Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2014 Feb;150(2):169-73. doi: 10.1177/0194599813512101. Epub 2013 Nov 7.
In this commentary, we review our experience with early glottic carcinomas in an attempt to identify points to consider when developing a treatment protocol and technical considerations in oncologic resection to maintain laryngeal function. We highlight several consistent themes: (1) difficult exposure is not always a contraindication to endoscopic resection; (2) depth of invasion may be apparent only intraoperatively; (3) radiation therapy should be offered for deeply invasive cancers requiring extensive cordectomy or for patients who cannot afford lengthy vocal downtime; however, (4) radiation therapy leads to acute dysphagia and collateral damage to the contralateral vocal fold that is avoided with surgery; (5) good voice can be obtained after healing if resection is limited to intramuscular cordectomy; (6) the key to optimal vocal results is adequate glottal closure; and (7) second look operations are occasionally necessary, and therefore preoperative counseling should include this possibility. Since both surgery and radiation therapy achieve excellent oncologic control, a patient-centered approach is preferred in management.
在这篇评论中，我们回顾了我们在早期声门癌治疗方面的经验，试图确定在制定治疗方案时需要考虑的要点，以及在维持喉功能的肿瘤切除方面的技术注意事项。我们强调了几个一致的主题：（1）困难的暴露并不总是内镜切除的禁忌症；（2）浸润深度可能仅在手术中显现；（3）对于需要广泛声带切除术的深部浸润性癌症或无法承受长时间声音失能的患者，应提供放射治疗；然而，（4）放射治疗会导致急性吞咽困难和对侧声带的附带损伤，而手术则可以避免这种损伤；（5）如果切除仅限于肌肉内声带切除术，愈合后可以获得良好的声音；（6）获得最佳声音效果的关键是充分的声门闭合；（7）偶尔需要二次手术，因此术前咨询应包括这种可能性。由于手术和放射治疗都能达到极好的肿瘤控制效果，因此在治疗管理中更倾向于以患者为中心的方法。
