Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France.
Head Neck. 2011 Nov;33(11):1638-48. doi: 10.1002/hed.21528. Epub 2011 Jan 6.
Evidence-based medicine integrates the best available data in decision making, with the goal of minimizing physicians' and patients' subjectivity. In 2006, the American Society of Clinical Oncology edited clinical practice guidelines for the use of larynx preservation strategies. The objective of this review was to evaluate the current levels of evidence for glottic squamous cell carcinoma. Current guidelines for early stage glottic cancer are based on low-level evidence. Conservation surgery (open or transoral) and radiation therapy are all valid options for T1 and selected T2 lesions. For advanced lesions, surgery and combined chemotherapy and radiation are options. High-level evidence favors combined chemotherapy and radiation therapy or altered fractionation radiation therapy as nonsurgical strategies for organ preservation, compared with radiation therapy alone. The optimal combination of chemotherapy, targeted therapy, and radiation therapy remains to be demonstrated, however, and for high-volume tumors, total laryngectomy may still be warranted.
循证医学将最佳可用数据整合到决策中，旨在最大程度地减少医生和患者的主观性。2006 年，美国临床肿瘤学会编辑了喉保护策略使用的临床实践指南。本综述的目的是评估当前声门型鳞状细胞癌的证据水平。目前早期声门癌的治疗指南基于低水平证据。对于 T1 和选择的 T2 病变，开放性或经口手术和放射治疗都是有效的选择。对于晚期病变，手术和联合化疗加放疗是可选方案。高级别证据支持与单纯放疗相比，联合化疗和放疗或改变分割放疗作为器官保留的非手术策略。然而，化疗、靶向治疗和放疗的最佳组合仍有待证明，对于大体积肿瘤，全喉切除术可能仍然是必要的。
