PREDIKTORI INVAZIJE UZNAPREDOVALOG SKVAMOCELULARNOG KARCINOMA LARINKSA NA TKIVO ŠTITASTE ŽLEZDE
Invazija štitaste žlezde kod uznapredovalnog karcinoma larinksa
Sažetak
Totalna laringektomija predstavlja standardni terapijski protokol u lečenju uznapredovalih karcinoma larinksa. Nema dovoljno istraživanja u ovoj oblasti koja bi ukazala na neophodnost sprovođenja tireoidektomije kod pacijenata sa uznapredovalim skvamocelularnim karcinomom larinksa, mada neke studije ukazuju da se u pojedinim centrima unilateralna tireoidektomija sprovodi rutinski. National Comprehensive Cancer Network (NCCN) preporučuje ipsilateralnu hemitireiodektomiju sa laringektomijom kod uznapredovalog skvamocelularnog karcinoma larinksa. Međutim, u ovim slučajevima rizik od pojave hipotireoze i hipoparatireoidizma je znatno veći, što zahteva redovno postoperativno praćenje hormonskog statusa i supstitucionu terapiju. Do invazije štitaste žlezde može doći usled direktnog ili limfovaskularnog širenja uznapredovalog skvamocelularnog karcinoma larinksa, a rizik od pojave lokoregionalnog recidiva i udaljenih metastaza u ovim slučajevima se značajno uvećava. Incidencija invazije štitaste žlezde kod pacijenata sa uznapredovalim skvamoznim karcinomom larinksa je relativno niska, a najčešći prediktori infiltracije su subglotisna i transglotisna ekstenzija laringealnog tumora, kao i direktna invazija tireoidne hrskavice. Očuvanje tkiva štitaste žlezde tokom laringektomije znatno utiče na smanjenje postoprativnog morbiditeta, medjutim, tireoidektomija se može indikovati ukoliko je na osnovu kliničkog, radiografskog i intraoperativnog nalaza procenjeno prisustvo faktora rizika za invaziju štitaste žlezde. Potrebna je pažljiva procena faktora rizika kako bi se izbegla pojava lokoregionalnog recidiva, a samim tim i značajno lošija prognoza.
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