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Tumores malignos de cabeça e pescoço em pacientes com menos de 18 anos de idade

Head and neck tumors in patients under the age of eighteen years

Resumos

A conduta ideal para os pacientes menores de 18 anos portadores de tumores malignos da região de cabeça e pescoço não é uniforme nos escassos relatos de literatura. Com o objetivo de mostrar e discutir a experiência no atendimento de cinqüenta casos tratados no Serviço de Cirurgia de Cabeça e Pescoço do Complexo Hospitalar Heliópolis, no período de 1978 a 1994, os autores procederam a uma análise retrospectiva de sua casuística. Os tipos histológicos mais freqüentes foram os derivados da linhagem epitelial, 24 casos (48%) e, entre eles, o carcinoma mucoepidermóide. Entre os tumores derivados do tecido mensequimal, os mais freqüentes foram o rabdomiossarcoma e os linfomas. A cavidade oral foi o sítio mais freqüentemente acometido (15 casos, 30%). Entre todos os pacientes, apenas 21 (42%) estavam vivos e sem evidência de doença em atividade por um período que variou de seis meses a 18 anos. Quatorze (28%) pacientes morreram em decorrência de doença não controlada após um período que variou de dez dias a dois anos a contar da data do final do tratamento. De quatorze (28%) pacientes não pudemos obter informações atualizadas de suas condições e foram considerados perdidos de seguimento. Estes tumores não devem ser vistos como neoplasias de adultos localizadas em pacientes pediátricos; devem ser estudados e abordados como uma doença que apresenta características próprias e que exigem, como no adulto, que a primeira intervenção para o diagnóstico ou para o tratamento não seja intempestiva e, de fato, tenha resolubilidade.

Neoplasia maligna de cabeça e pescoço; Neoplasia maligna na infância; Tratamento de neoplasia maligna de cabeça e pescoço; Carcinoma e sarcomas na infância


The management of the head and neck tumors in patients under 18 years of age is not uniform in the few reports of the literature. With the objective of showing and to discuss the experience on the treatment of fifty cases of the Head & Neck Service of Heliópolis Hospital, São Paulo, Brazil, between 1978 to 1994, the authors have prepared this retrospective study. The most frequent histologic types were the ones of epithelial origin (24 cases, 48%) and of them, the mucoepidermoid carcinoma. The rhabdomyosarcoma and the lymphomas were the most prevalent mesenchimal tumor. The oral cavity was the primary site more frequently involved (15 cases, 30%) and most of them were located on the lower geim. Ten patients with oral tumors were alive after a minimum of seven years of follow-up. In six cases the primary site was the parotid gland and in one case the tumor was of the submandibular gland. Unfortunately the prognosis of these cases could not be evaluated because only few cases had a closed ollow-up. The thyroid gland was the primary site in five patients, all with the pathologic diagnosis of papillary carcinoma and all of them were alive. The overall survival analysis show that of fifty cases, only 21 (42%) patients are alive and without disease for period of six months to 18 years of follow up. Fourteen (28%) patients died of the cancer,ten days to two years from the end of the treatment. The radiotherapy alone or in association with surgery should be evaluated very carefully in order to avoid the risk of complications and second primary tumors induced by irradiation. These tumors should not be considered as tumors of adulthood that developed in pediatric patients. They are a disease with well defined characteristics and need, as for adults, that the first approach for diagnosis or treatment be suitable and with high effectiveness.

Head and neck tumors; Cancer in childhood; Treatment of head and neck tumors; Carcinomas and sarcomas in children


ARTIGOS ORIGINAIS

Tumores malignos de cabeça e pescoço em pacientes com menos de 18 anos de idade

Head and neck tumors in patients under the age of eighteen years

Marcos Brasilino de CarvalhoI; Abrão Rapoport, TCBC-SPII; Antonio Sérgio FavaIII; Jossi L. KandaIII; Ricardo Pires de SouzaIII; Augusto F. MendesIV

IChefe do Serviço de Cirurgia de Cabeça e Pescoço

IICoordenador do Curso de Pós-Graduação do Serviço de Cirurgia de Cabeça e Pescoço

IIIMembros do Serviço de Cirurgia de Cabeça e Pescoço

IVEx-Residente do Serviço de Cirurgia de Cabeça e Pescoço

Endereço para correspondência Endereço para correspondência: Dr. Marcos Brasilino de Carvalho Rua Cônego Xavier, 276 - 9° andar 04231-030 - São Paulo - SP

RESUMO

A conduta ideal para os pacientes menores de 18 anos portadores de tumores malignos da região de cabeça e pescoço não é uniforme nos escassos relatos de literatura. Com o objetivo de mostrar e discutir a experiência no atendimento de cinqüenta casos tratados no Serviço de Cirurgia de Cabeça e Pescoço do Complexo Hospitalar Heliópolis, no período de 1978 a 1994, os autores procederam a uma análise retrospectiva de sua casuística. Os tipos histológicos mais freqüentes foram os derivados da linhagem epitelial, 24 casos (48%) e, entre eles, o carcinoma mucoepidermóide. Entre os tumores derivados do tecido mensequimal, os mais freqüentes foram o rabdomiossarcoma e os linfomas. A cavidade oral foi o sítio mais freqüentemente acometido (15 casos, 30%). Entre todos os pacientes, apenas 21 (42%) estavam vivos e sem evidência de doença em atividade por um período que variou de seis meses a 18 anos. Quatorze (28%) pacientes morreram em decorrência de doença não controlada após um período que variou de dez dias a dois anos a contar da data do final do tratamento. De quatorze (28%) pacientes não pudemos obter informações atualizadas de suas condições e foram considerados perdidos de seguimento. Estes tumores não devem ser vistos como neoplasias de adultos localizadas em pacientes pediátricos; devem ser estudados e abordados como uma doença que apresenta características próprias e que exigem, como no adulto, que a primeira intervenção para o diagnóstico ou para o tratamento não seja intempestiva e, de fato, tenha resolubilidade.

Unitermos: Neoplasia maligna de cabeça e pescoço; Neoplasia maligna na infância; Tratamento de neoplasia maligna de cabeça e pescoço; Carcinoma e sarcomas na infância.

ABSTRACT

The management of the head and neck tumors in patients under 18 years of age is not uniform in the few reports of the literature. With the objective of showing and to discuss the experience on the treatment of fifty cases of the Head & Neck Service of Heliópolis Hospital, São Paulo, Brazil, between 1978 to 1994, the authors have prepared this retrospective study. The most frequent histologic types were the ones of epithelial origin (24 cases, 48%) and of them, the mucoepidermoid carcinoma. The rhabdomyosarcoma and the lymphomas were the most prevalent mesenchimal tumor. The oral cavity was the primary site more frequently involved (15 cases, 30%) and most of them were located on the lower geim. Ten patients with oral tumors were alive after a minimum of seven years of follow-up. In six cases the primary site was the parotid gland and in one case the tumor was of the submandibular gland. Unfortunately the prognosis of these cases could not be evaluated because only few cases had a closed ollow-up. The thyroid gland was the primary site in five patients, all with the pathologic diagnosis of papillary carcinoma and all of them were alive. The overall survival analysis show that of fifty cases, only 21 (42%) patients are alive and without disease for period of six months to 18 years of follow up. Fourteen (28%) patients died of the cancer,ten days to two years from the end of the treatment. The radiotherapy alone or in association with surgery should be evaluated very carefully in order to avoid the risk of complications and second primary tumors induced by irradiation. These tumors should not be considered as tumors of adulthood that developed in pediatric patients. They are a disease with well defined characteristics and need, as for adults, that the first approach for diagnosis or treatment be suitable and with high effectiveness.

Key words: Head and neck tumors; Cancer in childhood; Treatment of head and neck tumors; Carcinomas and sarcomas in children.

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Full text available only in PDF format.

REFERÊNCIAS

1. Van der Laan BFAM, Baris G, Gregor RT, et al. Radiation-induced tumors of the head and neck. J Laryngol Otol 1995;109:346-9.

2. Jaffe BF. Pediatric head and neck tumors: a study of 178 cases. Laryngoscope 1973;83:1.644-51.

3. Son YH, Knapp DS. Oral cavity and oropharyngeal cancer in a younger population. Cancer 1985;55:441-4.

4. Sarkaria JN, Harari PM. Oral tongue cancer in young adults less than 40 years of age: rationale for agressive therapy. Head & Neck 1994;16:107-11.

5. Pratt CB, Douglass EC. Management of the less common cancers of childhood, In Pizzo PA & Poplack DG: Principles and Pratice of Pediatric Oncology, JB Lippincott Company, Philadelphia p:913- 938,1989.

6. Senter TP. Letter to the editor. Cancer 1989;64(3):781-2.

7. Grob JJ, Breton A, Bonate JL, et al. Keratitis, Ichthyosis, and deafness (kid) syndrome. Arch Dermatol 1987;123:777-82.

8. Kraemer KH, Lee MM, Scotto J. Xeroderma pigmentosum. Arch Dermatol 1987;123:241-50.

9. Kaplan MJ, Sabio H, Wanebo HJ, et al. Squamous cell carcinoma in the immunosuppressed patient: Fanconi's anemia. Laryngoscope 1985;95:771-4.

10. Nuutinen J, Karja J, Sainio P. Epithelial second malignant tumors in retinoblastoma survivors. Acta Ophtalmologica 1982;60: 133-40.

11. Conley J & Tinsley P. Treatment and prognosis of mucoepidermoid carcinoma in the pediatric age group. Arch Otolaryngol 1985; 111: 322-24.

12. Anderson GJ, Lawrence WC, Womer RB, et al. Rabdomyosarcoma of the head and neck in children. Arch Otolaryngol Head Neck Surg 1990;116:428-31.

13. Ferreiro JA & Weiland LH. Pediatric surgical pathology of head and neck. Sem Ped Surg 1994;3:168-81.

14. Brugère J. Tumors of head and neck. In: Bloom HJG: Cancer in children: clinical management, UICC Springer, Verlag, Berlin p:288- 299,1975.

15. Jaques DA, Krolls SO, Chambers RG. Parotid tumors in children. Am J Surg 1976;132:469-71.

16. Nasri S, Mark RJ, Sercarz JA, et al. Pediatric sarcomas of the head and neck other than rhabdomiosarcoma. Am J Otolaryngol 1995; 16:165-71.

17. Horowitz ME, Pratt CB, Weber BL, et al. Therapy of childhood soft tissue sarcomas other than rhabdomyosarcoma: a review of 62 cases treated at a single institution. J Clin Oncol 1986;4:559-64.

18. Hidalgo DA, Shenaq SM, Larson DL. Mandibular reconstruction in the pediatric patient. Head & Neck 1996;18:359-65.

19. Jerkin RDT, Anderson JR, Jereb B, et al. Nasopharyngeal carcinoma- a retrospective review of patients less than thirty years of age. Cancer 1981;47:360-6.

Recebido em 19/5/97

Aceito para publicação em 14/8/97

Trabalho realizado no Serviço de Cirurgia de Cabeça e Pescoço do Complexo Hospitalar Heliópolis.

  • 1. Van der Laan BFAM, Baris G, Gregor RT, et al. Radiation-induced tumors of the head and neck. J Laryngol Otol 1995;109:346-9.
  • 2
    Jaffe BF. Pediatric head and neck tumors: a study of 178 cases. Laryngoscope 1973;83:1.644-51.
  • 3. Son YH, Knapp DS. Oral cavity and oropharyngeal cancer in a younger population. Cancer 1985;55:441-4.
  • 4. Sarkaria JN, Harari PM. Oral tongue cancer in young adults less than 40 years of age: rationale for agressive therapy. Head & Neck 1994;16:107-11.
  • 5
    Pratt CB, Douglass EC. Management of the less common cancers of childhood, In Pizzo PA & Poplack DG: Principles and Pratice of Pediatric Oncology, JB Lippincott Company, Philadelphia p:913- 938,1989.
  • 6. Senter TP. Letter to the editor. Cancer 1989;64(3):781-2.
  • 7. Grob JJ, Breton A, Bonate JL, et al. Keratitis, Ichthyosis, and deafness (kid) syndrome. Arch Dermatol 1987;123:777-82.
  • 8. Kraemer KH, Lee MM, Scotto J. Xeroderma pigmentosum. Arch Dermatol 1987;123:241-50.
  • 9. Kaplan MJ, Sabio H, Wanebo HJ, et al. Squamous cell carcinoma in the immunosuppressed patient: Fanconi's anemia. Laryngoscope 1985;95:771-4.
  • 10. Nuutinen J, Karja J, Sainio P. Epithelial second malignant tumors in retinoblastoma survivors. Acta Ophtalmologica 1982;60: 133-40.
  • 11. Conley J & Tinsley P. Treatment and prognosis of mucoepidermoid carcinoma in the pediatric age group. Arch Otolaryngol  1985; 111: 322-24.
  • 12. Anderson GJ, Lawrence WC, Womer RB, et al. Rabdomyosarcoma of the head and neck in children. Arch Otolaryngol Head Neck Surg 1990;116:428-31.
  • 13. Ferreiro JA & Weiland LH. Pediatric surgical pathology of head and neck. Sem Ped Surg 1994;3:168-81.
  • 14
    Brugère J. Tumors of head and neck. In: Bloom HJG: Cancer in children: clinical management, UICC Springer, Verlag, Berlin p:288- 299,1975.
  • 15. Jaques DA, Krolls SO, Chambers RG. Parotid tumors in children. Am J Surg 1976;132:469-71.
  • 16. Nasri S, Mark RJ, Sercarz JA, et al. Pediatric sarcomas of the head and neck other than rhabdomiosarcoma. Am J Otolaryngol 1995; 16:165-71.
  • 17. Horowitz ME, Pratt CB, Weber BL, et al. Therapy of childhood soft tissue sarcomas other than rhabdomyosarcoma: a review of 62 cases treated at a single institution. J Clin Oncol 1986;4:559-64.
  • 18. Hidalgo DA, Shenaq SM, Larson DL. Mandibular reconstruction in the pediatric patient. Head & Neck 1996;18:359-65.
  • 19. Jerkin RDT, Anderson JR, Jereb B, et al. Nasopharyngeal carcinoma- a retrospective review of patients less than thirty years of age. Cancer 1981;47:360-6.
  • Endereço para correspondência:

    Dr. Marcos Brasilino de Carvalho
    Rua Cônego Xavier, 276 - 9° andar
    04231-030 - São Paulo - SP
  • Datas de Publicação

    • Publicação nesta coleção
      05 Ago 2010
    • Data do Fascículo
      Abr 1998

    Histórico

    • Aceito
      14 Ago 1997
    • Recebido
      19 Maio 1997
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