Leucoplasia bucal: considerações a respeito do tratamento e do prognóstico

Autores

  • Eduardo Madruga Lombardo Pontifícia Universidade Católica do Rio Grande do Sul
  • Michelle Roxo Gonçalves Universidade Federal do Rio Grande do Sul
  • Marcus Vinícius Reis Só Universidade Federal do Rio Grande do Sul
  • Marco Antônio Trevizani Martins Universidade Federal do Rio Grande do Sul
  • Vinícius Coelho Carrard Universidade Federal do Rio Grande do Sul

DOI:

https://doi.org/10.22456/2177-0018.44770

Palavras-chave:

Doenças da boca, Diagnóstico bucal, Leucoplasia bucal

Resumo

Leucoplasia bucal é uma mancha ou placa predominantemente branca, não-removível por raspagem, que não pode ser caracterizada como nenhuma outra lesão. Seu principal fator de risco é o tabaco. Qualquer região da mucosa pode ser afetada e as lesões apresentam potencial de malignização. Diversas formas de tratamento estão disponíveis, sendo a excisão cirúrgica com bisturi a mais utilizada. Objetivo: realizar uma revisão de literatura a respeito dos tratamentos disponíveis e prognóstico da leucoplasia. Resultados: além da excisão cirúrgica convencional, tratamentos cirúrgicos alternativos como a vaporização da lesão pela aplicação de laser de dióxido de carbono e a criocirurgia vêm se difundindo. Os tratamentos não-cirúrgicos envolvem a aplicação de retinóides, beta-caroteno, bleomicina ou de outros fármacos, relacionados com a terapia fotodinâmica. A escolha do tipo de tratamento a ser empregado se baseia na experiência clínica do profissional, tamanho da lesão e julgamento crítico da relação custo-benefício. Conclusão: a maior experiência clínica e a possibilidade de avaliação microscópica de toda peça cirúrgica favorecem a utilização da remoção cirúrgica convencional. Contudo, é importante destacar que a remoção de toda lesão não descarta a possibilidade de recorrência e de malignização, as quais ocorrem de forma imprevisível, independentemente do tratamento escolhido. Portando, os pacientes com leucoplasia bucal devem ser submetidos a um rígido programa de acompanhamento clínico periódico, favorecendo a identificação precoce da ocorrência de transformação maligna.

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Biografia do Autor

Eduardo Madruga Lombardo, Pontifícia Universidade Católica do Rio Grande do Sul

Residente em Cirurgia e Traumatologia Bucomaxilofaciais, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre/RS, Brasil.

Michelle Roxo Gonçalves, Universidade Federal do Rio Grande do Sul

Aluna de graduação, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brasil.

Marcus Vinícius Reis Só, Universidade Federal do Rio Grande do Sul

Professor adjunto na área de Endodontia, Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brasil.

Marco Antônio Trevizani Martins, Universidade Federal do Rio Grande do Sul

Professor adjunto na área de Patologia, Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brasil.

Vinícius Coelho Carrard, Universidade Federal do Rio Grande do Sul

Professor adjunto na área de Patologia, Departamento de Odontologia Conservadora, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brasil.

Referências

AMAGASA, T.; YAMASHIRO, M.; UZAWA, N. Oral premalignant lesions: from a clinical perspective. Int J Clin Oncol, Tokyo, v. 16, no. 1, p. 5-14, Feb. 2011.

BALASUNDARAM, I. et al. Is there any benefit in surgery for potentially malignant disorders of the oral cavity? J Oral Pathol Med, Copenhagen, v. 43, no. 4, p. 239-244, Apr. 2014.

BÁNÓCZY, J.; GINTNER, Z.; DOMBI, C. Tobacco use and oral leukoplakia. J Dent Educ, Washington, v. 65, no. 4, p. 322-327, Apr. 2001.

BÁNÓCZY, J.; RIGÓ, O. Prevalence study of oral precancerous lesions within a complex screening system in Hungary. Community Dent Oral Epidemiol, Copenhagen, v. 19, no. 5, p. 265-267, Oct. 1991.

BÁNÓCZY, J.; SUGÁR, L. Longitudinal studies in oral leukoplakias. J Oral Pathol, Copenhagen, v. 1, no. 6, p. 265-272, 1972.

BARNES, L. et al. Epithelial precursor lesions. In: BARNES, L. (Ed.). Pathology & genetics –hHead and neck tumours. Lyon, France: IARC Press, 2005. cap. 4 – Oral cavity and oropharynx, p.177-179.

BRAAKHUIS, B. J.; LEEMANS, C. R.; BRAKENHOFF, R. H. A genetic progression model of oral cancer: current evidence and clinical implications. J Oral Pathol Med, Copenhagen, v. 33, no. 6, p. 317-322, July 2004.

BROUNS, E. R. et al. Treatment results of CO2 laser vaporisation in a cohort of 35 patients with oral leukoplakia. Oral Dis, Copenhagen, v. 19, no. 2, p. 212-216, Mar. 2013.

CARRARD, V. et al. Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil. Oral Dis, Copenhagen, v. 17, no. 2, p. 171-179, Mar. 2011.

CAWSON, R. A.; LEHNER, T. Chronic hyperplastic candidiasis--candidal leukoplakia. Br J Dermatol, Oxford, v. 80, no. 1, p. 9-16, Jan. 1968.

CHANDU, A.; SMITH, A. C. The use of CO2 laser in the treatment of oral white patches: outcomes and factors affecting recurrence. Int J Oral Maxillofac Surg, Copenhagen, v. 34, no. 4, p. 396-400, June 2005.

CHEE, M.; SASAKI, C. Carbon dioxide laser fiber for the excision of oral leukoplakia. Ann Otol Rhinol Laryngol, St. Louis, v. 122, no. 9, p. 547-549, Sept. 2013.

CHEN, H. M. et al. Successful treatment of oral verrucous hyperplasia and oral leukoplakia with topical 5-aminolevulinic acid-mediated photodynamic therapy. Lasers Surg Med, New York, v.37, no. 2, p.114-122, Aug. 2005.

CHIESA, F. et al. Randomized trial of fenretinide (4-HPR) to prevent recurrences, new localizations and carcinomas in patients operated on for oral leukoplakia: long-term results. Int J Cancer, New York, v. 115, no. 4, p. 625-629, July 2005.

DIAJIL, A. et al. Clinical outcome following oral potentially malignant disorder treatment: a 100 patient cohort study. Int J Dent, Cairo. v. 2013, p. 809248, 2013.

DWIVEDI, P. P.; MALLYA, S.; DONGARI-BAGTZOGLOU, A. A novel immunocompetent murine model for Candida albicans-promoted oral epithelial dysplasia. Med Mycol, Oxford, v. 47, no. 2, p. 157-167, Mar. 2009.

EPSTEIN, J. B. et al. Topical bleomycin treatment of oral leukoplakia: a randomized double-blind clinical trial. Head Neck, New York, v. 16, no. 6, p. 539-544, Nov./Dec. 1994.

Epstein, J B. et al. A Topical bleomycin for the treatment of dysplastic oral leukoplakia. Cancer, v.83, no. 4, p.629-634, Aug. 1998.

Epstein, J. B.; Gorsky, M. Topical application of vitamin A to oral leukoplakia: A clinical case series. Cancer, v.86, no. 6, p. 921–927, 1999.

FEMIANO, F. et al. Oral leukoplakia: Open trial of topical therapy with calcipotriol compared with tretinoin. Int J Oral Maxillofac Surg, Copenhagen, v. 30, no. 5, p. 402-406, Oct. 2001.

GAREWAL, H. S. et al. Response of oral leukoplakia to beta-carotene. J Clin Oncology, New York, v. 8, no. 10, p. 1715-1720, Oct. 1990.

GAREWAL, H.S. et al. Beta-carotene produces sustained remissions in patients with oral leukoplakia: results of a multicenter prospective trial. Arch Otolaryngol Head Neck Surg, Chicago, v.125, no. 12, p. 1305-1310, Dec. 1999.

GÁSPÁR, L.; SZABÓ, G. Manifestation of the advantages and disadvantages of using the CO2 laser in oral surgery. J Clin Laser Med Surg, New York, v. 8, no. 1, p. 39-43, Feb. 1990.

GOORIS, P. J. et al. Carbon dioxide laser evaporation of leukoplakia of the lower lip: a retrospective evaluation. Oral Oncol, Amsterdam, v. 35, no. 5, p. 490-495, Sept. 1999.

GORSKY, M.; EPSTEIN, J. B. The effect of retinoids on premalignant oral lesions: focus on topical therapy. Cancer, New York, v. 95, no. 6, p. 1258-1264, Sept. 2002.

GRANT, W. E. et al. Photodynamic therapy of malignant and premalignant lesions in patients with 'field cancerization' of the oral cavity. J Laryngol Otol, London, v. 107, no. 12, p. 1140-1145, Dec. 1993.

GREEN, B.; COBB, A. R.; HOPPER, C. Photodynamic therapy in the management of lesions of the head and neck. Br J Oral Maxillofac Surg, Edinburgh, v. 51, no. 4, p. 283-287, June 2013.

HOLMSTRUP, P. et al. Long-term treatment outcome of oral premalignant lesions. Oral Oncol, Amsterdam, v. 42, no. 5, p. 461-474, May 2006.

HOLMSTRUP, P. et al. Oral premalignant lesions: is a biopsy reliable? J Oral Pathol Med, Copenhagen, v. 36, no. 5, p. 262-266, May 2007.

HONG, W. K. et al. 13-cis-retinoic acid in the treatment of oral leukoplakia. N Engl J Med, Boston, v. 315, no. 24, p. 1501-1505, Dec. 1986.

HSING, C. Y. et al. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients--a quality of life analysis. Oral Oncol, Oxford, v. 47, no. 6, p. 522-527, June 2011.

ISHII, J.; FUJITA, K.; KOMORI, T. Laser surgery as a treatment for oral leukoplakia. Oral Oncol, Oxford, v. 39, no. 8, p. 759-769, Dec. 2003.

JEPSEN, A.; WINTHER, J. E. Mycotic infection in oral leukoplakia. Acta Odontol Scand, London, v. 23, no. 3, p. 239-256, June 1965.

KAUGARS, G. E. et al. A clinical trial of antioxidants supplements in the treatment of oral leukoplakia. Oral Surg Oral Med Oral Pathol, St. Louis, v.78, no. 4, p. 462-468, Oct. 1994.

KAUGARS, G. E. et al. Use of antioxidant supplements in the treatment of human oral leukoplakia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, St. Louis, v. 81, no. 1, p. 5-14, Jan. 1996.

KAWCZYK-KRUPKA, A. et al. Comparison of cryotherapy and photodynamic therapy in treatment of oral leukoplakia. Photodiagnosis Photodyn Ther, Amsterdam, v. 9, no. 2, p. 148-155, June 2012.

KHAN, M. N. et al. CO2 Laser treatment of leukoplakia of the tongue: a case report and literature review. The Journal of Oral Laser Aplications, v. 7, no. 4, p. 255-260, winter 2007.

KONOPKA, K.; GOSLINSKI, T. Photodynamic therapy in dentistry. J Dent Res, Chicago, v. 86, no. 8, p. 694-707, Aug. 2007.

KRAMER, I. R. et al. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol, St. Louis, v. 46, no. 4, p. 518-539, Oct. 1978.

KÜBLER, A. et al. Treatment of oral leukoplakia by topical application of 5-aminolevulinic acid. Int J Oral Maxillofac Surg, Copenhagen, v. 27, no. 6, p. 466-469, Dec. 1998.

KUMAR, A et al. How should we manage oral leukoplakia? Br J Oral Maxillofac Surg, Edinburgh, v. 51, no. 5, p. 377–383, July 2013.

KURIBAYASHI, Y. et al. Recurrence patterns of oral leukoplakia after curative surgical resection: important factors that predict the risk of recurrence and malignancy. J Oral Pathol Med, Copenhagen, v. 41, no. 9, p. 682-688, Oct. 2012.

KVAAL, S. I.; WARLOE, T. Photodynamic treatment of oral lesions. J Environ Pathol Toxicol Oncol, New York, v. 26, no. 2, p. 127-133, 2007.

LEE, J. J. et al. Predicting cancer development in oral leukoplakia: ten years of translational research. Clin Cancer Res, Denville, v. 6, no. 5, p. 1702-1710, May 2000.

LIM, B.; SMITH, A.; CHANDU, A. Treatment of oral leukoplakia with carbon dioxide and potassium-titanyl-phosphate lasers: a comparison. J Oral Maxillofac Surg, Philadelphia, v. 68, no. 3, p. 597-601, Mar. 2010.

LIPPMAN, S. M. et al. Fenretinide activity in retinoid-resistant oral leukoplakia. Clin Cancer Res, Denville, v. 12, no. 10, p. 3109-3114, May 2006.

LIU, W. et al. Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patients. BMC Cancer, London, v. 10, p. 685, Dec. 2010.

LIU, W. et al. Oral cancer development in patients with leukoplakia--clinicopathological factors affecting outcome. PLoS One, San Francisco, v. 7, no. 4, p. e34773, Apr. 2012.

LODI, G. et al. Systematic review of randomized trials for the treatment of oral leukoplakia. J Dent Educ, Washington, v. 66, no. 8, p. 896-902, Aug. 2002.

LODI, G.; PORTER, S. Management of potentially malignant disorders: evidence and critique. J Oral Pathol Med, Copenhagen, v. 37, no. 2, p. 63-69, Feb. 2008.

LÓPEZ-JORNET, P.; CAMACHO-ALONSO, F. Comparison of pain and swelling after removal of oral leukoplakia with CO(2) laser and cold knife: a randomized clinical trial. Med Oral Patol Oral Cir Bucal, Valencia, v. 18, no. 1, p. e38-e44, Jan. 2013.

MALMSTRÖM, M. et al. Topical treatment of oral leukoplakia with bleomycin. Br J Oral Maxillofac Surg, Edinburgh, v. 26, no. 6, p. 491-498, Dec. 1988.

MELTZER, C. Surgical management of oral and mucosal dysplasias: the case for laser excision. J Oral Maxillofac Surg, Philadelphia, v. 65, no. 2, p. 293-295, Feb. 2007.

NAPIER, S. S.; SPEIGHT, P. M. Natural history of potentially malignant oral lesions and conditions: an overview of the literature. J Oral Pathol Med, Copenhagen, v. 37, no. 1, p. 1-10, Jan. 2008.

PANDEY, M. et al. Evaluation of surgical excision of non-homogeneous oral leukoplakia in a screening intervention trial, Kerala, India. Oral Oncol, Amsterdam, v. 37, no. 1, p. 103-109, Jan. 2001.

PIATELLI, A. et al. bcl2 expression and apoptotic bodies in 13-cis-retinoic acid (isotretinoin)-topically treated oral leukoplakia: a pilot study. Oral Oncol, Amsterdam, v. 35, no. 3, p. 314-320, May 1999.

PIETRUSKA, M. et al. Clinical evaluation of photodynamic therapy efficacy in the treatment of oral leukoplakia. Photodiagnosis Photodyn Ther, Amsterdam, v.11, no. 1, p. 34-40, Mar. 2014.

PINDBORG, J. J. Histological typing of cancer and precancer of the oral mucosa. Berlin: Springer, 1997.

PINHEIRO, A. L.; FRAME, J. W. Surgical management of premalignant lesions of the oral cavity with the CO2 laser. Braz Dent J, Ribeirão Preto, v. 7, no. 2, p. 103-108, 1996.

PRASAD, M. et al. Liquid nitrogen cryotherapy in the management of oral lesions: a retrospective clinical study. J Maxillofac Oral Surg, New Delhi, v. 8, no. 1, p.40-42, Mar. 2009.

REDDI, S. P.; SHAFER, A. T. Oral premalignant lesions: management considerations. Oral Maxillofac Surg Clin North Am, Philadelphia, v. 18, no. 4, p. 425-433, Nov. 2006.

REIBEL, J. Prognosis of oral pre-malignant lesions: significance of clinical, histopathological, and molecular biological characteristics. Crit Rev Oral Biol Med, Alexandria, v. 14, no. 1, p. 47-62, 2003.

RENSTRUP, G. Occurrence of candida in oral leukoplakias. Acta Pathol Microbiol Scand B Microbiol Immunol, Copenhagen, v. 78, no. 4, p. 421-424, 1970.

RIBEIRO, A. S. et al. A review of the nonsurgical treatment of oral leukoplakia. Int J Dent, Cairo, v. 2010, p. 186018, 2010.

ROODENBURG, J. L.; PANDERS, A. K.; VERMEY, A. Carbon dioxide laser surgery of oral leukoplakia. Oral Surg Oral Med Oral Pathol, St. Louis, v. 71, no. 6, p. 670-674, June 1991.

SAINI, R.; POH, C. F. Photodynamic therapy: a review and its prospective role in the management of oral potentially malignant disorders. Oral Dis, Copenhagen, v. 19, no. 5, p. 440-451, July 2013.

SAITO, T. et al. Development of squamous cell carcinoma from pre-existent oral leukoplakia: with respect to treatment modality. Int J Oral Maxillofac Surg, Copenhagen, v. 30, no. 1, p. 49-53, Feb. 2001.

SANKARANARAYANAN, R. et al. Chemoprevention of oral leukoplakia with vitamin A and beta carotene: an assessment. Oral Oncology, Oxford, v. 33, no. 4, 231-236, July 1997.

SCARDINA, G.A. et al. Evaluation of the clinical and histological effectiveness of isotretinoin in the therapy of oral leukoplakia: ten years of experience: Is management still up to date and effective? Methods Find Exp Clin Pharmacol, New York, v. 28, no. 2, p. 115-119, Mar. 2006.

SHAFIRSTEIN, G. et al. Using 5-Aminolevulinic acid and pulsed dye laser for photodynamic treatment of oral leukoplakia. Arch Otolaryngol Head Neck Surg, Chicago, v. 137, no. 11, p. 1117-1123, Nov. 2011.

SCHEIFELE, C.; REICHART, P. A.; DIETRICH, T. Low prevalence of oral leukoplakia in a representative sample of the US population. Oral Oncol, Oxford, v. 39, no. 6, p. 619-625, Sept. 2003.

SCHWARZ, F. et al. Cytologic and DNA-cytometric follow-up of oral leukoplakia after CO2- and Er:YAG-laser assisted ablation: a pilot study. Lasers Surg Med, New York, v. 37, no. 1, p. 29-36, July 2005.

SHAH, J. P. et al. Effect of retinoids on oral leukoplakia. Am J Surg, New York, v. 146, no. 4, p. 466-470, Oct 1983.

SIERÓN, A. et al. Photodynamic therapy (PDT) using topically applied delta-aminolevulinic acid (ALA) for the treatment of oral leukoplakia. J Oral Pathol Med, Copenhagen, v. 32, no. 6, p. 330-336, July 2003.

SILVERMAN JR, S.; GORSKY, M.; LOZADA, F. Oral leukoplakia and malignant transformation. A follow-up study of 257 patients. Cancer, v. 53, no. 3, 563–568, 1984.

SITHEEQUE, M. A.; SAMARANAYAKE, L. P. Chronic hyperplastic candidosis/candidiasis (candidal leukoplakia). Crit Rev Oral Biol Med, Alexandria, v. 14, no. 4, p. 253-267, 2003.

THOMSON, P. J.; WYLIE, J. Interventional laser surgery: an effective surgical and diagnostic tool in oral precancer management. Int J Oral Maxillofac Surg, Copenhagen, v. 31, no. 2, p. 145-153, Apr. 2002.

TOMA, S. et al. Treatment of oral leukoplakia with beta-carotene. Oncology, Basel, v. 49, no. 2, p. 77-81, 1992a.

TOMA, S. et al. Progressive 13-cis-retinoic acid dosage in the treatment of oral leukoplakia. Eur J Cancer B Oral Oncol, Oxford. v. 28B, no. 2, p. 121-123, Oct 1992b.

TRADATI, N. et al. Successful topical treatment of oral lichen planus and leukoplakias with fenretinida. Cancer Letters, Amsterdam, v. 76, no. 2-3, p 109-111, Jan. 1994.

TRADATI, N. et al. Oral leukoplakias: to treat or not? Oral Oncol, Amsterdam, v. 33, no. 5, p. 317-321, Sept. 1997.

TSAI, J. C. et al. Photodynamic Therapy of oral dysplasia with topical 5-aminolevulinic acid and light-emitting diode array. Lasers Surg Med, New York, v. 34, no. 1, p. 18-24, 2004.

van der HEM, P. S. et al. The results of CO2 laser surgery in patients with oral leukoplakia: a 25 year follow up. Oral Oncol, Oxford, v. 41, no. 1, p. 31-37, Jan. 2005.

van der WAAL, I. et al. Oral leukoplakia: a clinicopathological review. Oral Oncol, Oxford, v. 33, no. 5, p. 291-301, Sept. 1997.

van der WAAL, I. Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol, Oxford, v. 45, no. 4-5, p. 317-323, Apr./May 2009.

VLADIMIROV, B. S.; SCHIODT, M. The effect of quitting smoking on the risk of unfavorable events after surgical treatment of oral potentially malignant lesions. Int J Oral Maxillofac Surg, Copenhagen, v. 38, no. 11, p. 1188-1193, Nov. 2009.

WARNAKULASURIYA, S. et al. Oral epithelial dysplasia classification systems: predictive value, utility, weaknesses and scope for improvement. J Oral Pathol Med, Copenhagen, v. 37, no. 3, p. 127-133, Mar. 2008.

WILLIAM, W. N., JR. et al. High-dose fenretinide in oral leukoplakia. Cancer Prev Res (Phila), Philadelphia, v. 2, no. 1, p. 22-26, Jan. 2009.

WONG, F.; EPSTEIN, J.; MILLNER, A. Treatment of oral leukoplakia with topical bleomycin. A pilot study. Cancer, New York, v. 64, no. 2, p. 361-365, July 1989.

WONG, S. J. et al. A phase I trial of aminolevulinic acid-photodynamic therapy for treatment of oral leukoplakia. Oral Oncol, Oxford, v. 49, no. 9, p. 970-976, Sept. 2013.

YANG, S. W. et al. Treatment outcome of dysplastic oral leukoplakia with carbon dioxide laser--emphasis on the factors affecting recurrence. J Oral Maxillofac Surg, Philadelphia, v. 69, no. 6, p. e78-87, June 2011.

YU, C. H. et al. Comparison of clinical outcomes of oral erythroleukoplakia treated with photodynamic therapy using either light-emitting diode or laser light. Lasers Surg Med, New York, v. 41, no. 9, p. 628-633, Nov. 2009.

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Publicado

2018-10-15

Como Citar

Lombardo, E. M., Gonçalves, M. R., Só, M. V. R., Martins, M. A. T., & Carrard, V. C. (2018). Leucoplasia bucal: considerações a respeito do tratamento e do prognóstico. Revista Da Faculdade De Odontologia De Porto Alegre, 59(1), 34–41. https://doi.org/10.22456/2177-0018.44770

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Revisão de literatura