Quality of life of patients with advanced laryngeal cancer : systematic review and meta-analysis of surgery versus chemoradiation

Objetivo: Comparar a qualidade de vida do paciente tratado cirurgicamente por câncer avançado de laringe com aquele que foi submetido a quimioradioterapia exclusivos. Método: Revisão sistemática que utilizou, para a seleção dos artigos, 06 bases de dados (PubMed, MedLine, Embase, Web of Science, Cochrane Library e Lilacs) e as palavras-chave "head and neck cancer"; "advanced laryngeal cancer"; "laryngeal neoplasm"; larynx cancer"; "quality of life"; "outcomes/functional results";"total laringectomy"; "chemoradiotherapy". Os critérios de inclusão foram estudos específicos de câncer avançado de laringe, com comparação de modalidades de tratamento e avaliação da qualidade de vida. Resultados: Foram encontrados 321 artigos. Nove artigos preencheram todos os critérios de inclusão e desses, apenas três possuíam desenho metodológico e instrumento de mensuração de qualidade de vida comparáveis entre si e foram submetidos à metanálise . Os resultados evidenciaram que 90% dos estudos são retrospectivos e não randomizados. O tempo pós-tratamento em que os questionários de qualidade de vida foram aplicados mostrou grande variabilidade (3 meses a 11 anos). Conclusão: A meta-análise dos três estudos comparativos mostraram uma melhor qualidade de vida após o tratamento para indivíduos tratados com quimioradioterapia exlcusiva. No entanto, devido a existência de poucos estudos com dados relevantes na literatura, é necessário realizar pesquisas futuras com as seguintes características: (a) estudos prospectivos e randomizados, (b) multicêntrico, com maior número de indivíduos, e (c) enfatizando o funcional sequelas que ambos os tratamentos acarretam.Objective: To compare studies of quality of life in patients undergoing chemoradiotherapy or surgery for advanced laryngeal cancer. Method: Articles were selected for a systematic review by searching six databases (PubMed, Medline, Embase, Web of Science, Cochrane Library and Lilacs) for keywords "head and neck cancer," "advanced laryngeal cancer," "laryngeal neoplasm," "larynx cancer," "quality of life," "outcomes and functional results," "total laryngectomy" and "chemoradiotherapy." The included studies must related to advanced larynx cancer, comparisons of treatment modalities and assessment of patient quality of life in validated scales, well defined inclusion and exclusion criteria. Articles with poor methodological evaluation and duplicated results were excluded. Results: It was found 321 articles. Nine articles fitted to all inclusion criteria and of these, only three observed comparable methodological designs and standardized instruments for measuring quality of life and therefore subjected to meta-analysis. Our analysis observed that 90% of the studies were retrospective and nonrandomized. The time point post-treatment at which the quality of life questionnaires were assessed varied widely (3 months to 11 years). Conclusion: The meta-analysis of three comparable studies showed improved quality of life after treatment for subjects treated with chemoradiation alone. However, because of few studies with relevant data in literature, it is necessary to conduct future research with the following study characteristics: (a) prospective and randomized; (b) multicentric, with larger numbers of subjects; and (c) emphasizing the functional sequelae that both treatments entail