Evaluation der Ösophagoskopie im Staging und Restaging von Kopf-Hals-Plattenepithelkarzinomen

Zusammenfassung

Hintergrund Die Ösophagoskopie als Teil der Panendoskopie ist ein wichtiger Bestandteil der Diagnostik und Nachsorge von Patienten mit Kopf-Hals-Plattenepithelkarzinomen (HNSCC). Zweitkarzinome haben gravierenden Einfluss auf die Therapie der Primärerkrankung. Diese Arbeit soll prüfen, ob die routinemäßige Ösophagoskopie gerechtfertigt ist oder ob prädiktive Faktoren eine Selektion von Patienten mit erhöhtem Risikoprofil erlauben.

Material und Methoden In einem systematischen Review wurden die Inzidenz von Zweitkarzinomen des Ösophagus und die Komplikationsrate der Ösophagoskopie erfasst. Eine retrospektive Auswertung erfolgte am eigenen Patientenkollektiv. Zur Evaluation der gängigen Praxis an deutschen HNO-Kliniken wurde eine Umfrage durchgeführt.

Ergebnisse 1053 Ösophagoskopien bei 800 Patienten mit HNSCC wurden ausgewertet. Es traten 7 (0,9 %) synchrone Zweittumoren auf. In 253 Kontroll-Ösophagoskopien wurden 5 (2 %) metachrone Zweittumoren detektiert. In einem Fall (0,1 %) kam es zu einer iatrogenen Perforation. Ein Zusammenhang zwischen Risikofaktoren (Noxen, Lokalisation Primärtumor etc.) und der Inzidenz von Zweitkarzinomen wurde nicht nachgewiesen. Das Literaturreview ergab eine mittlere gewichtete Inzidenz der Zweitkarzinome für Europa/USA von 1,8 % und 4,1 % für Asien sowie eine Rate der iatrogenen Ösophagusperforation von 0–0,2 %. Die Umfrage zeigte eine routinemäßige Durchführung der Ösophagoskopie im Staging (100 %), in der Nachsorge in 65,3 %.

Schlussfolgerungen Die Ösophagoskopie ist ein sicheres Verfahren zum Ausschluss eines Zweitkarzinoms des Ösophagus. Um eine Patientenselektion nach entsprechendem Risikoprofil – insbesondere in der Tumornachsorge – zu ermöglichen, sind prospektive multizentrische Studien erforderlich.

Abstract

Objective Oesophagoscopy is important in diagnostic and follow up investigation in patients with head and neck squamous cell carcinoma (HNSCC). Second primary malignancies of the oesophagus have major impact on therapy of the primary tumour. Considering the low incidence of oesophageal second primaries and the serious complication of oesophageal perforation routine oesophagoscopy is being discussed.

Material and Methods Incidence of oesophageal second primaries and complication rates in oesophagoscopy were identified in a systematic review. A retrospective analysis was performed in our own patient collective. To evaluate the current practice at German ENT Clinics a survey was conducted.

Results 1053 oesophagoscopies in 800 patients were analysed. In 800 patients seven (0.9 %) synchronous secondary malignancies of the oesophagus occurred. In 253 follow up oesophagoscopies five (2 %) metachronous secondary malignancies were discovered. 14 (1.3 %) complications were detected; oesophageal perforation was only detected in one case (0.1 %). There was no association of certain risk factors with the incidence of secondary malignancies. The review of literature showed an incidence of secondary malignancies for Europe/USA of 1.8 % and for Asia of 4.1 %. Incidence of oesophageal perforation was 0–0.2 %. Survey results showed routine oesophagoscopy in staging (100 %) and regularly in follow up (65.3 %).

Conclusions Oesophagoscopy is a convenient method to detect secondary malignancies of the oesophagus. To allow a selection of patients developing secondary malignancies according to risk profiles further prospective multicentre studies are required.

Schlüsselwörter

Ösophagoskopie - Panendoskopie - Zweittumoren - Staging - Kopf- und Halskarzinome

Key words

panendoscopy - secondary primary - staging - head and neck cancer - oesophagoscopy

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