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Tumores da cavidade oral e orofaringe : abordagens terapêuticas atuais e futuras
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Os tumores da cavidade oral e orofaringe integram o conjunto de neoplasias comummente apelidado de tumores de cabeça e pescoço, apresentando atualmente morbimortalidade importante e estando intimamente relacionados com fatores ambientais como o consumo abusivo de álcool, tabaco e exposição ao HPV. O tipo histológico mais prevalente e sobre o qual têm incidido os progressos terapêuticos é o carcinoma pavimento-celular. As opções terapêuticas atualmente disponíveis produzem um conjunto de efeitos adversos considerável - disfagia, disfonia, xerostomia e trismo – que complexificam a abordagem destes doentes e motivam a procura de soluções menos invasivas, mais dirigidas e mais eficazes. Na esfera das estratégias cirúrgicas minimamente invasivas, a cirurgia robótica trans-oral (TORS) apresenta uma redução significativa da mobilidade peri-operatória sem prejuízo dos outcomes oncológicos obtidos convencionalmente. No que à terapêutica biológica/molecular diz respeito, o targetting de recetores de superfície celular como o EGFR, o VEGFR e proteínas com atividade tirosina-cinase apresenta potencial terapêutico comprovado e impacto positivo na sobrevida dos doentes. A fração dos indivíduos com tumores HPV-positivos suscitaram igualmente o interesse pela aplicação de vacinas profiláticas e terapêuticas no contexto deste subtipo tumoral, bem como em programas de de-escalation menos agressivos. Novos alvos terapêuticos estão atualmente em estudo, encompassando a descoberta de adicionais mecanismos fisiopatológicos responsáveis pelas neoplasias em questão. A temática carece de estudos de coorte com amostra considerável e metaanálises; esforços deverão ser igualmente encetados no sentido de analisar a real eficácia terapêutica das novas abordagens moleculares aos doentes da cavidade oral e orofaringe. A sua prevenção primária e a adoção de medidas na área de Saúde Pública que promovam a evicção dos fatores ambientais etiológicos, bem como o diagnóstico precoce das lesões, deverão acompanhar a evolução do conhecimento científico e abordagem ao doente.
Oral cavity and oropharyngeal tumors fall under the commonly denominated head & neck tumors and are currently responsible for significant morbidity-mortality rates, having also been associated with numerous environmental triggers like the abusive consumption of alcohol, tobacco and HPV exposure. The squamous cell carcinoma is the most prevalent histological subtype and on which major scientific research has focused. The available treatment options lead to an important number of adverse effects - dysphagia, dysphonia, voice production deficits and trismus - that complexify the standard patient approach and resulted in the search for less invasive, more targeted and efficient solutions. Trans-oral robotic surgery (TORS) stands out within the minimally invasive surgical procedures due to an effective reduction of peri-operatory morbidity without affecting oncological outcomes. In terms of biological/molecular weapons, the targetting of cell-surface receptors such as EGFR, VEGFR and tyrosine-kinase proteins has demonstrated potential therapeutic efficacy and a positive impact on patients’ overall survival. Because of the relevant incidence of HPV-positive tumors, there is growing interest in the adoption of prophylactic and therapeutic vaccines within the context, as well as less aggressive de-escalation programs. In line with the multiple new disease mechanisms found, new targets are currently under investigation as well. For now, the proposed topic is lacking big cohort studies and meta-analysis; there is also the need of additional effort put into analyzing the new molecular approaches’ real efficacy. It is crucial that primary prevention and the implementation of Public Health strategies focusing on the promotion of an early diagnosis and environmental triggers’ eviction can ultimately encompass the scientific research and patients’ approach.
Oral cavity and oropharyngeal tumors fall under the commonly denominated head & neck tumors and are currently responsible for significant morbidity-mortality rates, having also been associated with numerous environmental triggers like the abusive consumption of alcohol, tobacco and HPV exposure. The squamous cell carcinoma is the most prevalent histological subtype and on which major scientific research has focused. The available treatment options lead to an important number of adverse effects - dysphagia, dysphonia, voice production deficits and trismus - that complexify the standard patient approach and resulted in the search for less invasive, more targeted and efficient solutions. Trans-oral robotic surgery (TORS) stands out within the minimally invasive surgical procedures due to an effective reduction of peri-operatory morbidity without affecting oncological outcomes. In terms of biological/molecular weapons, the targetting of cell-surface receptors such as EGFR, VEGFR and tyrosine-kinase proteins has demonstrated potential therapeutic efficacy and a positive impact on patients’ overall survival. Because of the relevant incidence of HPV-positive tumors, there is growing interest in the adoption of prophylactic and therapeutic vaccines within the context, as well as less aggressive de-escalation programs. In line with the multiple new disease mechanisms found, new targets are currently under investigation as well. For now, the proposed topic is lacking big cohort studies and meta-analysis; there is also the need of additional effort put into analyzing the new molecular approaches’ real efficacy. It is crucial that primary prevention and the implementation of Public Health strategies focusing on the promotion of an early diagnosis and environmental triggers’ eviction can ultimately encompass the scientific research and patients’ approach.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Tumores da cavidade oral e orofaringe Carcinoma pavimento-celular Cirurgia robótica trans-oral Inibidores da tirosina-cinase Tumores HPV-positivos Otorrinolaringologia