Karcinom glave i vrata – trenutne mogućnosti i perspektive u liječenju

Drago Prgomet

Maligni tumori glave i vrata su vrlo heterogena skupina u koje ubrajamo tumore gornjega aerodigestivnog trakta – usnice i usne šupljine, orofarinksa, nazofarinksa, hipofarinksa, grkljana, žlijezda slinovnica, nosne šupljine i sinusa. Najčešći maligni tumor ovih sijela jest karcinom pločastih stanica. Njegova pojava je povezana uz pušenje duhana i konzumiranje alkohola, no u zadnje vrijeme primjetan je porast karcinoma povezanih s HPV-infekcijom. Liječenje karcinoma glave i vrata temelji se na lokalizaciji tumora, stupnju invazije i proširenosti bolesti. Unatoč napretku u liječenju zadnjih desetljeća, karcinomi ove regije tijela i dalje su povezani s visokom smrtnošću i značajnim padom kvalitete života. Liječenje karcinoma glave i vrata sastoji se od kirurgije, kemoterapije, radioterapije, ciljane terapije, imunoterapije te kombiniranja ovih postupaka. U kirurškom dijelu svjedočimo razvoju novih postupaka temeljenih na endoskopskim pristupima, uključujući transoralnu robotsku kirurgiju. Uz citostatike na bazi platine i taksana, inhibitora receptora epidermalnog faktora rasta – tirozin kinaze, zadnjih su godina intenzivna istraživanja u primjeni imunološke terapije. U ovom radu obrađena su recentna istraživanja o terapiji i smjernicama primjenjivim u budućnosti u liječenju karcinoma glave i vrata.

Head and neck cancers typically include cancers of the lips and oral cavity, oropharynx, nasopharynx and hypopharynx, larynx, salivary glands, nasal cavity and sinuses. Their occurrence is associated with tobacco and alcohol consumption, but recently a significant increase in cancers associated with HPV infection has been observed. Treatment of head and neck cancer is based on the location of the tumor, the degree of invasion, and the presence of metastases. Despite advances in treatment in recent decades, these diseases have been associated with high mortality and a significant decline in quality of life. Multidisciplinary approach to head and neck cancer consists of surgery, chemotherapy, radiotherapy, targeted therapies, immunotherapies and a combination of these procedures. In the surgical section, we are witnessing the development of new procedures based on endoscopic approaches including transoral robotic surgery (TORS). In addition to platinum-based chemotherapy and taxanes, epidermal growth factor receptor inhibitors – tyrosine kinase, intensive research into the use of immuneb therapy has been conducted in recent years. This paper deals with recent research on the therapy and future guidelines in the treatment of head and neck cancer.