RESUMO
The choice of the most appropriate treatment in early-stage glottic cancer with anterior commissure involvement remains controversial. Its therapeutic management is complex because it is a significant prognostic indicator of local control with 37% recurrence, due to the difficulty in establishing tumour extension with understaging of up to 40%, and due to the comparison of results in series on tumours that behave variably as they progress, such as T1a, T1b and T2a with commissure involvement. Furthermore, the complexity of the surgical approach using transoral CO2 laser microsurgery requires surgical skill, appropriate equipment and experience. Aspects to be reviewed in this document are: an updated anatomical definition of the anterior commissure, tumour progression based on histopathological studies, usefulness of videostroboscopy and NBI in diagnostic accuracy, validity of imaging tests, oncological results published in series reviews, systematic reviews and meta-analyses, tumour margin treatment and voice evaluation.Finally, by way of a summary, the document includes a series of recommendations for the treatment of these tumours.
Assuntos
Glote , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/terapia , Glote/patologia , Humanos , Neoplasias Laríngeas/patologiaRESUMO
La elección del tratamiento más adecuado en el cáncer glótico en estadio precoz con afectación de la comisura anterior sigue siendo controvertida. La complejidad en su manejo terapéutico está justificada por ser un significativo indicador pronóstico de control local, con un porcentaje de recidiva del 37%, por la dificultad en establecer la extensión tumoral con una infraestadificación que llega a alcanzar el 40%, y por la comparación de resultados en series formadas por tumores de diferente comportamiento evolutivo, como son T1a, T1b y T2a con afectación comisural. A estos datos se suma la complejidad del abordaje quirúrgico mediante microcirugía transoral con láser CO2 que requiere habilidad quirúrgica, equipamiento adecuado y experiencia. Los aspectos a revisar en este documento son: definición anatómica actualizada de la comisura anterior, progresión tumoral en función de estudios histopatológicos, utilidad de la videoestroboscopia y la NBI en la precisión diagnóstica, validez de las pruebas de imagen, resultados oncológicos publicados en revisión de series, revisiones sistemáticas y metaanálisis, tratamiento de los márgenes y evaluación de la voz. Finalmente, y a modo de resumen, el documento incluye una serie de recomendaciones para el tratamiento de estos tumores
The choice of the most appropriate treatment in early-stage glottic cancer with anterior commissure involvement remains controversial. Its therapeutic management is complex because it is a significant prognostic indicator of local control with 37% recurrence, due to the difficulty in establishing tumour extension with understaging of up to 40%, and due to the comparison of results in series on tumours that behave variably as they progress, such as T1a, T1b and T2a with commissure involvement. Furthermore, the complexity of the surgical approach using transoral CO2 laser microsurgery requires surgical skill, appropriate equipment and experience. Aspects to be reviewed in this document are: an updated anatomical definition of the anterior commissure, tumour progression based on histopathological studies, usefulness of videostroboscopy and NBI in diagnostic accuracy, validity of imaging tests, oncological results published in series reviews, systematic reviews and meta-analyses, tumour margin treatment and voice evaluation.Finally, by way of a summary, the document includes a series of recommendations for the treatment of these tumours
