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Organerhalt bei Larynx-Hypopharynx-Karzinomen

Was ist das?

Organ preservation in laryngeal and hypopharyngeal cancer – what does it mean?

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Organerhaltende Therapieansätze bei Karzinomen des Larynx und Hypopharynx als Alternative zur kompletten Kehlkopfentfernung (Laryngektomie) wurden in den letzten 2 Jahrzehnten signifikant weiterentwickelt und in der klinischen Betrachtung etabliert. Insbesondere die transorale Laserchirurgie hat sich einen festen Stellenwert in der Behandlung mikrolaryngoskopisch gut übersehbarer Karzinome (bis Tumorgröße T3) erarbeitet, wobei je nach Erfahrung des Operateurs in Einzelfällen auch offene Teilresektionen des Kehlkopfs zur Anwendung kommen. Übereinkunft herrscht bezüglich der nach wie vor gültigen Notwendigkeit der Laryngektomie, die bei fortgeschrittenen Tumoren des Larynx und Hypopharynx oft die rehabilitativ günstigste und onkologisch sauberste Therapie der Wahl darstellt. Hat das Karzinom eine Ausbreitung, die durch Teilresektionen nicht mehr sinnvoll behandelbar ist, können multimodale Therapieansätze zum Einsatz kommen, die in den letzten Jahren im Rahmen klinischer Studien diversifiziert wurden. Früh konnte gezeigt werden, dass solche Organerhaltungsprogramme in onkologischer Hinsicht gleichwertig mit der Laryngektomie zu setzen sind und langfristig funktionell zufrieden stellende Organerhaltungsraten bis zu 60% erreichen können. Der aktuelle Fokus richtet sich derzeit auf den Stellenwert der Induktionschemotherapie, dem zusätzlichen Einsatz von Biologicals (insb. EGFR-Blockade) und die Reduktion der Spättoxizität.

Abstract

In the last 2 decades organ preserving surgical and multimodal therapy strategies in laryngeal and hypopharyngeal cancer have been significantly developed. Transoral laser surgery has been established in clinical routine for management of well visible tumors in microlaryngoscopy. Depending on the personal experience of the surgeon, classic open procedures for partial larynx resections are still indicated in many situations. There is no question that laryngectomy is still of high value due to clear oncological and functional results. Tumors within defined borders, which are not sufficiently to manage by partial resection can be treated within so called organ preservation programs, which include primarily chemoradiation with salvage surgery if needed. These programs can result in long time larynx preservation rates up to 60% with survival rates comparable to laryngectomy. Present discussion focuses on relevance of induction chemotherapy, additional use of biologicals, like EGFR-targeting, and reduction of late toxicity, which limits sufficient functional outcome.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde/Plastische Operationen, Universitätsklinik Leipzig, 04103, Liebigstraße 18a, Leipzig, Deutschland

    A. Dietz

  2. Medizinische Klinik III, Charité, Deutschland, Berlin

    U. Keilholz

  3. Klinik und Poliklinik für Strahlentherapie, Universität, Deutschland, Würzburg

    M. Flentje

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  1. A. Dietz
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  2. U. Keilholz
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  3. M. Flentje
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Correspondence to A. Dietz.

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Dietz, A., Keilholz, U. & Flentje, M. Organerhalt bei Larynx-Hypopharynx-Karzinomen. Onkologe 13, 118–128 (2007). https://doi.org/10.1007/s00761-006-1153-0

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