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Aktuelle Therapieoptionen bei rezidivierenden Kopf-Hals-Tumoren

Current therapy options in recurrent head and neck cancer

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Zusammenfassung

Rezidive sind eine der zentralen Ursachen für die nach wie vor schlechte Prognose von Plattenepithelkarzinomen im Kopf-Hals-Bereich (HNSCC, 5-Jahres-Überleben 42% europaweit). Im Vordergrund steht bei Ersterkrankung, Rezidiv bzw. Zweittumor die chirurgische Therapie. Ist für das Primärkarzinom keine R0-Resektion (Resektionsrand >5 mm) möglich, reduziert sich die Prognose um 50%, bei Rezidiven bzw. Zweittumoren mit R1- bzw. R2-Resektion oder nichtresektablen Fernmetastasen liegt in > 80% der Fälle eine palliative Situation vor. Nach Radio- bzw. Radiochemotherapie ist bei Op. auf die Kriterien der Salvage-Chirurgie (Minderdurchblutung des Gewebes, Fibrosegrad, Wundheilungsstörungen) zu achten und im Sinne der Funktionalität das Vorgehen anzupassen. Im Rezidivfall kann die primäre Op. ggf. durch adjuvante Therapien ergänzt werden (Reirradiation), evtl. auch durch Chemotherapeutika bzw. „targeted therapies“. Die interdisziplinäre Zusammenarbeit und Falldiskussion muss in einem Tumorboard erfolgen.

Abstract

Recurrent disease is one of the main reasons for the persistently poor prognosis of squamous cell carcinoma of the head and neck (HNSCC; European 5-year survival, 42%). The main treatment option for primary and secondary malignancy as well as recurrent disease is surgical therapy. If R0 resection (resection margin >5 mm) for a primary tumor is not viable, survival probability is reduced by 50%. In recurrent or secondary tumors with R1- or -2 resection or in the presence of non-resectable metastases, a palliative situation results in more than 80% of cases. In the case of surgery following radiotherapy or radiochemotherapy, attention should be paid to the criteria for salvage surgery (tissue perfusion, fibrosis, wound healing) and the procedure adapted to focus on functionality. In the case of relapse, primary surgery can potentially be supplemented with adjuvant therapy protocols such as (re-) irradiation, as well as possibly with chemotherapeutic agents or targeted therapies. Interdisciplinary collaboration and case discussions should take place in the context of a tumor board.

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Boehm, A., Wichmann, G., Mozet, C. et al. Aktuelle Therapieoptionen bei rezidivierenden Kopf-Hals-Tumoren. HNO 58, 762–769 (2010). https://doi.org/10.1007/s00106-010-2156-0

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