Neck Dissection und adjuvante postoperative Therapie beim Oro- und Hypopharynxkarzinom: Empfehlungen der aktuellen S3-Leitlinie – Teil II

Dieser Beitrag ist als Teil II der bereits in der LRO erschienenen Arbeit „Chirurgische Therapie des Oropharynxkarzinoms: Empfehlungen der aktuellen S3-Leitlinie – Teil I“ zu verstehen. Neben der chirurgischen Therapie des Primärtumors des Hypopharynxkarzinoms werden die Neck Dissection und die adjuvante postoperative Therapie des Oro- und Hypopharynxkarzinoms gemäß den Ausführungen der neuen S3-Leitlinie „Diagnostik, Therapie, Prävention und Nachsorge des Oro- und Hypopharynxkarzinoms“ [1] dargestellt.

Abstract

Part II of the S3 guideline report deals with the surgical treatment of hypopharyngeal carcinoma, neck dissection for oropharyngeal and hypopharyngeal carcinomas and adjuvant therapy options. Primary surgical therapy ± adjuvant radio- or radiochemotherapy and primary radio- or radiochemotherapy are established as primary therapies for local-regional hypopharyngeal carcinomas. Direct randomized comparisons of both basic therapeutic procedures were never conducted. Available registry data show a worse prognosis of hypopharyngeal carcinoma compared to oropharyngeal carcinomas in all locoregional tumor stages, regardless of the treatment method. For T1N0–T2N0 squamous cell carcinoma of the hypopharynx, there are no relevant differences in overall survival and locoregional relapse rate between primary surgical and primary non-surgical treatment. Primary surgical therapy ± adjuvant radiotherapy or radiochemotherapy and primary radiotherapy or radiochemotherapy are established as primary therapies for advanced but locoregionally limited hypopharyngeal carcinomas. Neck dissection is an integral part of the primary surgical treatment of oropharyngeal and hypopharyngeal cancer. There are only a few randomized studies on non-surgical organ preservation for advanced hypopharyngeal cancer as an alternative to pharyngolaryngectomy, but these have led to the recommendation of alternative concepts in the new guideline. The indication and implementation of postoperative adjuvant radiotherapy and radiochemotherapy for hypopharyngeal carcinoma do not differ from those for HPV/p16-negative and -positive oropharyngeal carcinoma.

Kernaussagen

• Als primäre Therapien für lokoregionär begrenzte Hypopharynxkarzinome sind die primär chirurgische Therapie ± adjuvante Radio- oder Radiochemotherapie und die primäre Radio- oder Radiochemotherapie etabliert. Direkte randomisierte Vergleiche zu beiden prinzipiellen Therapieverfahren wurden nie durchgeführt.

• Die verfügbaren Registerdaten zeigen unabhängig vom Therapieverfahren in allen lokoregionär begrenzten Tumorstadien eine schlechtere Prognose als bei Oropharynxkarzinomen.

• Für T1-N0- bis T2-N0-Plattenepithelkarzinome des Hypopharynx zeigen sich zwischen einer primär operativen und einer primär nichtoperativen Therapie keine relevanten Unterschiede in Bezug auf das Gesamtüberleben und die lokoregionäre Rückfallrate.

• Aus retrospektiven Betrachtungen bei fortgeschrittenen Hypopharynxkarzinomen ist bekannt, dass sich die Tracheotomie, die vor einer Laryngektomie oder einer Teillaryngektomie notwendig wird, negativ auf die Prognose auswirken kann.

• Die Neck Dissection ist fester Bestandteil der primär operativen Therapie des Oro- und Hypopharynxkarzinoms. Sie orientiert sich an der Klassifikation nach Robbins unter Berücksichtigung der Halslevel. Veraltete Begriffe wie „funktionelle“ oder „supraomohyoidale“ Neck Dissection sollten nicht mehr verwendet werden.

• Die Pharyngolaryngektomie ist als Primärtherapie immer noch wichtiger Bestandteil der therapeutischen Optionen bei Karzinomen in fortgeschrittenen Stadien. Die komplette, also zirkuläre Hypopharynxresektion macht grundsätzlich die Rekonstruktion des Speisewegs erforderlich.

• Für den nichtchirurgischen Organerhalt des fortgeschrittenen Hypopharynxkarzinoms als Alternative zur Pharyngolaryngektomie gibt es nur wenige randomisierte Studien, die jedoch zu einer Empfehlung dieser alternativen Konzepte in der neuen Leitlinie geführt haben.

• Die Indikation und Durchführung der postoperativen adjuvanten Radio- und Radiochemotherapie beim Hypopharynxkarzinom unterscheiden sich nicht von denen des HPV/p16-negativen und -positiven Oropharynxkarzinoms.

Schlüsselwörter

Hypopharynxkarzinom - Oropharynxkarzinom - Kopf-Hals-Tumoren - adjuvante Therapie - Neck Dissection - Chirurgie

Keywords

hypopharyngeal carcinoma - oropharyngeal carcinoma - head and neck tumors - adjuvant therapy - neck dissection - surgical treatment

Publikationsverlauf

Artikel online veröffentlicht:
01. Oktober 2024

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