RESSALVA Atendendo solicitação do(a) autor(a), o texto completo desta dissertação será disponibilizado somente a partir de 21/02/2026 MONICA MORENO DE CARVALHO Relationship Between the Degree of Radio-induced Mucositis in Patients with Head and Neck Cancer and Clinical-Pathological Characteristics and Demographics Araçatuba - SP 2025 MONICA MORENO DE CARVALHO Relationship Between the Degree of Radio-induced Mucositis in Patients with Head and Neck Cancer and Clinical-Pathological Characteristics and Demographics Dissertação apresentada à Universidade Estadual Paulista (UNESP), Faculdade de Odontologia de Araçatuba, para obtenção do título de Mestra em Odontologia. Área de Concentração: Estomatologia e Psiconeuroimunologia Orientadora: Profa. Dra. Aline Satie Takamiya Coorientador: Prof. Dr. Glauco Issamu Miyahara Araçatuba - SP 2025 Catalogação na Publicação (CIP) Diretoria Técnica de Biblioteca e Documentação – FOA / UNESP Carvalho, Monica Moreno de. C331r Relationship between the degree of radio-induced mucositis in patients with head and neck cancer and clinical-pathological characteristics and demographics / Monica Moreno de Carvalho. - Araçatuba, 2025 36 f. : tab. Dissertação (Mestrado) – Universidade Estadual Paulista (UNESP), Faculdade de Odontologia, Araçatuba Orientadora: Profa. Aline Satie Takamiya Coorientador: Prof. Glauco Issamu Miyahara 1. Neoplasias de cabeça e pescoço 2. Mucosite 3. Dor I. T. Black D6 CDD 617.63 Claudio Hideo Matsumoto CRB-8/5550 Dedico este trabalho aos meus pais, Jacinta Moreno Garcia de Carvalho e Dedilton Rufino de Carvalho, que sob muito sol, fizeram- me chegar até aqui, pela sombra. AGRADECIMENTOS Gostaria de agradecer em especial, todos pacientes que atendi durante a minha trajetória acadêmica, os quais me ensinaram muito sobre gratidão, paciência e persistência. Eles não foram somente essenciais para a realização desse trabalho, como também me proporcionaram um enorme crescimento pessoal, do qual sou imensamente grata. Agradeço aos meus pais, Dedilton Rufino de Carvalho e Jacinta Moreno Garcia de Carvalho, aos quais eu devo toda a minha gratidão pelos esforços realizados. A dedicação e apoio incondicional deles me permitiram a realização deste sonho. Agradeço por sempre me apoiarem nas minhas decisões, fazendo o possível e o impossível para torná-las reais. À minhas irmãs, Marize Moreno de Carvalho e Mariane Moreno de Carvalho, por todo apoio e incentivo concedido a mim durante a minha vida, da qual partilharmos alegrias e tristezas juntas. Obrigada por sempre acreditarem em mim e na minha capacidade, me encorajando a buscar tudo aquilo que almejo. Minhas avós Ester Ferreira dos Santos (in memoriam) e Regina Moreno Lopes Garcia (in memoriam), e ao meu padrinho Evaldo Claudino de Faria (in memoriam), que ao longo de suas vidas sempre demonstraram tanto carinho e afeto a mim. Muito do que aprendi sobre compaixão veio de seus exemplos. Aos meus tios Kelle Nakamoto de Carvalho e Marcelo Rufino de Carvalho, e minhas primas Karolini de Oliveira Carvalho e Yasmin de Oliveira Carvalho, por todo apoio e acolhimento ao longo desses anos. Ao meu namorado Lucas Câmara Costa Fernandes, que me apoiou no meu sonho de realizar o mestrado e me tornar professora. Agradeço por compreender minha ausência, por escutar os meus desabafos, tomar minhas dores e sempre me incentivar. Seu amor incondicional me ajudou a passar por todo processo. À minha sogra, Karina Gonzalez Câmara Fernandes, da qual partilhou lágrimas nos momentos difíceis e sorrisos nos momentos alegres. Sua dedicação pelo ensino me inventiva e me inspira desde a graduação até os momentos atuais, sou muito grata por todos os ensinamentos. À minha amiga e eterna orientadora, Luciana Estevam Simonato, por ter me mostrado a beleza da Estomatologia e me inspirado a seguir os seus caminhos. Agradeço por toda aprendizagem e vivências, dos quais sempre demonstrou todo seu cuidado e zelo comigo ao longo desses anos. À minhas amigas de longa data, Ingrid Estanislau, Isabella Duarte e Jessica Scola, que compreenderam a minha ausência e sempre torceram pela minha realização. Agradeço a amizade que sempre me fortalece. Aos meus amigos, Carol Puglieri, Ian Careno, Luísa Bortolozo, Maria Fernanda Molina, Murilo Belucio, Victor Nunes, Vitória Calsen e in memoriam Maria Fernanda Roldan, que estiveram ao meu lado em todos os momentos, compartilhando alegrias e tristezas e me proporcionando momentos de descontração. À minhas amigas da graduação, Amanda Borges Vitorino Camargos, Carolini de Oliveira Hernandes, Juliana Dela Líbera e Mônica Ribeiro de Oliveira Santana, que desde a faculdade me incentivaram e comemoraram comigo cada pequena conquista que pudessem me trazer até aqui. À minha amiga Karolina Facina, pela sua presença em minha vida, tornando-a mais leve. Obrigada pela sua amizade. À Mariana Mel Dos Anjos Gardinal, que se tornou uma grande amiga e sempre esteve disposta a me ajudar quando precisei. Toda gratidão ao seu carinho e cuidado comigo. À toda equipe de laserterapia que me ajudou imensamente na realização dessa pesquisa, em especial Isabela Ferreira Cerato e Rebecca Muzel Abuchain, que foram essenciais para a elaboração deste trabalho. Aos meus colegas da pós-graduação, que me ajudaram e tornaram esse trajeto mais fácil Ana Livia, Bruna Benicio, Vitória Iaros, Pedro Victor, Tamara Fernandes e Ricarla Fernandes. As alunas Ana Eduarda, Ana Júlia, Ana Paula e Heloísa Mota, que tornaram minha rotina mais leve e das quais carrego um grande carinho. À Profa. Aline Satie Takamiya, por sua orientação paciente e todos os ensinamentos aos longos desses anos. Agradeço por ter transmitido todo o conhecimento necessário, sua competência e disponibilidade foram essenciais para realização deste trabalho. Ao Prof. Glauco Issamu Miyahara, pela confiança no meu trabalho, sua paciência, disponibilidade e valiosas contribuições para o meu crescimento acadêmico. Sou eternamente grata pela oportunidade concedida a mim. Suas correções e conselhos sempre foram de grande apreço. Ao Prof. Daniel Galera Bernabé, por toda sua dedicação ao ensino. Me ajudou em todo o processo acadêmico, me ensinando com maestria. Sua didática e empenho com a ciência me incentivam. Ao Prof. Vítor Bonetti Valente, por todos os ensinamentos, obrigado por contribuir com a minha formação profissional. À Adriana de Paula e Silva Rahal Leal, que sempre esteve disposta a me ajudar no que precisei e à Léia Janaína Spínola Santos, por todo carinho e paciência comigo. Aos funcionários da Pós-Graduação, Cristiane Regina Lui Matos, Elis Andréa Pinto e Lucas Sousa da Rocha pela disponibilidade e gentileza em me ajudar. Ao Centro de Oncologia Bucal (COB) e toda equipe multidisciplinar que sempre foram tão atenciosos comigo, Anne Faria, Daniene Tesoni, Gabrielle Duarte, Patrícia Gonçalves e Regiane Mazzarioli. À Faculdade de Odontologia de Araçatuba (FOA/UNESP), que me proporcionou todas as ferramentas e estruturas necessárias para o desenvolvimento deste trabalho. À Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Código de Financiamento 001, pela concessão da bolsa de mestrado. “A educação tem raízes amargas, mas os seus frutos são doces.” Aristóteles RESUMO CARVALHO, M. M. Relação entre o grau de mucosite radio-induzida em pacientes com câncer da cabeça e do pescoço e as características clínico-patológicas e demográficas. 2025. Dissertação (Mestrado) - Faculdade de Odontologia, Universidade Estadual Paulista (UNESP), Araçatuba, 2025. A mucosite oral é um processo inflamatório causado pelos efeitos citotóxicos dos tratamentos antineoplásicos, sendo frequentemente observado em pacientes submetidos a tratamentos na região de cabeça e pescoço. Prejudicando significativamente os indivíduos e afetando a fala, deglutição e a mastigação. A etiopatogênese da mucosite ainda permanece bastante controversa. Os fatores relacionados ao tratamento e ao paciente têm sido apontados, como fatores causadores e modificadores das alterações de mucosites orais radio-induzidas. Assim, o propósito deste estudo foi avaliar a relação entre o grau de mucosite radio-induzida, os aspectos clínicos-patológicos e demográficos em pacientes durante o tratamento de câncer de cabeça e pescoço. Para a realização deste estudo, foram recrutados pacientes diagnosticados com câncer da cabeça e pescoço, submetidos ao tratamento de radioterapia obrigatório. Os pacientes foram avaliados clinicamente diariamente e responderam verbalmente a um questionário. Para a realização da análise estatísticas foram separados dois tempos, onde o tempo 1 foram analisados os dados em relação ao início da mucosite oral e o tempo 2 em relação ao pior grau apresentado pelos pacientes. Foram incluídos 50 pacientes, com cerca de 78% dos pacientes do sexo masculino. A quimioterapia (P= .034) foi associada aos pacientes que apresentaram lesões de mucosite oral até a décima sessão de radioterapia. Diabetes (P= .017), dermatite por radiação (P=.017) e dermatite por radiação moderada (P=.013) foram estatisticamente associadas ao grau grave de mucosite no momento de seu início. Enquanto hipertensão (P= .030), diabetes (P= .016), alcoolismo leve e moderado (P= .029), dermatite por radiação (P= .001), odinofagia (P= .022), ardência bucal (P= .003), dificuldade de higiene (P= .020) e uso de opioides (P= .045) foram associados aos graus mais severos no momento da exacerbação da lesão. Fumantes severos foram associados à maior ocorrência de lesões de mucosite na região labial nos dois tempos. Este estudo apresentou prevalência significativamente em relação a mucosite oral induzida por radiação e o seu grau com as características clínico-patológicas e demográficas. Estabelecer hábitos de vida saudáveis e manter uma higiene oral saudável são essenciais na prevenção da mucosite oral. Palavras-chave: câncer de cabeça e pescoço; mucosite; dor; características clínico- patológicas. ABSTRACT CARVALHO M. M. Relationship between the degree of radio-induced mucositis in patients with head and neck cancer and clinical-pathological characteristics and demographics. 2025. Dissertação (Mestrado) - Faculdade de Odontologia, Universidade Estadual Paulista (UNESP), Araçatuba, 2025. Oral mucositis is an inflammatory process caused by the cytotoxic effects of antineoplastic treatments and is frequently observed in patients undergoing treatment of the head and neck region. It significantly impairs individuals and affects their speech, swallowing, and chewing. However, the etiopathogenesis of mucositis remains controversial. Factors related to treatment and the patient have been identified as factors that cause and modify changes in radio-induced oral mucositis. Thus, the purpose of this study was to evaluate the relationship between the degree of radiation-induced mucositis and the clinical-pathological and demographic aspects of patients during treatment for head and neck cancer. To conduct this study, patients diagnosed with head and neck cancer who underwent mandatory radiotherapy treatment were recruited. The patients were clinically evaluated daily and answered a questionnaire verbally. Two time points were separated for statistical analysis: Time 1 analyzed data regarding the onset of oral mucositis and time 2 analyzed data regarding the worst degree presented by the patients. Fifty patients were included, with approximately 78% of the patients being male. Chemotherapy (P= .034) was associated with patients who presented with oral mucositis lesions up to the tenth radiotherapy session. Diabetes (P= .017), radiation dermatitis (P= .017) and moderate radiation dermatitis (P= .013) were significantly associated with severe mucositis at the time of onset. Hypertension (P= .030), diabetes (P= .016), mild and moderate alcoholism (P= .029), radiation dermatitis (P= .001), odynophagia (P= .022), burning mouth (P= .003), difficulty with hygiene (P= .020) and use of opioids (P= .045) were associated with the most severe degree of lesion exacerbation. Severe smoking was associated with a greater occurrence of mucositis lesions in the lip region at two specific times. This study showed a significant prevalence of radiation-induced oral mucositis and its degree in relation to clinical-pathological and demographic characteristics. Establishing healthy lifestyle habits and maintaining healthy oral hygiene are essential for preventing oral mucositis. Keywords: head and neck cancer; mucositis; pain; clinical characteristics; pathological characteristics. LISTA DE TABELAS Table 1 Demographic and clinicopathological variables of patients Table 2 Biobehavioral variables of patients 20 22 Table 3 Associations clinical-pathological, biobehavioral characteristics in the time one 23 Table 4 Associations clinical-pathological, biobehavioral characteristics in the time two 25 LISTA DE ABREVIATURAS E SIGLAS BRA CAPES COB CT MRI NY OM OSCC UICC UNESP USA Brazil Coordination for the Improvement of Higher Education Personnel Oral Oncology Center Computed Tomography Magnetic Resonance Imaging New York Oral Mucositis Oral Squamous Cell Carcinoma Union for International Cancer Control São Paulo State University United States of America VAS RTOG SD SP SPSS WHO Visual Analog Scale Radiation Therapy Oncology Group Standard Deviation São Paulo Statistical Package for the Social Sciences World Health Organization SUMÁRIO 1 INTRODUCTION 14 2 PATIENTS AND METHODS 16 2.1 Study Design and Ethical Aspects 16 2.2 Characterization of the Sample and the Study 16 2.3 Daily Evaluation 17 2.4 Demographic and Clinical-pathological Characteristics 18 2.5 Data Analysis 18 3 RESULTS 20 4 DISCUSSIONS 26 5 CONCLUSIONS 30 REFERENCES 31 30 5 CONCLUSIONS The interaction of clinical-pathological, demographic and bio-behavioral characteristics shows different behaviors depending on the stage of OM. 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