Gois, Jucimara N.; Barbosa, Susana A.; Matos, Felipe R.; Cesar, Carla H.; Paranhos, Luiz Renato

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REVIEW ARTICLE • J. Bras. Patol. Med. Lab. 56 • 2020 • https://doi.org/10.5935/1676-2444.20200046 copiar

Deglutition manifestations in patients with oropharyngeal cancer subjected to conservative therapy: systematic review

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

Caracterizar la producción científica e identificar las alteraciones de deglución en personas con cáncer de orofaringe sometidas a tratamiento conservador.

Métodos:

Se realizó una búsqueda en cinco bases de datos electrónicas [Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine National Institutes of Health (PubMed), Web of Science y Scopus], además de la literatura gris en las bases de datos OpenThesis y OpenGrey, evitando sesgo de selección y publicación. Se consideraron elegibles los estudios longitudinales prospectivos sobre el tema: trastornos de deglución en pacientes con cáncer de orofaringe sometidos a tratamiento conservador. El riesgo de sesgo y la calidad metodológica individual de los estudios seleccionados se evaluaron mediante la herramienta de evaluación crítica del Instituto Joanna Briggs (JBI) para uso de sus revisiones sistemáticas, estudios prospectivos y longitudinales.

Resultados:

La búsqueda encontró 899 registros y, tras análisis, cuatro de ellos cumplieron los criterios de elegibilidad. Entre los estudios incluidos, todos los pacientes presentaron algún tipo de trastorno de la deglución. Los más frecuentes fueron: fuerza y retracción reducidas de la base de la lengua, retraso en el disparo de la deglución, elevación laríngea reducida, presencia de residuo en lengua y paladar, en región faríngea, valléculas y pared posterior de la faringe, así como en el interior de los vestíbulos y en los senos piriformes.

Conclusión:

Esta revisión sistemática sugiere que los tratamientos conservadores producen alteraciones de deglución o intensifican aquellas que ya existen, independientemente del tipo y de la intensidad de radiación, así como de la estadificación del tumor. Hay, sin embargo, poca estandarización en las metodologías de investigación, lo que hace difícil un estudio de metanálisis.

Palabras clave:
cáncer; orofaringe; radioterapia; quimioradioterapia; trastornos de deglución

Authors	Q.1	Q.2	Q.3	Q.4	Q.5	Q.6	Q.7	Q.8	Q.9	Q.10	Q.11	Total	% yes/risk of bias
Graner et al. (2003)	√	√	√	--	--	√	√	--	√	√	√	8	73%/low
Pauloski et al. (2006)	√	√	√	--	--	√	√	--	√	√	√	8	73%/low
Feng et al. (2007)	√	√	√	--	--	√	√	--	√	√	√	8	73%/low
Logemann et al. (2008)	√	√	√	--	--	√	√	√	√	√	√	9	82%/low

Database	Search strategy (January, 2019)	Results
LILACS (http://lilacs.bvsalud.org/)	• tw:((Dysphagia and Radiotherapy)) AND (instance:"regional") AND (db:("LILACS"))	49
	• tw:((Disfagia and Radioterapia)) AND (instance:"regional") AND (db:("LILACS"))	79
	• tw:((Dysphagia and Chemoradiotherapy)) AND (instance:"regional") AND ( db:("LILACS"))	4
	• tw:((Disfagia and Quimiorradioterapia)) AND (instance: "regional") AND (db:("LILACS"))	0
	• tw:((Deglutition Disorders and Radiotherapy)) AND (instance:"regional") AND (db:("LILACS"))	18
	• tw:((Deglutition Disorders and Chemoradiotherapy)) AND (instance:"regional") AND (db:("LILACS"))	1
	• tw:((Swallowing Disorders AND Radiotherapy)) AND (instance:"regional") AND (db:("LILACS"))	17
	• tw:((Swallowing Disorders AND Chemoradiotherapy)) AND (instance:"regional") AND (db:("LILACS"))	0
	• tw:((Dysphagia and Oropharyngeal Neoplasms)) AND (instance:"regional") AND (db:("LILACS"))	97
Scielo (http://www.scielo.org/)	Dysphagia and radiotherapy	32
	Disfagia and radioterapia	29
	Dysphagia and chemioradiotherapy	0
	Disfagia and quimioradiotherapy	1
	Deglutition disorders and radiotherapy	5
	Swallowing disorders and radiotherapy	9
	Dysphagia and oropharyngeal neoplasms	3
	Disfagia and cancer orofaringe	3
PubMed (http://www.ncbi.nlm.nih.gov/pubmed)	"Deglutition Disorders" [All Fields] OR "Swallowing Disorders" [All Fields] OR "Dysphagia" [All Fields] OR "Oropharyngeal Dysphagia" [All Fields] AND ("Oropharyngeal Neoplasms" [All Fields] OR "Oropharyngeal Cancers" [All Fields] OR "Oropharynx Cancer" [All Fields] OR "Oropharyngeal Neoplasm" [All Fields] OR "Pharyngeal cancer" [All Fields] AND "Radiotherapy" [All Fields] OR "Radiation Therapy" [All Fields] OR "Chemoradiotherapy"[All Fields]	186
Scopus (http://www.scopus.com/)	(("Deglutition Disorders" OR "Swallowing Disorders" OR "Dysphagia") AND ("Oropharyngeal Neoplasms" OR "Oropharyngeal Cancers" OR "Pharyngeal cancer") AND ("Radiotherapy" OR "Radiation Therapy" OR "Chemoradiotherapy"))	317
Web of Science (http://apps.webofknowledge.com/)	(("Deglutition Disorders" OR "Swallowing Disorders" OR "Dysphagia" OR "Oropharyngeal Dysphagia") AND ("Oropharyngeal Neoplasms" OR "Oropharyngeal Cancers" OR "Oropharynx Cancer" OR "Oropharyngeal Neoplasm" OR "Pharyngeal cancer") AND ("Radiotherapy" OR "Radiation Therapy" OR "Chemoradiotherapy"))	43
OpenThesis (http://www.openthesis.org/)	("Deglutition Disorders" OR "Swallowing Disorders" OR "Dysphagia") AND ("Oropharyngeal Neoplasms" OR "Oropharyngeal Cancers" OR "Pharyngeal cancer") AND ("Radiotherapy" OR "Radiation Therapy")	6
OpenGrey (http://www.opengrey.eu/)	"Deglutition Disorders" AND "Chemorradiotherapy"	0
Total		899

Author and year	Study location	Sample	Age range	Type of study	Evaluation	Cancer site	Staging	Type of treatment/ volume of dosage	Follow-up period
Graner et al. (2003)	Minnesota	- 11 individuals - 7 men - 4 women	37 to 78 years	Longitudinal and prospective	Videofluoroscopy	Oropharynx, hypopharynx and larynx	Stages III and IV	Dose fracionada 72 Gy and 150 mg/m²	Before treatment and five months after
Pauloski et al. (2006)	Washington	- 170 individuals - 132 men - 38 women	34 to 80 years	Longitudinal and prospective	Videofluoroscopy	Nasopharynx, oral cavity, oropharynx, hypopharynx and larynx	Stage IV	22 - Radiotherapy 147 - Chemoradiotherapy (total dose 6947 to 6919 cGy)	Before treatment, one, three, six and 12 months after
Feng et al. (2007)	Michigan	- 36 individuals - 30 men - 6 women	Average 56 years	Longitudinal and prospective	Videofluoroscopy	Nasopharynx and oropharynx	Stages III and IV	-	Before treatment and three months after
Logemann et al. (2008)	New York	- 48 individuals - 38 men - 10 women	38 to 76 years	Longitudinal and prospective	Videofluoroscopy	Nasopharynx, oropharynx, hypopharynx and larynx	Stages I, II, III, and IV	36 - Chemoradiotherapy 12 - Radiotherapy (total dose 6500 to 7920 cGy)	Before treatment, three, and 12 months after

Authors	Reduced tongue-base retraction		Reduced laryngeal elevation		Delayed pharyngeal swallowing		Presence of pyriform sinuses residue		Vallecule residue		Incomplete cricopharyngeal closure		Aspiration
Authors	Before	After	Before	After	Before	After	Before	After	Before	After	Before	After	Before	After
Graner et al. (2003)	45%	82%^* * p < 0.05.	45%	82%^* * p < 0.05.	27%	36%	21%	60%	36%	72%	18%	36%	15%	45%
Pauloski et al. (2006)	-	-	14.6%	26.9%*	-	-	-	-	-	-	10.3%	37.5%	-	-
Feng et al. (2007)	61%	92%^* * p < 0.05.	22%	67%^* * p < 0.05.	-	-	14%	19%	28%	48%	58%	61%	8%	47%^* * p < 0.05.
Logemann et al. (2008)	68%	84%^* * p < 0.05.	5%	26%	37%	53%	0%	16%	-	-	-	-	-	-

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E-mail: jbpml@sbpc.org.br

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[1] CORRESPONDING AUTHOR: Jucimara Nascimento Gois, 0000-0003-4951-7652. e-mail: jucimara02@hotmail.com