Aktueller Status der Therapie und Prophylaxe des Oropharynxkarzinoms

Zusammenfassung

Die Inzidenz von Oropharynxkarzinomen nimmt weltweit signifikant zu. Aufgrund ihres Zusammenhangs mit chronischem Tabak-/Alkoholkonsum, zunehmend aber auch mit dem humanen Papillomavirus HPV-16, sind die Oropharynxkarzinome eine genetisch heterogene Tumorgruppe mit hoher prognostischer Diversifikation. Dieser Beitrag versucht auf Basis der aktuellen Evidenzlage Empfehlungen zu Therapie, Prophylaxe und Früherkennung darzulegen.

Abstract

Incidence of oropharyngeal carcinoma (OPSCC) is increasing significantly worldwide. Due to its association with chronic tobacco/alcohol consumption, but increasingly also with the human papillomavirus HPV-16, oropharyngeal carcinoma is a genetically heterogeneous tumor group with high prognostic diversification. HPV-associated OPSCC respond significantly better to previous treatment concepts than non-HPV-associated. Both after primary surgical as well as after radiotherapie, radiochemotherapie and anti-EGFR treatment, this tumor group shows a significantly better survival. There is no evidence that in HPV association only primary radiotherapy concepts should be used. Currently, in the 8th edition of the TNM classification (UICC, AJCC), the HPV-associated different prognostic consideration with a rearrangement of the tumor stages and the N status was taken into account. Regardless of the known blur, p16 status detection is the most practicable and least expensive method of detection today, and is therefore consistently recommended (also by the AJCC and UICC TNM committees). HPV16 positive non-smokers differ from HPV-16 negative smokers by nearly 50 % in 5-year survival. Transoral robot surgery (TORS), which is highly acclaimed in the US today, with the Da Vinci Telemanipulator (Intuitive Surgical) has triggered a downright euphoric discussion on the minimally invasive surgery of resectable OPSCC. Based on a stable data set, it is now clear that an R0 resection must be sought regardless of the surgical procedure. Resection margins < 5 mm (R0 < 5 mm) are considered to be an “intermediate risk” situation and, like the N status, influence the adjuvant concept (radiochemotherapy). During and after transoral surgical procedures, the risk of rebleeding should never be underestimated and can not be ruled out with the utmost care.

Schlüsselwörter

Oropharynxkarzinom - Human Papilloma Virus - HPV - Transoral Robot Surgery - Radiochemotherapie - Salvage-Therapie

Key words

Oropharyngeal carcinoma - Human papilloma virus - Transoral robot surgery - Radiochemotherapy - Salvage therapy

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