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ASCOによる喉頭癌治療における喉頭温存ガイドライン

参考文献(出典文献のアップデート版):
Forastiere AA, Ismaila N, Lewin JS, Nathan CA, Adelstein DJ, Eisbruch A, Fass G, Fisher SG, Laurie SA, Le QT, O'Malley B, Mendenhall WM, Patel S, Pfister DG, Provenzano AF, Weber R, Weinstein GS, Wolf GT. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018 Apr 10;36(11):1143-1169. doi: 10.1200/JCO.2017.75.7385. Epub 2017 Nov 27. PMID: 29172863.
出典
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1: American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer.
著者: American Society of Clinical Oncology, David G Pfister, Scott A Laurie, Gregory S Weinstein, William M Mendenhall, David J Adelstein, K Kian Ang, Gary L Clayman, Susan G Fisher, Arlene A Forastiere, Louis B Harrison, Jean-Louis Lefebvre, Nancy Leupold, Marcy A List, Bernard O O'Malley, Snehal Patel, Marshall R Posner, Michael A Schwartz, Gregory T Wolf
雑誌名: J Clin Oncol. 2006 Aug 1;24(22):3693-704. doi: 10.1200/JCO.2006.07.4559. Epub 2006 Jul 10.
Abstract/Text: PURPOSE: To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials.
METHODS: A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors.
RESULTS: Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated.
RECOMMENDATIONS: All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.
J Clin Oncol. 2006 Aug 1;24(22):3693-704. doi: 10.1200/JCO.2006.07.455...

声門上癌:手術(TOVS)所見

経口挿管、全身麻酔下にまず腫瘍の浸潤範囲を鉗子で触診しながら確認すると、腫瘍は喉頭蓋左側を中心とし、喉頭蓋谷、披裂喉頭蓋ヒダまでの浸潤がみられた。病変周囲を生食で洗浄した後に1.5%ヨード液を散布すると腫瘍の上皮内進展がヨード不染帯として描出された。ヨード不染帯から5-10mmの安全域を確保しながら切除を開始した。まず喉頭蓋正中部を切除し、喉頭蓋舌面、喉頭蓋谷、喉頭蓋前間隙へと切除を進めた。次に喉頭蓋軟骨を正中部で切断し、左側の咽頭喉頭蓋ヒダ、披裂喉頭蓋ヒダを切除後、左上喉頭動脈の分枝をクリッピングして切断、最後に喉頭蓋基部の軟骨を切断して腫瘍を一塊に摘出した。遊離した左仮声帯上面から披裂喉頭蓋ヒダの粘膜をクリップにて縫着し手術を終了した。術直後に抜管し、気管切開は不要であった。術後の病理組織診断では、切除断端は陰性であった。

声帯白斑症の喉頭内視鏡所見

右声帯に白色の腫瘍を認める。生検の結果はmoderate dysplasiaであった。外観上は扁平上皮癌と区別がつかない。
出典
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1: 塩谷彰浩先生ご提供

喉頭乳頭腫の喉頭内視鏡所見

両側声帯および声門上部に多発性の乳頭状腫を認める。
出典
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1: 塩谷彰浩先生ご提供

喉頭癌の喉頭内視鏡所見

a:右声門癌 右声帯に不整な腫瘍を認める。右声帯固定も認め、T3に相当する所見である。
b:声門上癌 喉頭蓋左縁に不整な腫瘍を認める。T1に相当する所見である。
出典
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1: 塩谷彰浩先生ご提供

喉頭癌TNM分類

出典
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1: 日本頭頸部癌学会編:頭頸部癌取扱い規約 改訂第6版、pp49-50、金原出版、2018

症例:64歳男性。声門上癌(扁平上皮癌)T2N0

出典
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1: 塩谷彰浩先生ご提供

術後2カ月の喉頭内視鏡所見

出典
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1: 塩谷彰浩先生ご提供

喉頭癌の治療アルゴリズム

出典
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1: 日本頭頸部癌学会編:頭頸部癌診療ガイドライン2022年版. P.72-74 金原出版、2022年.

ASCOによる喉頭癌治療における喉頭温存ガイドライン

参考文献(出典文献のアップデート版):
Forastiere AA, Ismaila N, Lewin JS, Nathan CA, Adelstein DJ, Eisbruch A, Fass G, Fisher SG, Laurie SA, Le QT, O'Malley B, Mendenhall WM, Patel S, Pfister DG, Provenzano AF, Weber R, Weinstein GS, Wolf GT. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018 Apr 10;36(11):1143-1169. doi: 10.1200/JCO.2017.75.7385. Epub 2017 Nov 27. PMID: 29172863.
出典
imgimg
1: American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer.
著者: American Society of Clinical Oncology, David G Pfister, Scott A Laurie, Gregory S Weinstein, William M Mendenhall, David J Adelstein, K Kian Ang, Gary L Clayman, Susan G Fisher, Arlene A Forastiere, Louis B Harrison, Jean-Louis Lefebvre, Nancy Leupold, Marcy A List, Bernard O O'Malley, Snehal Patel, Marshall R Posner, Michael A Schwartz, Gregory T Wolf
雑誌名: J Clin Oncol. 2006 Aug 1;24(22):3693-704. doi: 10.1200/JCO.2006.07.4559. Epub 2006 Jul 10.
Abstract/Text: PURPOSE: To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials.
METHODS: A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors.
RESULTS: Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated.
RECOMMENDATIONS: All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.
J Clin Oncol. 2006 Aug 1;24(22):3693-704. doi: 10.1200/JCO.2006.07.455...

声門上癌:手術(TOVS)所見

経口挿管、全身麻酔下にまず腫瘍の浸潤範囲を鉗子で触診しながら確認すると、腫瘍は喉頭蓋左側を中心とし、喉頭蓋谷、披裂喉頭蓋ヒダまでの浸潤がみられた。病変周囲を生食で洗浄した後に1.5%ヨード液を散布すると腫瘍の上皮内進展がヨード不染帯として描出された。ヨード不染帯から5-10mmの安全域を確保しながら切除を開始した。まず喉頭蓋正中部を切除し、喉頭蓋舌面、喉頭蓋谷、喉頭蓋前間隙へと切除を進めた。次に喉頭蓋軟骨を正中部で切断し、左側の咽頭喉頭蓋ヒダ、披裂喉頭蓋ヒダを切除後、左上喉頭動脈の分枝をクリッピングして切断、最後に喉頭蓋基部の軟骨を切断して腫瘍を一塊に摘出した。遊離した左仮声帯上面から披裂喉頭蓋ヒダの粘膜をクリップにて縫着し手術を終了した。術直後に抜管し、気管切開は不要であった。術後の病理組織診断では、切除断端は陰性であった。