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PESQUISA DE NEOPLASIAS ESOFAGICAS SECUNDARIAS EN LOS PACIENTES CON CANCER DE CABEZA Y CUELLO

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PESQUISA DE NEOPLASIAS ESOFAGICAS SECUNDARIAS EN LOS PACIENTES CON CANCER DE CABEZA Y CUELLO

(especial para SIIC © Derechos reservados)
El riesgo de neoplasia esofágica es alto en los pacientes con cáncer previo de cabeza y cuello (7.4%) en nuestra serie. Es recomendable la observación cuidadosa de este grupo de alto riesgo.
hans9.jpg Autor:
Hans Scherübl
Columnista Experto de SIIC

Institución:
Charité-Universitätsmedizin Berlin Campus Benjamin Franklin Berlin, Germany

Artículos publicados por Hans Scherübl
Recepción del artículo
4 de Agosto, 2004 		Primera edición
19 de Mayo, 2005 		Segunda edición, ampliada y corregida
7 de Junio, 2021

PESQUISA DE NEOPLASIAS ESOFAGICAS SECUNDARIAS EN LOS PACIENTES CON CANCER DE CABEZA Y CUELLO

Resumen
Estudios clínicos prospectivos realizados en Brasil y Japón muestran que 5% a 14% de los pacientes que presentan cáncer de cabeza y cuello (CCC), también evolucionan hacia cáncer esofágico de células escamosas (CECE) invasivo. De manera similar, el riesgo de CECE podría ser tan alto como 3.3% a 8.2% en las personas con antecedentes de consumo intenso de alcohol y tabaco. A pesar de los beneficios en cuanto a la supervivencia obtenidos mediante la pesquisa y el tratamiento precoz del CECE, la vigilancia cuidadosa de los grupos de alto riesgo no está actualmente recomendada en los países occidentales. Para definir el riesgo de CECE en los pacientes con CCC en Berlín, investigamos prospectivamente mediante videoesofagoscopia y biopsias esofágicas tomadas al azar 148 pacientes portadores de CCC para detectar cánceres esofágicos secundarios. Se tomaron 4 muestras para biopsia cada 3 cm, a lo largo de todo el esófago, aun en las regiones de aspecto normal. Además, se tomó muestra para biopsia de toda lesión evidente. Se detectó histológicamente displasia de células escamosas (neoplasia intraepitelial) de grado bajo o alto en 10 de los 148 pacientes (6.8%). Todas las displasias, excepto una, se diagnosticaron sincrónicamente con cáncer de cabeza y cuello. Además, se diagnosticó carcinoma esofágico de células epiteliales en 11 de los 148 pacientes (7.4%). La mayoría de estos cánceres invasivos (63.6%) fueron metacrónicos. Obviamente, el riesgo de neoplasia de células escamosas en el esófago es alto en los pacientes con un cáncer (previo) de cabeza y cuello. Es recomendable la vigilancia cuidadosa en este grupo de alto riesgo. Más aun, en vista del reconocido “riesgo de malignización de campo”, en el futuro debería preconizarse una efectiva prevención mediante quimioterapia.

Palabras clave
Cáncer de cabeza y cuello, cáncer esofágico de células escamosas, videoesofagoscopia


Artículo completo
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SCREENING FOR SECOND ESOPHAGEAL NEOPLASIAS IN PATIENTS WITH HEAD AND NECK CANCER

Abstract
Prospective clinical studies in Brasil and Japan have shown that 5-14% of patients suffering from head and neck cancer (HNC) also develop esophageal squamous cell cancer (ESCC). Similarly, the risk for ESCC may be as high as 3.3% to 8.2% in persons with (previous) heavy alcohol and tobacco consumption. Despite the survival benefit achieved by screening for and treating early ESCC, surveillance of high-risk groups is currently not recommended in Western countries. To define the ESCC risk in HNC patients in Berlin, we prospectively screened 148 HNC patients for second esophageal cancers by videoesophagoscopy and random esophageal biopsies. 4 biopsy specimens were taken every 3 cm throughout the entire length even of normal looking esophagi. In addition, any lesion was biopsied. Low- or high-grade squamous cell dysplasia (= intraepithelial neoplasia) was detected histologically in 10 of the 148 patients (6.8%). All but one dysplasias were diagnosed synchronously with the head and neck cancer. In addition, esophageal squamous cell carcinoma was diagnosed in 11 of the 148 patients (7.4%). The majority of invasive cancers (63.6%) occurred metachronously. Thus, the risk of squamous cell neoplasia of the esophagus is high in patients with (previous) head and neck cancer. Surveillance is recommended in this high-risk group. Moreover, in light of the well known “field-cancerization-risk” effective chemoprevention should be aimed for in the future.

Key words
Chemoprevention, human papilloma virus, field cancerization, squamous cell neoplasm


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Especialidades
Principal: Oncología
Relacionadas: Anatomía Patológica, Cirugía, Diagnóstico por Imágenes



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Bibliografía del artículo
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