Leucoplasia em pregas vocais: eficácia da vitamina A no tratamento inicial
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2021-05-17
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Universidade Estadual Paulista (Unesp)
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A leucoplasia laríngea é definida como uma lesão branca na mucosa, cuja gênese relaciona-se ao depósito de queratina no epitélio, estimulado pelo tabagismo crônico. Por ser considerada lesão pré neoplásica, o tratamento de escolha é cirúrgico, mas há quem advogue um tratamento clínico inicial com vitamina A, entretanto, a literatura é escassa na comprovação da eficácia deste tratamento. Objetivo: Avaliar a eficácia do tratamento clínico com vitamina A no manejo inicial da leucoplasia de pregas vocais. Material e Método: Estudo de coorte longitudinal. Foram selecionados pacientes com diagnóstico de leucoplasia de pregas vocais, confirmado pelo exame de videolaringoestroboscopia. As imagens endoscópicas foram fotografadas e os exames gravados. A partir dessas imagens, com auxílio do software Image J, foi feito o cálculo proporcional das dimensões da placa leucoplásica. Aos pacientes elegíveis foi prescrito tratamento com vitamina A por dois meses na dose de 50.000UI duas vezes ao dia. Após esse período, os pacientes repetiram o exame de videolaringoestroboscopia para análises comparativas dos exames pré e pós tratamento. A interpretação da eficácia do tratamento foi baseada em quatro desfechos: I - melhora completa: ausência de lesão; II - melhora parcial até 50% em relação à lesão inicial; III - melhora parcial entre 51 a 99% em relação à lesão inicial; IV - aumento da lesão. Resultados: completaram o tratamento e todas as avaliações 15 pacientes (oito mulheres e sete homens). Destes, seis pacientes apresentavam lesões bilaterais, totalizando 21 pregas vocais. Tabagismo foi reportado por 86,8% dos pacientes. Na comparação pré e pós tratamento, em sete pregas vocais observou-se remissão completa das lesões (desfecho I), em seis observou-se melhora parcial (desfecho II) e em oito observou-se aumento das lesões (desfecho IV). Conclusão: Na amostra estudada, o tratamento medicamentoso das leucoplasias laríngeas com vitamina A na dose diária de 100.000UI por dois meses mostrou-se eficaz na diminuição ou erradicação das lesões em 62% dos casos, especialmente nas lesões de aspecto regular. Entretanto, o pequeno tamanho amostral e o curto tempo de follow up não nos permitem padronizar a vitamina A no tratamento inicial das leucoplasias, sendo necessários estudos adicionais.
Laryngeal leukoplakia is defined as a white lesion in the mucosa, its genesis is related to the deposit of keratin in the epithelium, stimulated by chronic smoking. Because it is considered a pre-neoplastic lesion, the treatment of choice is surgical, but there are those who advocate an initial clinical treatment with vitamin A, however, the literature is scarce in proving the effectiveness of this treatment. Objective: To evaluate the effectiveness of clinical treatment with vitamin A in the initial management of vocal fold leukoplakia. Material and Method: Longitudinal cohort study. Patients diagnosed with vocal fold leukoplakia were selected, confirmed by the exam of videolaryngostroboscopy. The endoscopic images were photographed and the exams were recorded. From these images, using the Image J software, the proportional calculation of the dimensions of the leukoplastic plaque was made. Eligible patients were prescribed vitamin A treatment for two months at a dose of 50,000 IU twice daily. After this period, the patients repeated the videolaryngostroboscopy exam for comparative analysis of the pre and post-treatment exams. The interpretation of treatment efficacy was based on four outcomes: I - complete improvement: absence of injury; II - partial improvement up to 50% in relation to the initial injury; III - partial improvement between 51 to 99% in relation to the initial injury; IV - increased lesion. Results: 15 patients (eight women and seven men) completed treatment and all evaluations. Of these, six patients had bilateral lesions, totaling 21 vocal folds. Smoking was reported by 86.8% of patients. In the comparison before and after treatment, seven vocal folds showed complete remission of the lesions (outcome I), in six there was partial improvement (outcome II) and in eight there was an increase in the lesions (outcome IV). Conclusion: In the sample studied, drug treatment of laryngeal leukoplakia with vitamin A at a daily dose of 100,000 IU for two months proved to be effective in reducing or eradicating lesions in 62% of cases, especially in regular-looking lesions. However, the small sample size and the short follow-up time do not allow us to standardize vitamin A in the initial treatment of leukoplakia, requiring additional studies.
Laryngeal leukoplakia is defined as a white lesion in the mucosa, its genesis is related to the deposit of keratin in the epithelium, stimulated by chronic smoking. Because it is considered a pre-neoplastic lesion, the treatment of choice is surgical, but there are those who advocate an initial clinical treatment with vitamin A, however, the literature is scarce in proving the effectiveness of this treatment. Objective: To evaluate the effectiveness of clinical treatment with vitamin A in the initial management of vocal fold leukoplakia. Material and Method: Longitudinal cohort study. Patients diagnosed with vocal fold leukoplakia were selected, confirmed by the exam of videolaryngostroboscopy. The endoscopic images were photographed and the exams were recorded. From these images, using the Image J software, the proportional calculation of the dimensions of the leukoplastic plaque was made. Eligible patients were prescribed vitamin A treatment for two months at a dose of 50,000 IU twice daily. After this period, the patients repeated the videolaryngostroboscopy exam for comparative analysis of the pre and post-treatment exams. The interpretation of treatment efficacy was based on four outcomes: I - complete improvement: absence of injury; II - partial improvement up to 50% in relation to the initial injury; III - partial improvement between 51 to 99% in relation to the initial injury; IV - increased lesion. Results: 15 patients (eight women and seven men) completed treatment and all evaluations. Of these, six patients had bilateral lesions, totaling 21 vocal folds. Smoking was reported by 86.8% of patients. In the comparison before and after treatment, seven vocal folds showed complete remission of the lesions (outcome I), in six there was partial improvement (outcome II) and in eight there was an increase in the lesions (outcome IV). Conclusion: In the sample studied, drug treatment of laryngeal leukoplakia with vitamin A at a daily dose of 100,000 IU for two months proved to be effective in reducing or eradicating lesions in 62% of cases, especially in regular-looking lesions. However, the small sample size and the short follow-up time do not allow us to standardize vitamin A in the initial treatment of leukoplakia, requiring additional studies.
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Leucoplasia, Pregas vocais, Vitamina A, Retinoide, Leukoplakia, Vocal folds, Vitamin A, Retinoid