Ist die primäre Chirurgie bei fortgeschrittenen Kopf-Hals-Karzinomen noch aktuell?

Zusammenfassung

Organerhaltende Therapiestrategien für Kopf-Hals-Karzinome haben in den letzten Jahren ihre Wirksamkeit in kontrollierten Studien bewiesen. Vor allem in den USA werden sie deshalb an vielen Kliniken der primär chirurgischen Therapie vorgezogen. Bestimmte Primärtumoren sprechen jedoch schlecht auf Radiochemotherapie an. Es hat sich weiterhin gezeigt, dass die Intensivierung der nicht chirurgischen Primärtherapien eine ausgeprägte Toxizität mit besorgniserregenden Mortalitätsraten aufweist. Viele Faktoren müssen bei der Wahl der Therapie berücksichtig werden. In dieser Übersichtsarbeit wird für die wichtigsten Primärtumorlokalisationen die aktuelle Literatur dargestellt und diskutiert.

Abstract

Organ preservation protocols for advanced head and neck carcinoma have proven to be successful in controlled clinical trials. This has led to an increase in the use of primary chemoradiation for these tumors. However, the intensification of nonoperative treatment protocols has been associated with a dramatic increase in acute treatment-related toxicity and mortality. In this paper, the role of primary surgical care is reviewed. Recent publications in the field and current treatment concepts are discussed.

Schlüsselwörter

primäre Chirurgie - Kopf-Hals-Karzinome - chirurgische Primärtherapien

Key words

primary surgical - head and neck cancer - operative treatment protocols

Literatur

• 1 Trotti A, Pajak TF, Gwede CK. et al . TAME: development of a new method for summarising adverse events of cancer treatment by the Radiation Therapy Oncology Group.  Lancet Oncol. 2007;  8 613-624.1
• 2 The NCCN Clinical Practice Guidelines in Oncology Head and Neck cancers . National Comprehensive Cancer Network, Inc. Web site. Online:.  http://www.nccn.org Stand 19.03.2010
• 3 Cooper JS, Pajak TF, Forastiere AA. et al . Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. Radiation Therapy Oncology Group 9501/Intergroup.  N Engl J Med. 2004;  350 1937-1944
• 4 Preuss SF, Weinell A, Molitor M. et al . Nuclear surviving expression is associated with HPV-independent carcinogenesis and is a negative prognostic marker in oropharyngeal squamous cell carcinoma.  Br J Cancer. 2008;  98 627-632
• 5 Fakhry C, Westra WH, Li S. et al . Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial.  J Natl Cancer Inst. 2008;  100 261-269
• 6 Worden FP, Kumar B, Lee JS. et al . Chemoselection as a strategy for organ preservation in advanced oropharynx cancer: response and survival positively associated with HPV16 copy number.  J Clin Oncol. 2008;  26 3138-3146
• 7 Parsons JT, Mendenhall WM, Stringer SP. et al . Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both.  Cancer. 2002;  94 2967-2968
• 8 Yom SS, Machtay M, Biel MA. et al . Survival impact of planned restaging and early surgical salvage following definitive chemoradiation for locally advanced squamous cell carcinomas of the oropharynx and hypopharynx.  Am J Clin Oncol. 2005;  28 385-392
• 9 The Department of Veterans Affairs Laryngeal Cancer Study Group . Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer.  N Engl J Med. 1991;  324 1685-1690
• 10 Forastiere AA, Goepfert H, Maor M. et al . Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer.  N Engl J Med. 2003;  349 2091-2098
• 11 Weber RS, Berkey BA, Forastiere A. et al . Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91–11.  Arch Otolaryngol Head Neck Surg. 2003;  129 44-49
• 12 Posner MR, Wirth LJ. Cetuximab and radiotherapy for head and neck cancer.  N Engl J Med. 2006;  354 ((6)) 634-636
• 13 Gourin CG, Conger BT, Sheils WC. et al . The effect of treatment on survival in patients with advanced laryngeal carcinoma.  Laryngoscope. 2009;  119 1312-1317
• 14 Machtay M, Moughan J, Trotti A. et al . Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis.  J Clin Oncol. 2008;  26 3582-3589
• 15 Goodwin Jr WJ. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means?.  Laryngoscope. 2000;  110 ((Suppl. 93)) 1-18
• 16 Hall SF, Groome PA, Irish J. et al . The natural history of patients with squamous cell carcinoma of the hypopharynx.  Laryngoscope. 2008;  118 1362-1371
• 17 Riechelmann H. Humane Papillomaviren bei Kopf-Hals-Karzinomen.  Laryngo-Rhino-Otol. 2010;  89 43-48
• 18 Tsou YA, Lin MH, Hua CH. et al . Survival outcome by early chemoradiation therapy salvage or early surgical salvage for the treatment of hypopharyngeal cancer.  Otolaryngol Head Neck Surg. 2007 Nov;  137 711-716
• 19 Laramore GE, Scott CB, Schuller DE. et al . Is a surgical resection leaving positive margins of benefit to the patient with locally advanced squamous cell carcinoma of the head and neck: a comparative study using the intergroup study 0034 and the Radiation Therapy Oncology Group head and neck database.  Int J Rad Oncol Biol Phys. 1993;  27 1011-1010

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