Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL.
J Clin Oncol. 2018 Apr 10;36(11):1143-1169. doi: 10.1200/JCO.2017.75.7385. Epub 2017 Nov 27.
Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
更新喉癌治疗中保留喉策略应用指南建议。
专家组对 2005 年 1 月至 2017 年 5 月期间的文献进行了系统回顾。
专家组确认，适当选择患者采用保留喉方法不会影响生存。与全喉切除术和辅助治疗相比，没有任何一种保留喉方法具有生存优势。内镜手术切除在疾病局限（T1、T2）患者中的应用和 T4a 疾病或严重预处理喉功能障碍患者的初始全喉切除术的应用得到支持。增加了治疗后评估区域淋巴结的正电子发射断层扫描成像和评估嗓音及吞咽功能的最佳方法的新建议。
T1、T2 喉癌患者应采用内镜切除或放疗的方法保留喉，这两种方法的结果相似。对于局部晚期（T3、T4）疾病患者，器官保留手术、联合化疗和放疗或单纯放疗都有可能保留喉，而不影响总生存率。对于广泛 T3 或大 T4a 病变和/或预处理喉功能不良的选定患者，全喉切除术可能会获得更好的生存率和生活质量。经放化疗后颈淋巴结（N+）完全临床和影像学反应的患者，无需行选择性颈清扫术。所有患者在治疗前均应进行嗓音和吞咽功能的基线评估，并接受关于治疗选择对嗓音、吞咽和生活质量潜在影响的咨询。更多信息可在 www.asco.org/head-neck-cancer-guidelines 和 www.asco.org/guidelineswiki 上获取。
