Nicht resektable Kopf-Hals-Tumoren und deren Therapie

Zusammenfassung

Fortgeschrittene Plattenepithelkarzinome der Mundhöhle, des Oro-, Hypopharynx und Larynx erweisen sich oft als nicht sinnvoll resektabel. In die komplexen Überlegungen zur Resektabilität fließen morphologische, funktionelle und sozialethische Aspekte ein, die oft eine Therapieentscheidung deutlich erschweren. Im Falle einer Nicht-Resektabilität bieten sich die modernen kurativen Ansätze der multimodalen Therapieprotokolle an, die heute, nach in Studien abgesichertem Nachweis, als simultane Radiochemotherapie empfohlen werden. Als begleitende Chemotherapeutika kommen aktuell Cis-, Carboplatin, 5-Fluorouracil, Mitomycin C und die Gruppe der Taxane zur Anwendung. Ergänzend wird beispielsweise zur Vermeidung einer Glossektomie die interstitielle Brachytherapie empfohlen. Rettungschirurgische Maßnahmen (salvage surgery) konzentrieren sich erstrangig auf Residuen persistierender Halslymphknotenmetastasen nach erfolgter Radiochemotherapie. Der Stellenwert einer alleinigen Chemotherapie wird in ihrem rein palliativen Charakter gesehen.

Decision Making in Non Resectable Head and Neck Tumours

Advanced squamous cell carcinomas of the oral cavity, oro-, hypopharynx and larynx often have to be categorised as non resectable disease. Complex decision making for therapy is influenced by morphological, social and ethical aspects. In case of non resectability, simultaneous chemo radiation therapy is evident and recommended. Different substances for additional chemotherapy like Cis-, Carboplatine, 5-Fluorouracile, Mitomycin C and Taxans are in use. Alternatively for selected cases (to avoid total glossectomy for instance) brachytherapy is recommended. Salvage surgery after primary chemo radiation is predominantly common in residual neck disease. Sole chemotherapy is suggested for second or third line palliative treatment.

Schlüsselwörter

Radiochemotherapie · nicht resektable Kopf-Hals-Tumoren

Key words

Chemo radiation · non-resectable, advanced head and neck tumours

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