Pracy P, Loughran S, Good J, Parmar S, Goranova R
Department of ENT/Head and Neck Surgery,Queen Elizabeth Hospital Birmingham,Birmingham,UK.
University Department of Otolaryngology,Manchester Royal Infirmary,Manchester,UK.
J Laryngol Otol. 2016 May;130(S2):S104-S110. doi: 10.1017/S0022215116000529.
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With an age standardised incidence rate of 0.63 per 100 000 population, hypopharynx cancers account for a small proportion of the head and neck cancer workload in the UK, and thus suffer from the lack of high level evidence. This paper discusses the evidence base pertaining to the management of hypopharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care. Recommendations • Cross-sectional imaging with computed tomography of the head, neck and chest is necessary for all patients; magnetic resonance imaging of the primary site is useful particularly in advanced disease; and computed tomography and positron emission tomography to look for distant disease. (R) • Careful evaluation of the upper and lower extents of the disease is necessary, which may require contrast swallow or computed tomography and positron emission tomography imaging. (R) • Formal rigid endoscopic assessment under general anaesthetic should be performed. (R) • Nutritional status should be proactively managed. (R) • Full and unbiased discussion of treatment options should take place to allow informed patient choice. (G) • Early stage disease can be treated equally effectively with surgery or radiotherapy. (R) • Endoscopic resection can be considered for early well localised lesions. (R) • Bulky advanced tumours require circumferential or non-circumferential resection with wide margins to account for submucosal spread. (R) • Offer primary surgical treatment in the setting of a compromised larynx or significant dysphagia. (R) • Midline lesions require bilateral neck dissections. (R) • Consider management of silent nodal areas usually not addressed for other primary sites. (G) • Reconstruction needs to be individualised to the patients' needs and based on the experience of the unit with different reconstructive techniques. (G) • Consider tumour bulk reduction with induction chemotherapy prior to definitive radiotherapy. (R) • Consider intensity modulated radiation therapy where possible to limit the consequences of wide field irradiation to a large volume. (R) • Use concomitant chemotherapy in patients who are fit enough and consider epidermal growth factor receptor blockers for those who are less fit. (R).
这是英国参与头颈癌患者护理的专业协会认可的官方指南。下咽癌的年龄标准化发病率为每10万人口0.63例，在英国头颈癌工作量中占比很小，因此缺乏高级别证据。本文讨论了下咽癌管理的证据基础，并为接受癌症护理的这组患者的管理提供建议。
建议
• 所有患者均需进行头部、颈部和胸部计算机断层扫描的横断面成像；原发部位的磁共振成像尤其对晚期疾病有用；以及计算机断层扫描和正电子发射断层扫描以寻找远处疾病。（推荐）
• 必须仔细评估疾病的上下范围，这可能需要吞咽造影或计算机断层扫描和正电子发射断层扫描成像。（推荐）
• 应在全身麻醉下进行正式的硬质内镜评估。（推荐）
• 应积极管理营养状况。（推荐）
• 应充分且无偏见地讨论治疗方案，以便患者做出明智的选择。（良好实践）
• 早期疾病采用手术或放疗治疗效果相当。（推荐）
• 对于早期局限性良好的病变可考虑内镜切除。（推荐）
• 体积较大的晚期肿瘤需要进行带宽切缘的环形或非环形切除，以应对黏膜下扩散。（推荐）
• 在喉功能受损或有明显吞咽困难的情况下提供原发性手术治疗。（推荐）
• 中线病变需要双侧颈部清扫。（推荐）
• 考虑对通常其他原发部位未涉及的隐匿性淋巴结区域进行处理。（良好实践）
• 重建需要根据患者的需求个体化，并基于单位在不同重建技术方面的经验。（良好实践）
• 考虑在确定性放疗前用诱导化疗缩小肿瘤体积。（推荐）
• 尽可能考虑调强放射治疗，以限制大野照射对大体积组织的影响。（推荐）
• 对身体状况足够好的患者使用同步化疗，对身体状况较差的患者考虑使用表皮生长因子受体阻滞剂。（推荐）
