Chirurgické přístupy k sarkomům hlavy a krku – současné koncepce a perspektivy

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Authors: J. Astl ^{1 3} ; J. Hložek ^1,2 ; L. Dzan ^1,2 ; D. Kovář ^1,2 ; J. Rotnágl ^1,2 ; L. Petruželka ⁴ ; R. Holý ^1,2
Authors‘ workplace: Department of Otorhinolaryngology and Maxilofacial Surgery, 3rd Faculty of Medicine, Charles University and Military University Hospital Prague, Prague ¹; Department of Ear, Nose and Throat, 3rd Faculty of Medicine, Charles University and Military University Hospital Prague, Prague ²; Department of Otolaryngology, Institute of Postgraduate Medical Education, University Motol Hospital, Prague ³; Department of Oncology, 1st Faculty of Medicine, Charles University and Military University Hospital Prague, Prague ⁴
Published in: Otorinolaryngol Foniatr, 73, 2024, No. 3, pp. 167-175.
Category: Review Article
doi: https://doi.org/10.48095/ccorl2024167

Overview

Úvod a cíl: Sarkomy měkkých tkání představují neobvyklý typ malignity v oblasti hlavy a krku. Počet případů je popisován jako nízký. Mnoho autorů popisuje toto maligní onemocnění jako vzácný nádor hlavy a krku u dospělých. Na druhou stranu je sarkom součástí maligních onemocnění se špatnou prognózou v dětském, adolescentním a dospělém věku. Z literárních údajů vyplývá, že počty pacientů se sarkomy nelze přehlížet (27 908 případů za 7 let v Evropě na 500 mil. obyvatel). Sarkomy jsou sice málo častým zhoubným onemocněním, ale nejedná se o vzácné nádory. Proto potřebujeme aktuální poznatky a doporučení pro klinickou praxi v léčbě těchto heterogenních typů zhoubných mezenchymálních nádorů. Metoda: Analyzovali jsme literaturu o sarkomech hlavy a krku s využitím databáze Web of Science. Vyhledali jsme všechny práce popisující všechny typy léčby sarkomů v této oblasti. Tato studie analyzovala diagnostická kritéria sarkomů a léčebné plány sarkomů v oblasti hlavy a krku. Diskuze: Doporučení na základě mnoha faktorů. Sarkomy měkkých tkání v oblasti hlavy a krku jsou vzácné nebo málo časté. Incidence sarkomu měkkých tkání se pohybuje kolem 5 případů na 100 tis. obyvatel ročně. Musíme se zaměřit na nové znaky pro identifikaci rizikových faktorů sarkomu. Zásadní význam má proto patologické vyšetření a rozvoj molekulárních technik. Diagnostika na základě biopsie a histologie, včetně imunohistochemie a detekce specifických nádorových markerů. Doporučené zobrazovací metody: ultrazvuk, CT, HRCT, MR, PET CT. Přesná klasifikace a stratifikace musí být provedena v onkologickém týmu zahrnujícím patologa, onkologa, chirurga, radiologa. V literatuře byla uvedena obecná doporučení pro léčebný protokol a plánování léčby sarkomu hlavy a krku v závislosti na jeho velikosti, lokalizaci a biologickém chování. V literatuře byla popsána analýza údajů o základních léčebných modalitách v onkologické chirurgii, radioterapii a chemoterapii. V současné době nemáme k dispozici údaje o imunoterapii.

Klíčová slova:

terapie – léčba – diagnóza – doporučení – pokyny – sarkom hlavy a krku

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ORCID authors

J. Astl 0000-0002-8022-0200,

J. Hložek 0000-0002-3584-9747,

L. Dzan 0000-0003-3034-1845,

D. Kovář 0000-0002-7370-264X,

J. Rotnágl 0000-0003-2692-0342,

L. Petruželka 0000-0002-4397-0635,

R. Holý 0000-0001-8073-3658.

Accepted for review: 7. 4. 2024

Accepted for printing: 28. 6. 2024

Richard Holý, MD, PhD.

Department of Otorhinolaryngology and Maxillofacial Surgery