Funktionserhaltende Therapie des Kehlkopf- und des Hypopharynxkarzinoms

Zusammenfassung

Die Prinzipien der transzervikalen und lasermikrochirurgischen Kehlkopfteilresektionen werden beschrieben, die onkologischen und funktionellen Ergebnisse diskutiert und den Ergebnissen der Strahlentherapie respektive der Radiochemotherapie gegenübergestellt. In den letzten 10 Jahren hat die endoskopische Kehlkopfteilresektion bei frühen Stimmlippen- und supraglottischen Kehlkopfkarzinomen breite Anwendung gefunden und die transzervikalen Teilresektionen zurückgedrängt. Die onkologischen Ergebnisse hinsichtlich Überleben und Kehlkopferhalt der verschiedenen Kehlkopfteilresektionen sind vergleichbar, die funktionellen Ergebnisse der endoskopischen Chirurgie sind besser und die Morbidität ist deutlich geringer. Unter dem Aspekt des Kehlkopferhalts, sind die chirurgischen Verfahren der Strahlentherapie überlegen. Es hat sich gezeigt, dass mit der Lasermikrochirurgie bei Stimmlippenkarzinomen mit Bewegungseinschränkung oder Fixation, bei supraglottischen Karzinomen mit Befall des prä- und/oder des paraglottischen Raums sowie bei Hypopharynxkarzinomen bei geeigneter Indikationsstellung mit vertretbarer Morbidität gute onkologische und funktionelle Resultate erzielt worden sind. Bei diesen Tumoren sind transzervikale Teilresektionen bei selektierten Patienten an Zentren mit anerkannter Expertise erfolgreich durchgeführt worden. Die zunächst sehr positiv bewerteten Studienergebnisse über die Effektivität der Radiochemotherapie mit dem Ziel des Organerhalts beim Kehlkopf- und Hypopharynxkarzinom werden in der letzten Zeit aufgrund von Berichten über Spätkomplikationen kritischer gesehen.

Abstract

Functional Organ Preservation in Laryngeal and Hypopharyngeal Cancer

The principles of open vs. laser microsurgical approaches for partial resections of the larynx are described, oncological as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.

Schlüsselwörter

Larynxkarzinom - Hypopharynxkarzinom - Behandlung - Organerhalt - Kehlkopfteilresektion - transorale Lasermikrochirurgie - Chemoradiotherapie

Key words

laryngeal cancer - hypopharyngeal cancer - treatment - organ preservation - partial laryngectomy - transoral laser microsurgery - chemoradiation

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