas/fisiopatología , Neoplasias Laríngeas/fisiopatología , Antineoplásicos/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Cisplatino/uso terapéutico , Terapia Combinada , Trastornos de Deglución/etiología , Dispepsia/etiología , Fluoroscopía , Neoplasias Hipofaríngeas/complicaciones , Neoplasias Hipofaríngeas/tratamiento farmacológico , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Laríngeas/tratamiento farmacológico , Neoplasias Laríngeas/radioterapia , Paclitaxel/análogos & derivados , Paclitaxel/uso terapéutico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Grabación en VideoRESUMEN
BACKGROUND: The main goals of larynx preservation protocols are preservation of a functional larynx with intact voice and maintenance of normal deglutition. However, few studies have addressed functional outcomes. OBJECTIVES: To evaluate voice and swallowing in patients enrolled in a larynx preservation protocol. DESIGN AND SETTING: Acoustic analysis of 15 patients and videofluoroscopic evaluation of 14 patients who underwent chemoradiotherapy in an attempt to preserve the larynx. PATIENTS: Forty-three patients with larynx or hypopharynx squamous cell carcinomas were treated with weekly paclitaxel (30 mg/m2) and cisplatin (20 mg/m2) concurrent to radiotherapy (180-rad/d fraction [1.8 Gy] to 7040 rad [70.4 Gy]). Voice was analyzed perceptually and acoustically in 15 patients. Videofluoroscopic evaluation of swallowing was performed in 14 patients, focusing on oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration, and dysphagia severity. RESULTS: Vocal analysis produced normal results in 1 patient, mild dysphonia in 4, moderate dysphonia in 6, and severe dysphonia in 4. The mean fundamental frequency for acoustic analysis was 131.4 Hz for men and 109.8 Hz for women. Acoustic measures of perturbation and noise were above the reference limits, indicating changes in the voice signal. Swallowing analysis showed inefficient bolus preparation in 13 patients and changes in the bolus propulsion in 12. Stasis was observed in all areas of the oropharynx. Five patients had reduction in laryngeal elevation, and 12 had stasis in the hypopharynx. Five patients presented with silent aspiration. We detected functional swallowing in 3 patients, mild dysphagia in 7, mild or moderate dysphagia in 2, and severe dysphagia in 2. CONCLUSIONS: Laryngeal preservation resulted in voice and swallowing abnormalities, but they tend to be mild to moderate, allowing intelligible communication and efficient swallowing in most patients.