Laryngeal cancer treatment: review of literature published over the last ten years

Abstract:

The purpose of this study is to analyze the characteristics of the scientific bibliographic production about laryngeal cancer treatment in the last ten years. Cochrane Handbook precepts were followed that involved the formulation of the question to be investigated, the location, the studies selection and the critical assessment of the articles. The articles published between 2002 and 2011 were selected in LILACS and ScIELO database, using laringect$ descriptor and in PubMed database using the laringect* descriptor. Full texts were analyzed, potentially relevant for the review, using a standardized form, when the following data were collected: objectives, research design, findings and discussion about laryngeal cancer treatment. Initially 299 studies were identified. After reviewing titles and abstracts, considering inclusion and exclusion, verifying coherence with the research theme and eliminating those studies which were included in more than one database, 72 studies were actually analyzed as they referred to laryngeal cancer in their descriptors and/or abstracts. From this research it is possible to identify gaps and opportunities for the development of studies that verify standardized techniques of laryngeal cancer treatment with the increase of analytical and interventional studies based on randomized clinical trials, considering especially guidelines such as CONSORT, STROBE and GRADE for planning and publication.

Keywords:
Laryngectomy; Laryngeal Neoplasms; Tracheostomy; Therapeutics; Review; Complications

Resumo:

Este estudo tem como objetivo analisar as características da produção bibliográfica científica sobre o tratamento do câncer de laringe nos últimos dez anos. Foram seguidos os preceitos do Cochrane Handbook, que envolveu a formulação da questão a ser investigada, a localização, a seleção dos estudos e a avaliação crítica dos artigos. Os artigos publicados entre 2002 e 2011 foram selecionados por meio das bases de dados LILACS e ScIELO, utilizando-se o descritor laringect$ e na base de dados PubMed, utilizando-se o descritor laringect*. Analisaram-se os textos completos, potencialmente relevantes para a revisão, utilizando-se um formulário padronizado, quando os seguintes dados foram coletados: objetivos, desenho da pesquisa, resultados encontrados e discussão sobre o tratamento em câncer de laringe. Inicialmente foram identificados 299 estudos. Após a revisão dos títulos e resumos, consideração dos critérios de inclusão e exclusão, verificação da coerência com a temática pesquisada e eliminação dos estudos que estavam concomitantemente em mais de uma base de dados, 72 foram efetivamente analisados por referirem nos descritores e/ou nos resumos o tema câncer de laringe. A partir desta pesquisa, é possível verificar lacunas e oportunidades para o desenvolvimento de estudos que verifiquem técnicas padronizadas de tratamento do câncer de laringe com o aumento de estudos analíticos e de intervenção baseados em ensaios clínicos randomizados, especialmente considerando diretrizes como CONSORT, STROBE e GRADE para o seu planejamento e publicação.

Descritores:
Laringectomia; Neoplasias Laríngeas; Traqueostomia; Terapêutica; Revisão; Complicações

Introduction

Laryngectomy is a surgical procedure in which sometimes all the structures that produce laryngeal sound and from neighboring muscles are removed, transferring nasal flow to tracheostoma. Laryngectomies may be partial or total and tracheostomy may be temporary or definitive.

Total laryngectomy consists in removing the larynx, it implies the loss of physiological voice and in definitive tracheostomy an artificial hole is made in the trachea, below the larynx¹.

One of the reasons why this procedure is sometimes necessary when a person remains without these important structures is when cancer occurs¹.

According to data from INCA-National Cancer Institute, Brazil has a

high incidence of laryngeal malignant tumors, the second most frequent being the upper aerodigestive tract, accounting for 25% of head and neck malignant tumors and 2% of malignant neoplasms. Moreover, it is the sixth most common location in the male population of 40 years in average, with 3,369 deaths recorded in 2011. The treatment of laryngeal cancer depends on the location and extent, it can be treated with surgery and/or radiotherapy and chemotherapy combined with radiotherapy.

Due to the great importance of preserving the voice for the patient's quality of life, sometimes radiation therapy can be used first, leaving surgery for the salvage. In addition, even in patients who were submitted to total laryngectomy the rehabilitation of voice is possible through the esophageal voice, tracheo-esophageal phonation prosthesis¹ and the use of eletrolarynx².

Currently, many studies demonstrate the impact severity of laryngectomy on patients' quality of life. More precisely in the physical aspects (comfort and pain), personal, family, social and professional².

Communication ability is a fundamental element to the quality of life and all preventive action in this area will contribute significantly to promoting global health³.

Speech therapy has been trying to build its knowledge, directing its practices not only for the technological development, but also to widen formal content, social and political responsibility, contributing for the improvement of conditions of life in the population³.

The speech therapist who works in the public health needs updates that meet the guidelines and principles of the NHS, turning not only for rehabilitation therapy, but also for the promotion and prevention⁴.

In view of the need to know the topic, the advancements and gaps in the scientific knowledge accumulated in terms of laryngeal cancer the objective of the study is to analyze the bibliographic production indexed on partial and total laryngectomies in the last ten years.

Methods

Cochrane Handbook precepts were followed that involved the formulation of the question to be investigated, the location, the studies selection and the critical assessment of the articles. The question in the investigation that subsidized the review was: "Which are the characteristics of the scientific bibliographic productions on the laryngeal cancer treatment?".

In formulating the question for investigation, there was an attempt to do the bibliographic research on the central theme of this paper, based on LILACS, ScIELO and PubMed database. The following parameters were used: laringect$, for LILACS and ScIELO database (for abstract and title); and laringect* (abstract and title) for PubMed database.

Literature Review

Selection of the Articles

In this study articles published between 2002 and 2011 in journals indexed in LILACS, ScIELO and PubMed database available in full were included. This enabled a more detailed analysis of the characteristics of bibliographic productions on the treatment of laryngeal cancer.

For the selected articles the criteria for inclusion was the term used in the search, at least in one of the places: key-words, abstract and/or title. In addition, it was used as criteria for inclusion: complete articles published in Portuguese between the years 2002 and 2011, in LILACS, PudMed and/or Scielo database on the research theme.

Criteria for exclusion considered: texts with insufficient data for the study, studies not related to the objective of the research, texts found in more than one database and studies published outside the period related to the objective of the research.

Analysis of the Articles

Only those studies which abstract had a relationship with the objective of the study were evaluated and selected, and later the full articles were obtained. The complete texts were analyzed, potentially relevant for review, using a standardized form in which the following data was collected: objectives, research design, findings and discussion on the treatment of laryngeal cancer.

Initially, 299 studies were identified. After reviewing the titles and abstracts, as well as reviewing the studies considering the criteria for inclusion and exclusion, 72 studies were actually analyzed as they referred in their results and/or in their conclusions to the theme of laryngeal cancer (Figure 1).

Figure 1:
Schematic representation of the research method and results obtained: excluded and included studies

Results and Discussion

Analyzing all the articles selected for the research (Figure 2) it was found a large percentage from the medical sector that deals with the concern of these researchers, especially after the year 2007, regarding the use of surgical techniques for the treatment of laryngeal cancer. Many studies^{5 21} have been done with the aim to investigate the efficiency of different surgical methods with a view to the most satisfactory possible prognostic in these patients affected by cancer.

Figure 2:
List of studied articles published in LILACS and ScIELO on the treatment of larynx cancer

The articles were distributed from the point of view of the result studied: 39 articles included medical treatment aspects, 14 quality of life, 14 on voice and swallowing and 12 articles with more than one theme.

Speech therapy is included in publications on the treatment of laryngeal cancer, in studies dealing with rehabilitation of functions related to communications (in this case, especially oral communication)^{22 27}, evaluation of quality of life^{9 12 25 28 30}, swallowing rehabilitation^{9 28 30} and alterations of smell and taste³¹.

During the research it was also verified a considerable percentage of publications from the nursing sector related with the bio-psycho-social aspects directly linked to the rehabilitation and/or postoperative handling/care which the patients must be submitted to^{32 39}.

Few studies were found, from the psychology sector³⁶, and these, most of a descriptive character, referring to psycho-social aspects involved in the rehabilitation of patients affected by laryngeal cancer, a characteristic that was evident in this research and that are similar to the studies from the nursing sector^{32 35}, as described above.

It was noticed, mainly in the last five years, the concern of the authors^{5 36}to verify the association between quality of life/voice and quality of life/swallowing. It was observed also the interest in investigating the correlations between conservative surgical techniques and radical surgeries in obtaining positive prognostics, as well as the concern with the bio-psycho-social aspects of each patient, fact that points to the increase in the interest of professionals to promote a holistic treatment considering the various aspects involved in the rehabilitation of patients exposed to such condition.

The literature studied^{5 36}points to the importance of multidisciplinary interventions in the prevention and treatment of laryngeal cancer and highlights the importance of considering the patient's point of view when developing rehabilitation strategies, however, no article mentioned the multidisciplinary approach theme as their main focus.

Nevertheless, this review suggests some need regarding those publications that deal with the treatment of laryngeal cancer. From the analysis done it can be observed that the majority of papers are of a descriptive nature.

To analyze the effectiveness of the interventions it would be relevant that analytical studies were conducted and published, especially intervention studies, especially randomized clinical studies, considering the golden standard for the practice based on evidence regarding the attainment of standardized techniques of treatment, be it for rehabilitation using surgical techniques or not³⁷.

Among the intervention studies published it was observed that the recommendations for planning and publication of intervention studies are not always considered, which would result in an improvement in the quality of articles published as well as qualifying the available information³⁷.

An aspect that stood out in the literature research was the absence of mentioning the complications and adverse reactions, side effects and safety of treatments implemented both in the medical field as the techniques of voice rehabilitation. The mention of complications resulting from interventions or even adverse reactions is a relevant aspect in intervention studies of any nature, as normally these are present in a higher or lower rate in any type of intervention.

Conclusion

The characteristics of the publications related to the treatment of laryngeal cancer are mostly the result of medical and speech therapy areas, and there is a considerable number of publications in Nursing and few in Psychology.

From this research it is possible to verify the absence to mention adverse reactions, side effects and safety of treatments implemented both in the medical area and techniques of speech therapy rehabilitation, which use to be present in a higher or lower rate in any type of intervention.

There is space for the development of studies to verify standardized techniques of treatment of laryngeal cancer in Brazil with the increase of analytical studies and intervention based on randomized clinical studies, especially considering guidelines such as CONSORT, STROBE and GRADE for planning and publication^{37 40}.

The identification of characteristics and gaps in bibliographic productions on the theme contributes for the researchers of speech therapy disorders related to laryngeal cancer direct their studies to the solution of these demands. From this it will be possible to improve the strategies for the treatment already in existence and elaborate standardized techniques that contemplate the needs of the patient, contributing with subsidies that qualify the practice based on scientific evidence.

Referências

• ¹
  Caldas ASC, Facundes VLD, Silva HJ. Reabilitação das funções do olfato e do paladar em laringectomizados totais: revisão sistemática. Rev CEFAC. 2012;14(2):343-9.
• ²
  Carmo RD, Camargo Z, Nemr K. Relação entre qualidade de vida e auto-percepção da qualidade vocal de pacientes laringectomizados totais: estudo piloto. Rev CEFAC. 2006;8(4):518-28.
• ³
  Goulart BNG, Henckel C, Klering CE, Martini M. Fonoaudiologia e promoção da saúde: relato de experiência baseado em visitas domiciliares. Rev CEFAC. 2010;12(5):842-9.
• ⁴
  Celín SH, Gobbi FHA, Lemos SMA. Fonoaudiologia e humanização. In: 16° Congresso Brasileiro de Fonoaudiologia; 2008.
• ⁵
  Ballin AC, Filho EDM, Sela GB, Catani GS, Filho JMI, Ballin CH et al. Avaliação sistematizada da dificuldade de exposição das pregas vocais na microcirurgia da laringe. Arq. Int. Otorrinolaringol. 2010;14(3):294-301.
• ⁶
  Chedid HM, Amar A, Lehn CN, Franzi SA, Rapoport A. Avaliação dos fatores clínicos e do tratamento em pacientes com carcinoma epidermóide da laringe submetidos à cirurgia. Rev. Bras. Cir. Cabeça Pescoço. 2009;38(4):242-5.
• ⁷
  Meyer G, Silva GS, Sousa AA, Soares JMA, Salles JMP. Reconstrução de hipofaringe com retalho miocutâneo peitoral maior após faringolaringetomia total. Rev. Bras. Cir. Cabeça Pescoço. 2010;39(4):290-2.
• ⁸
  Ahumada NG, Oliveira CLA, Takimoto RM, Ferraz R. Grampeador no fechamento da faringe após laringectomia total: experiência de 7 anos. Rev. Bras. Cir. Cabeça Pescoço. 2011;40(3):144-7.
• ⁹
  Silva DCF, Takimoto RM, Gielow I ,Cervantes O. Avaliação da deglutição e da qualidade de vida relacionada à deglutição de indivíduos submetidos a laringectomia total: comparação entre as técnicas manual e mecânica (stapler) de reconstrução faríngea. Rev. Bras. Cir. Cabeça Pescoço. 2011;40(4):178-85.
• ¹⁰
  Dedivitis RA, Andrade Sobrinho J, Castro MAF. Fatores prognósticos e impacto da comorbidade na laringectomia fronto-lateral. Rev. Col. Bras. Cir. 2009;36(5):392-7.
• ¹¹
  Matos LL, Kanda JL, Pinto FR, Waisberg J, Henriques AC. Faringocoloplastia como reconstrução tardia pós-faringolaringectomia total por carcinoma espinocelular de hipofaringe: relato de caso e revisão da literatura. Arq Bras Ciên Saúde. 2009;34(2):108-12.
• ¹²
  Queija DS, Portas JG, Dedivitis RA, Lehn CN, Barros APB. Deglutição e qualidade de vida após laringectomia e faringolaringectomia total. Brazilian J. Otorhinolaryngol. 2009;75(4):556-64.
• ¹³
  Paula FC, Gama RR. Avaliação de qualidade de vida em laringectomizados totais. Rev. Bras. Cir. Cabeça Pescoço. 2009;38(3):177-82.
• ¹⁴
  Costa CC, Chagas JFS, Pascoal MBN, Aquino JLB, Martins LD, Brandi Filho LA. Técnica endoscópica para colocação secundária de prótese vocal em pacientes laringectomizados. Rev. Bras. Cir. Cabeça Pescoço. 2009;38(1):41-5.
• ¹⁵
  Dedivitis RA, Cruvinel Neto J, Navarro JN. Resultados da laringectomia horizontal supraglótica. Rev. Bras. Cir. Cabeça Pescoço. 2009;38(1):34-6.
• ¹⁶
  Sakae FA, Wiikmann C, Imamura R, Tsuji DH, Sennes LU. Tumor carcinóide atípico de laringe: 3 anos de acompanhamento clínico após tratamento cirúrgico conservador. Arq. Int. Otorrinolaringol. 2007;11(4):481-4.
• ¹⁷
  Maia Filho PC, Lopes L, Costa ALC, Zdanowski R, Dias FL, Marques A et al. Uso da cola de fibrina na prevenção de fistula faringocutânea em pacientes submetidos a laringectomia ou orofaringectomia. Rev. Bras. Cir. Cabeça Pescoço. 2008;37(2):100-3.
• ¹⁸
  Chone CT, Teixeira C, Andreollo NA, Spina AL, Barcelllos IHK, Quagliato E, et al. Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória. Rev Bras Otorrinolaringol. 2008;74(2):230-4.
• ¹⁹
  Queija DS, Ferreira AS, Portas JG, Dedivitis RA, Pfuetzenreiter Júnior EG, Bohn NP et al. Avaliação vocal e auto-percepção da desvantagem vocal (VHI) após laringectomia fronto-lateral.Rev. Bras. Cir. Cabeça Pescoço. 2007;36(2):95-9.
• ²⁰
  Dedivitis RA. Resultados na cirurgia conservadora do carcinoma espinocelular de laringe. Rev. Bras. Cir. Cabeça Pescoço. 2007;37(1):48-50.
• ²¹
  Campos GG, Reis JGC, Hadj LA, Araújo ML, Mello PP, Mello LFP. Laringectomia fronto anterior: técnica de Tucker. Estudo restrospectivo. Rev Bras Otorrinolaringol. 2004;70(2):171-6.
• ²²
  Takeshita TK, Zozolotto HC, Ricz H, Dantas RO, Ricz LA. Correlação entre voz e fala traqueoesofágica e pressão intraluminal da transição faringoesofágica. Pró-Fono R Atual Cient. 2010;22(4):485-90.
• ²³
  Kim JDU, Andrade NMM, Brescia MEG, Sugueno LA, Simões CA, Dedivitis RA et al. Nova técnica de confecção de fístula traqueoesofágica secundária e locação de prótese fonatória em pacientes submetidos a laringectomia total. Rev. Bras. Cir. Cabeça Pescoço. 2011;40(3):120-4.
• ²⁴
  Santos CB, Caria PHF, Tosello DO, Bérzin F. Comportamento dos músculos cervicais em indivíduos com fala esofágica e laringe artificial. Rev CEFAC. 2010;12(1):82-90.
• ²⁵
  Gadenz CD, Souza CH, Cassol M, Martins VB, Santana MG. Análise da qualidade de vida e voz de pacientes laringectomizados em fonoterapia participantes de um grupo de apoio. Distúrb Comum. 2011;23(2):203-15.
• ²⁶
  Chone CT, Seixas VO, Andreollo NA, Quagliato E, Barcelos IHK, Spina AL et al. Uso de manometria computadorizada para estudo do espasmo do segmento faringoesofágico em pacientes com voz traqueoesofágica inadequada antes e após aplicação de toxina botulínica. Brazilian J. Otorhinolaryngol. 2009;75(2):182-7.
• ²⁷
  Azevedo JF. Laringectomia e faringolaringectomia near-total a Pearson ampliadas: opções avançadas na preservação cirúrgica da voz. Rev Bras. Cir. Cabeça Pescoço. 2007;36(4):222-5.
• ²⁸
  Gomes TABF, Melo FR. Qualidade de vida do laringectomizado traqueostomizado. Rev. Bras. Cir. Cabeça Pescoço. 2010;39(3):199-205.
• ²⁹
  Cielo CA, Berwig LC, Wiethan FM, Schuster LC, Freitas GP, Urnau D. Reabilitação fonoaudiológica pós-laringectomia fronto-lateral sem aritenoidectomia: Relato de caso. Salusvita. 2011;30(1):21-37.
• ³⁰
  Pernambuco LA, Silva HJ, Nascimento GKBO, Silva EGF, Balata PMM, Santos VS et al. Atividade elétrica do masseter durante a deglutição após laringectomia total. Brazilian J. Otorhinolaryngol. 2011;77(5):645-50.
• ³¹
  Caldas ASC, Facundes VLD, Melo TMA, Dourado Filho MG, Pinheiro Júnior PF, Silva HJ. Alterações e avaliações das funções do olfato e do paladar em laringectomizados totais: revisão sistemática. J Soc Bras Fonoaudiol. 2011;23(1):82-8.
• ³²
  Bettinelli LA, Tourinho Filho H, Capoani P. Experiências de idosos após laringectomia total. Rev Gaúcha Enferm. 2008;29(2):214-20.
• ³³
  Matos RE, Soares E, Castro ME, Fialho AVM, Caetano JA. Dificuldades de comunicação verbal do cliente laringectomizado. Rev. enferm. UERJ. 2009;17(2):176-81.
• ³⁴
  Santana ME, Sawada NO. Fístula faringocutânea após laringectomia total: Revisão sistemática. Rev Latino-am Enfermagem. 2008;16(4):772-8.
• ³⁵
  Aquino VV, Zago MMF. O significado das crenças religiosas para um grupo de pacientes oncológicos em reabilitação. Rev Latino-am Enfermagem. [periódico na Internet]. Jan-Fev 2007 [acesso em 15 de outubro de 2013]; 15(1): [aproximadamente 6 p.]. Disponível em: http://www.scielo.br/pdf/rlae/v15n1/pt_v15n1a07.pdf
  » http://www.scielo.br/pdf/rlae/v15n1/pt_v15n1a07.pdf
• ³⁶
  Barbosa LNF, Francisco AL. Paciente laringectomizado total: perspectivas para ação clínica do psicólogo. Paidéia. 2011;21(48):73-81.
• ³⁷
  Martins J, Sousa LM, Oliveira AS. Recomendações do enunciado CONSORT para o relato de estudos clínicos controlados e randomizados. Medicina. 2009;42(1):9-21.
• ³⁸
  Dainesi SM, Aligieri P. Como as recomendações "consort" podem assegurar a qualidade dos relatos de estudos clínicos?. Rev Assoc Med Bras. 2005; 51(2):61-74.
• ³⁹
  Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saúde Pública. 2010;44(3):559-65.
• ⁴⁰
  Ministério da saúde. Diretrizes metodológicas: elaboração de pareceres técnico-científicos. 3ª edição revisada e atualizada. Brasília - DF, 2011.

Publication Dates

• Publication in this collection
  Aug 2015

History

• Received
  31 July 2013
• Accepted
  29 July 2014