Se estima que el 4% de la población mayor de 40 años tiene signos físicos compatibles con Nt, mientras que el 40% de la población en el mismo grupo etario tiene alguna anormalidad ultrasonográfica consistente con la definición de Nt.
This is a review article intended to let the medical community know the procedures regarded as the gold standard in the multidisciplinary approach to patients with head and neck cancer. A review was carried out in PubMed looking for works published between January 2010 and December 2015. The search used the terms "interdisciplinary", "multidisciplinary", "management groups", "clinical rounds", "tumor boards", and "head and neck cancer" (n = 57). Subsequently, information related to specific experiences on head and neck was selected and analyzed (n = 29). Relevant information will be presented. In addition, the approach to these neoplasms in Mexico will be described based on the treatment guidelines used by Health Institutions with the largest numbers of patients with this pathology. (creativecommons.org/licenses/by-nc-nd/4.0/).
KEY WORDS
Introducción: Se ha observado un incremento mundial importante del cáncer diferenciado de tiroides. Suele presentarse clínicamente como nódulos en el cuello, y aunque la mayoría de estos son de naturaleza benigna, es importante la detección de malignidad en forma preoperatoria debido a que las lesiones malignas son las que requieren tratamiento quirúrgico. Existe todavía controversia respecto al manejo terapéutico por la falta de estudios controlados y existe además mucha heterogeneidad en la práctica clínica cotidiana. Objetivos: Esta guía de práctica clínica (GPC) contiene recomendaciones clínicas desarrolladas de forma sistematizada para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el tratamiento de pacientes con cáncer de tiroides en estadios tempranos, localmente avanzados y metastásicos.
Resumen El receptor del factor de crecimiento epidérmico (EGFR, por sus siglas en inglés) se expresa con preferencia en los carcinomas escamosos de cabeza y cuello (CE-CC) y es un blanco terapéutico prometedor. El cetuximab (CTX) es el único agente cuyo blanco es el EGFR que ha sido aprobado para el tratamiento del carcinoma epidermoide. La indicación aprobada por la Food and Drug Administration en 2006 señala el uso de CTX en combinación con radioterapia para el tratamiento de CE-CC locorregionalmente avanzados irresecables, exceptuando el carcinoma nasofaríngeo. En 2011 se aprobó el uso de CTX en combinación con platino y 5-fluorouracilo como tratamiento de primera línea en CE-CC recurrente o metastásico. Para homogeneizar y llegar a un consenso multiinstitucional y multidisciplianario con base en evidencia científica, se realizó una reunión en la que se revisó la literatura existente y se discutió el papel del cetuximab en el tratamiento de pacientes con CE-CC. Este trabajo revisa las indicaciones actuales basadas en la evidencia del uso de CTX en el tratamiento de pacientes con CE-CC. (creativecommons.org/licenses/by-nc-nd/4.0/).
PALABRAS CLAVE
Background:In laryngeal cancer, multidisciplinary treatment improves the patient's quality of life and the possibility of preserving the larynx. Most cases occur in a locally advanced stage. The aim is to present the results according to the stage. Method: A retrospective study which analyzed the clinical stage, type of primary treatment, outcomes, and survival was analyzed. Results: A total of 451 patients were included in the study. The median age was 66 years. The majority of the tumors presented in advanced stage (72%) and the most affected subsite was the glottis (84.5%). In the early stage, the most frequent treatment was radiotherapy as the only treatment modality. In Stages III and IVA, 65% were resectable. In Stage IVB, the management was non-surgical, with control in 26% of the cases. Survival at 10 years was related to the clinical stage: 81.7% for Stage I and 0% for Stages IVB and IVC. Conclusions: Patients with laryngeal cancer should be treated according to the clinical stage, through a multidisciplinary approach. Long-term follow-up showed a worse prognosis for advanced clinical stages.
Epidermal growth factor receptor is preferably expressed in head and neck squamous cell carcinomas and is a promising therapeutic target. Cetuximab is the only epidermal growth factor receptor-targeted agent that has been approved for the treatment of squamous cell carcinoma. The 2006 FDA-approved indication refers to the use of cetuximab in combination with radiotherapy for the treatment of locoregional, advanced, unresectable head and neck squamous cell carcinoma, except for nasopharyngeal carcinoma. In 2011, the use of cetuximab in combination with platinum and 5-fluorouracil was approved as first-line treatment for recurrent and/or metastatic head and neck squamous cell carcinoma. In order to homogenize and arrive at a multidisciplinary, multi-institutional consensus based on scientific evidence, a meeting was held where the existing literature was reviewed and the role of cetuximab in the treatment of patients with head and neck squamous cell carcinoma was discussed. This work reviews current evidence-based indications for the use of cetuximab in the treatment of patients with head and neck squamous cell carcinoma. (creativecommons.org/ licenses/by-nc-nd/4.0/).
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