Borges Marcela-Maria-Fontes, Malta Cássia-Emanuella-Nóbrega, Ribeiro Reverton-Soares, Cetira-Filho Edson-Luiz, de Moura José-Fernando-Bastos, Rebouças Lievin-Matos, Costa Fábio-Wildson-Gurgel, Silva Paulo-Goberlânio-de Barros, Mota Mario-Rogerio-Lima
Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil.
J Clin Exp Dent. 2024 Apr 1;16(4):e503-e515. doi: 10.4317/jced.61385. eCollection 2024 Apr.
To evaluate the influence of chemotherapy on the prevalence of trismus in irradiated head and neck cancer patients.
This systematic review guided by PRISMA-2020 and registered in PROSPERO (CRD42021255377) screened 963 articles in 7 scientific-databases (PubMed, Lilacs, Livivo, Scopus, Embase, Web of Science, EBSCO) and 3 grey-literature databases (Open Grey, Google Scholar, ProQuest) and eight articles were included for qualitative synthesis, meta-analysis (combined odds ratio, inverse variance method plus random effects), heterogeneity analysis (I² and Tau²), one-of-out evaluation and publication bias analysis (Eggs' and Begg's tests) (RevMan®, <0.05). The Newcastle-Ottawa Quality Assessment Scale Cohort Studies was used to assess the risk of bias (RoB). The classification assessment, development, and recommendations (GRADE) approach was used to assess the certainty of evidence.
The eight articles evaluated 1474 patients treated with chemoradiotherapy and 858 patients treated with radiotherapy. Five articles had low RoB, and three had high RoB. Chemoradiotherapy significantly (=0.0003) increased the prevalence of trismus (OR=2.55, 95% CI = 1.53-4.23) compared to radiotherapy, with significant (=0.010) but low heterogeneity (I²=59%;Tau²=0.29). There was no significant risk of publication bias, one-out analysis showed no significant difference between studies, and GRADE showed a moderate level of evidence. Trismus was directly associated to worse quality of life.
The incidence of trismus increases when chemotherapy is combined with radiotherapy for head and neck cancer, which negatively impacts the quality of life. Radiotherapy, Chemoradiotherapy, Head and Neck Neoplasms, Trismus, Quality of Life.
评估化疗对接受放疗的头颈癌患者牙关紧闭患病率的影响。
本系统评价以PRISMA - 2020为指导，并在国际前瞻性系统评价注册库（CRD42021255377）注册，在7个科学数据库（PubMed、Lilacs、Livivo、Scopus、Embase、Web of Science、EBSCO）和3个灰色文献数据库（Open Grey、Google Scholar、ProQuest）中筛选了963篇文章，纳入8篇文章进行定性综合、荟萃分析（合并比值比、逆方差法加随机效应）、异质性分析（I²和Tau²）、逐一剔除评估和发表偏倚分析（Egger检验和Begg检验）（RevMan®，<0.05）。采用纽卡斯尔 - 渥太华质量评估量表队列研究来评估偏倚风险（RoB）。采用分级评估、发展和建议（GRADE）方法来评估证据的确定性。
这8篇文章评估了1474例接受放化疗的患者和858例接受放疗的患者。5篇文章的RoB较低，3篇文章的RoB较高。与放疗相比，放化疗显著（=0.0003）增加了牙关紧闭的患病率（OR = 2.55，95%CI = 1.53 - 4.23），具有显著（=0.010）但较低的异质性（I² = 59%；Tau² = 0.29）。没有显著的发表偏倚风险，逐一剔除分析显示各研究之间无显著差异，GRADE显示证据水平为中等。牙关紧闭与较差的生活质量直接相关。
头颈癌放化疗联合应用时牙关紧闭的发生率增加，这对生活质量产生负面影响。放疗、放化疗、头颈肿瘤、牙关紧闭、生活质量。
