Tratamento de Câncer de Laringe estágio I

Tratamento de Câncer de
Laringe estágio I
Flávio Hojaij
Tratamento de Câncer de
Laringe estágio I
• SCHEDULE
- introduction
- staging
- types of treatment
- recommendations
Tratamento de Câncer de
Laringe estágio I
• Introduction
- Bases for treatment
disease-free
function
quality of life
cost effective
Tratamento de Câncer de
Laringe estágio I
• Introduction
- larynx function
breathe
air-way protection
speech
Tratamento de Câncer de
Laringe estágio I
• Staging
Supraglote
T1 -Tumor limitado a uma sub-
localização anatômica da supraglote,
com mobilidade normal da corda
vocal
Tratamento de Câncer de
Laringe estágio I
• Staging
Glote
T1- Tumor limitado à(s) corda(s) vocal(ais)
(pode envolver a comissura anterior ou
posterior), com mobilidade normal da(s)
corda(s)
T1a Tumor limitado a uma corda vocal
T1b Tumor que envolve ambas as cordas
vocais
Tratamento de Câncer de
Laringe estágio I
• Staging
Subglote
T1-Tumor limitado à subglote
Tratamento de Câncer de
Laringe estágio I
• Treatment-modalities
- Radiotherapy
- Surgery
Endoscopic
Open ressection
Lefebvre JL,et al-
Expert Rev Anticancer Ther. 2004
Tratamento de Câncer de
Laringe estágio I
treatment-modalities
- Radiotherapy
- Surgery
Endoscopic
Open ressection
morbidity
Silver CE, et al
Otolaryngol Clin North Am. 2008
Tratamento de Câncer de
Laringe estágio I
• types of treatment
- disease free
- function
- Radiotherapy = Endoscopic Surgery
Hartl DMOtolaryngol Clin North Am. 2012 Oct;45(5):1143-61
Tratamento de Câncer de
Laringe estágio I
• Treatment-modalities
Choosing...
- patient characteristics
- Exposure
- Skills
- costs
Tratamento de Câncer de
Laringe estágio I
• recommendations
1. Consider endoscopic surgery for tumors
involving mid-portion of one vocal cord
Tratamento de Câncer de
Laringe estágio I
Consider radiation therapy for bilateral tumors
(T1B), involvement of anterior comissure (6466 Gy in 2 Gy daily fractions), and for patients
who are not candidates for endoscopic
surgery
Tratamento de Câncer de
Laringe estágio I
• recommendations
1. Consider endoscopic surgery for tumors
involving mid-portion of one vocal cord
2. Consider radiation therapy for bilateral tumors
(T1B), involvement of anterior comissure (6466 Gy in 2 Gy daily fractions), and for patients
who are not candidates for endoscopic
surgery
3. Consider either modality for tumors involving
full length of one vocal cord
Tratamento de Câncer de
Laringe estágio I
- recommendations*
4. If radiotherapy is chosen, consider for
supraglottic T1-2* lesions inclusion in radiation
field of levels II-IV up to 50 Gy. Similar to
subglottic tumors including level VI
5. If surgery is chosen for supraglottic tumors,
consider bilateral node dissection of levels IIIV*
6. Consider either modality for T2* lesions