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Multimodaler Larynxerhalt

Wege zur besseren Patientenselektion

Multimodal laryngeal preservation

Current data-based opinion

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Zusammenfassung

In dem folgenden Artikel soll die aktuelle Studienlage zum Thema multimodaler Larynxerhalt bei fortgeschrittenen Larynx-/Hypopharynxkarzinomen dargestellt und dem Leser die Möglichkeit einer Standortbestimmung gegeben werden. Prinzipiell wird zwischen simultanen und Induktionsradiochemotherapieprotokollen unterschieden. In Hinblick auf Spättoxizität und damit verbundene Funktionseinschränkungen zeichnet sich derzeit ab, dass Induktionsprotokolle den bislang propagierten platinbasierten Simultanprotokollen bezüglich des funktionellen Larynxerhalts überlegen sind. Ein zukünftiger Schwerpunkt liegt in der besseren Patientenselektion, obgleich es bislang keine ausreichend robusten biologischen Prädiktoren gibt. Die individuelle Response auf eine Kurzinduktionschemotherapie erscheint derzeit klinisch als verlässlichster Marker für eine individuelle Therapieentscheidung und wird aktuell in klinischen Studien erprobt. Da es als Alternative zur Laryngektomie keinen multimodalen Standard gibt, sollte das Thema derzeit ausschließlich in Studien weiterentwickelt werden.

Abstract

This article presents the current data and discussion on multimodal laryngeal preservation strategies in advanced laryngeal/hypopharyngeal carcinoma. Principally a distinction is made between simultaneous and induction chemoradiation protocols. In terms of late toxicity and related functional limitations, induction protocols are far superior to simultaneous platinum-based chemoradiation. Currently, the individual response to the first cycle of (short) induction chemotherapy appears to be the most reliable clinical marker for making treatment decisions, and this is under clinical investigation. No standard multimodal therapeutic alternative to laryngectomy exists; therefore, at this time multimodal strategies should only be carried out within the framework of clinical trials.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinik Leipzig, Liebigstr. 10–14, 04103, Leipzig, Deutschland

    A. Dietz, A. Boehm & G. Wichmann

  2. Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinik Leipzig, Leipzig, Deutschland

    D. Niederwieser

  3. Klinik und Poliklinik für Strahlentherapie, Universitätsklinik Leipzig, Leipzig, Deutschland

    S. Dietzsch

  4. Sektion Phoniatrie und Audiologie der Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinik Leipzig, Leipzig, Deutschland

    M. Fuchs

Authors
  1. A. Dietz
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  2. A. Boehm
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  3. G. Wichmann
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  4. D. Niederwieser
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  5. S. Dietzsch
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  6. M. Fuchs
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Correspondence to A. Dietz.

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Dietz, A., Boehm, A., Wichmann, G. et al. Multimodaler Larynxerhalt. HNO 60, 19–31 (2012). https://doi.org/10.1007/s00106-011-2416-7

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