Complicações bucais da radioterapia em cabeça e pescoço

Abstract

A radioterapia é uma forma terapêutica amplamente utilizada para o tratamento das neoplasias malignas da cabeça e pescoço. Porém, altas doses de radiação em extensos campos que irão incluir a cavidade bucal, maxila, mandíbula e glândulas salivares freqüentemente resultam em diversas reações indesejadas. Dentre as complicações da radioterapia estão a mucosite, candidose, disgeusia, cárie por radiação, osteorradionecrose, necrose do tecido mole e xerostomia. OBJETIVO: O objetivo deste artigo é fazer uma breve revisão das reações adversas que podem ser detectadas durante o tratamento radioterápico em região de cabeça e pescoço. MÉTODO: A literatura pertinente que trata do assunto foi revisada. FORMA DE ESTUDO: Revisão de literatura. RESULTADOS: A radioterapia ainda está associada a diversas reações adversas, que afetam de forma significativa a qualidade de vida dos pacientes. CONCLUSÕES: O tratamento multidisciplinar, incluindo a equipe médica, o cirurgião-dentista, o fonoaudiólogo, o nutricionista e o psicólogo é a melhor alternativa para minimizar ou mesmo prevenir tais complicações.

Evaluation of acute radiation effects on mandibular movements of patients with head and neck cancer

“…Radiotherapy (RT) is a modality used in the treatment of malignant tumors which the therapeutic agent is the ionizing radiation, i.e. that one which promotes ionization in the environment where charged, turning it electrically unstable 11,12 . By creating unstable atoms whose free electrons join to other adjacent atoms, which also become unstable with increased negative charges, damage to the cellular deoxyribonucleic acid (DNA) occurs, preventing the replication of the neoplastic cell 13 .…”

“…Most of patients undergoing RT for head and neck receive a total dose from 50 to 70 Gray (Gy) as a curative dose. These doses are fractionated in a period from five to seven weeks, once a day, five days a week, with daily dose of approximately 2 Gy 8,11,15 . The side effects of RT established for the treatment of patients with H&NC significantly interfere on the quality of life of these individuals 16 .…”

“…The side effects of RT established for the treatment of patients with H&NC significantly interfere on the quality of life of these individuals 16 . Among the effects located in the head and neck area it may be mentioned: mucositis, dermatitis, dry mouth, hypogeusia, osteoradionecrosis, fibrosis and trismus 4,11,13,15 . Radiation-induced trismus, a reduced mobility of the jaw 17,18 due to the fibrosis that occurs in the masticatory muscles when they are in the radiation field 5,[17][18][19] has a negative impact on the quality of life of the patients 5,13 , as it causes alterations in the facial appearance 18 , difficulty in food intake 5,10,20 , in the use of dental prostheses 10 and in the speech 5 , compromises the oral hygiene 5,19 and it may lead to depression 5 .…”

“…In addition, some authors 17,25 confirm the direct influence of this therapy associated with chemotherapy in the emergence of this complication, while other authors 5 disagree. Due to the contradictory data in the scientific literature with regards to the appearance of radiation-induced trismus in the course of irradiation therapy and the high rate of patients with H&NC undergoing high doses of RT in extensive radiation fields 11 , there is a need to better investigate the occurrence of possible changes in the mandibular mobility in irradiated patients, as well as which associated factors would be involved in the onset of these complications, so that after this investigation, data for prevention programs and/or reduction of such dysfunctions may be provided.…”

Punica granatum Linn. prevention of oral candidiasis in patients undergoing anticancer treatment

“…The irradiated patients have a higher trend to develop oral infections caused by fungi and bacteria 7 . The increased risk of oral candidiasis is probably caused by the fall of salivary flow as a consequence of radiotherapy.…”