Dias Fernando L, Lima Roberto A, Kligerman Jacob, Cernea Claudio R
Head and Neck Surgery Service, Instituto Nacional de Cancer/INCA, Rio de Janeiro, Brazil.
ORL J Otorhinolaryngol Relat Spec. 2005;67(6):311-8. doi: 10.1159/000090040. Epub 2005 Dec 1.
Historically, patients with advanced laryngeal cancer have been treated with radical surgery and adjuvant radiation therapy. Intensive surgical research has allowed surgeons to deal with almost any local extension and to propose an appropriate surgical procedure for each case. Several function-sparing surgical options are available to treat moderately advanced/advanced laryngeal cancer. Better understanding of the anatomy and biology of cancer in this anatomical site has enabled us to devise effective oncological strategies associated with a great effort to preserve laryngeal function. Numerous efforts have been made to augment the therapeutic armamentarium with the addition of chemotherapeutic agents combined with radiation therapy. For advanced laryngeal cancer, the debate is still open between partial/subtotal surgical procedures, which are more efficient but sacrifice parts of the larynx, and radiotherapy/chemoradiation protocols which can preserve the larynx and its function even though it requires radical surgery for salvage. Efforts should be made to select patients properly, in an individual basis, based on tumor characteristics, clinical aspects, patient's expectations, and the expertise of the head and neck oncologic team for the various therapeutic strategies in order to get better oncological results in association with the preservation of the laryngeal form and function, when possible.
从历史上看，晚期喉癌患者一直接受根治性手术和辅助放疗。深入的外科研究使外科医生能够应对几乎任何局部扩展情况，并为每个病例提出合适的手术方案。有几种保留功能的手术选择可用于治疗中晚期/晚期喉癌。对该解剖部位癌症的解剖学和生物学有了更深入的了解，使我们能够制定有效的肿瘤学策略，并在很大程度上努力保留喉功能。人们已经做出了许多努力，通过添加化疗药物与放疗相结合来扩充治疗手段。对于晚期喉癌，在部分/次全手术（更有效但会牺牲部分喉部）与放疗/放化疗方案（尽管挽救时需要根治性手术，但能保留喉部及其功能）之间的争论仍未平息。应根据肿瘤特征、临床情况、患者期望以及头颈肿瘤团队对各种治疗策略的专业知识，在个体基础上恰当地选择患者，以便在可能的情况下，在保留喉部形态和功能的同时获得更好的肿瘤学治疗效果。
