Postterapeutické hodnotenie priamej endoskopickej autofluorescencie a ej použitie v enežmente liečby rakoviny hrtana

Priama endoskopická autofluorescencia hrtana zlepšuje diagnostiku a ohraničenie prekanceróz a karcinómu. Cieľom tejto štúdie je posúdiť diagnostický potenciál a obmedzenia tejto diagnostickej metódy po chirurgickej liečbe a (alebo) po liečbe rádioterapiou. V retrospektívnej štúdii sme urobili 149 vyšetrení u 118 pacientov. Pacientov sme rozdelili do skupín podľa typu liečby a v prípade liečby rádioterapiou aj podľa času medzi autofluorescenčným vyšetrením a ukončením liečby rádioterapiou. Autofluorescencia bola indukovaná pomocou Xenónovej lampy s použitím filtrovaného pásoveho svetla modrej farby (vlnová dĺžka 390 - 470 nm ) a následne zaznamenaná pomocou veľmi citlivej trojčipovej CCD kamery. (DAFE systém firmy Richard Wolf, Knittlingen, Nemecko). Podozrivé ložiská boli vyšetrené direktnou mikrolaryngoskopiou a bola z nich odobratá vzorka na histologické vyšetrenie. Výsledky autofluorescencie sme porovnávali s výsledkami histologických vyšetrení. Výsledky senzitivity a špecificity endoskopickej autofluorescencie sa po liečbe výraznejšie nezmenili a sú porovnateľné s citlivosťou vyšetrenia pred liečbou. Na základe našich výsledkov by sa mohla priama endoskopická autofluorescencia používať aj po chirurgickej liečbe a rádioterapii na dispenzarizáciu pocientov s rakovinou hrtana.

Kľúčové slová:
autofluorescencia, endoskopia, rakovina hrtana, chirurgia, radioterapia.

Autoři: V. Kavečanský ¹; I. Čavarga ²; N. Lukán ³; P. Feciskanin ⁴; P. Bohuš ⁵
Působiště autorů: ENT Department, ORL Humenné, s. r. o., Humenné, Slovakia ¹; Department of Pneumology and Phtiseology, Medical Faculty Safarik University, Košice, Slovakia ²; th Department of Internal Medicine, Medical Faculty Safarik University, Košice, Slovakia ³; ENT Department of Eastern-Slovakian Institute of Oncology, Košice, Slovakia ⁴; Department of Pathology, Unversity Hospital, Košice, Slovakia ⁵
Vyšlo v časopise: Otorinolaryngol Foniatr, 61, 2012, No. 2, pp. 95-99.
Kategorie: Původní práce

Souhrn

Kľúčové slová:
autofluorescencia, endoskopia, rakovina hrtana, chirurgia, radioterapia.

Zdroje

1. Alfano, R. R., Tata, D. B., Cordero, J., Tomashefsky, P., Longo, F. W., Alfami, M. A.: Laser-induced fluorescence spectroscopy from native cancerous and normal tissue. IEEE J Quant Elektron, 1984, 12, pp. 1507-1511.

2. Arens, C., Dreyer, T., Glanz, H., Malzahn, K.: Indirect autofluorescence laryngoscopy in the diagnosis of laryngeal cancer and its precursor lesions. Eur Arch Otorhinolaryngol., 261, 2004, pp. 71-76.

3. Arens, C., Glanz, H, Dreyer, T., Malzahn, K.: Compact endoscopy of the larynx. Ann Otol Rhinol Laryngol,, 112, 2003, pp. 113-119.

4. Arens, C., Glanz, H., Woenckhaus, J., Hersemeyer, K., Kraft, M.: Histologic assessment of epithelial thickness in early laryngeal cancer or precursor lesions and its impact on endoscopic imaging. Eur Arch Otorhinolaryngol, 264, 2007, pp. 645-649.

5. Arens, C., Malzahn, K., Dias, O., Andrea, M., Glanz, H.: Endoscopic imaging techniques in the diagnosis of laryngeal precursor lesions. Laryngorhinootologie, 78, 1999, pp. 685-691.

6. Arens, C., Reussner, D., Neubacher, H., Woenckhaus, J., Glanz, H.: Spectrometric measurement in laryngeal cancer. Eur Arch Otorhinolaryngol, 263, 2006, pp. 1001-1007.

7. Arens, C., Reussner, D., Woenckhaus, J., Leunig, A., Betz, C. S., Glanz, H.: Indirect fluorescence laryngoscopy in the diagnosis of precancerous and cancerous, laryngeal lesions. Eur Arch Otorhinolaryngol, 264, 2007, pp. 621-626.

8. Betz, C. S., Arens, C., Leunig, A.: Autofluorescence diagnosis of cancers of the upper aerodigestive tract. Endo-Press, Tuttlingen, 2007.

9. Brush, J., Lipnick, S. L., Phillips, T., Sitko, J., McDonald, J. T., McBride, W. H.: Molecular mechanisms of late normal tissue injury. Semin Radiat Oncol (US), 17, 2007, pp. 121-130.

10. Canney, P. A, Dean, S.: Transforming growth factor beta: a promoter of late connective tissue injury following radiotherapy. Br J Radiol, 63, 1990, pp. 620-623.

11. Delank, W., Khanavkar, B., Nakhosteen, J. A., Stoll, W.: A pilot study of autofluorescent endoscopy for the in vivo detection of laryngeal cancer. Laryngoscope, 110, 2000, pp. 368-373.

12. Evans, E. S., Hahn, C. A., Kocak, Z., Zhou, S. M., Marks, L. B.: The role of functional imaging in the diagnosis and management of late normal tissue injury. Semin Radiat Oncol (US), 17, 2007, pp. 72-80.

13. Gale, N., Kambic, V., Michaels, L., Cardesa, A., Hellquist, H., Zidar, N., Poljak, M.: The Ljubljana classification: a practical strategy for the diagnosis of laryngeal precancerous lesions. Adv Anat Pathol, 2000, 7, pp. 240-251.

14. Gupta, N. K., Swindell, R.: Concomitant methotrexate and radiotherapy in advanced head and neck cancer: 15 year follow up of a randomized clinical trial. Clin Oncol, 13, 2001, 339-344.

15. Hall, E. J.: Radiobiology for the radiologist, 4th ed. Lippincott, Philadelphia, PA, 1994, pp. 211-229.

16. Hellquist, H., Cardesa, A., Gale, N., Kambic, V., Michaels, L: Criteria for grading in the Ljubljana classification of epithelial hyperplastic laryngeal lesions; a study by members of the Working Group of Epithelial Hyperplastic Laryngeal Lesions of the European Society of Pathology. Histopathology, 34, 1999, pp. 226-233.

17. Kleinsasser, O.: Die klassifikation und Differentialdiagnose der Epithelhyperplasien der Kehlkopfschleimhaut auf Grund histomorfologischer Merkmale. Z Laryngol Rhinol Otol, 42, 1963, pp. 339-362.

18. Lam, S., Palcic. B.: Autofluorescence bronchoscopy in the detection of squamous metaplasia and dysplasia in current and former smokers. J Nat Cancer Inst, 91, 1999, 561-563.

19. Lee, C. E., Prabhu, Y. V., Slevin, N. J.: Ollagen Vascular Diseases and Enhanced Radiotherapy-induced Normal Tissue Effects - a Case Report and a Review of Published Studies, Clinical Oncology, 23, 2011, pp. 73-78.

20. Malzahn, K., Dreyer, T., Glanz, H., Arens, C.: Autofluorescence endoscopy in the diagnosis of early laryngeal cancer and its precursor lesions. Laryngoscope, 112, 2002, pp. 488-493.

21. Morris, M. M., Powell, S. N.: Irradiation in the setting of collagen vascular disease: acute and late complications. J Clin Oncol, 15, 1997, pp. 2728-2735.

22. Mostafa, B. E, Shafik, A. G., Fawaz, S.: The role of flexible autofluorescence laryngoscopy in the diagnosis of malignant lesions of the larynx. Acta Otolaryngol, 127, 2007, pp. 175-179.

23. Paczona, R., Temam, S., Janot, F., Marandas, P., Luboinski, B.: Autofluorescence videoendoscopy for photodiagnosis of head and neck carcinoma. Eur Arch Otorhinolaryngol, 260, 2003, pp. 544-548.

24. Posner, M. R.: Options in the Treatment of Head and Neck Cancer. CMP Medica, New York, 2006.

25. Ross, J. G., Husary, D. H, Mayr, N. A, Davis, C. S.: Acute and late reactions to radiation therapy in patients with collagen vascular diseases. Cancor, 71, 1993, pp. 3744-3752.

26. Sadri, M., McMahon, J., Parker, A.: Management of laryngeal dysplasia: a review. Eur Arch Otorhinolaryngol, 263, 2006, pp. 843-852.

27. Shanmugaratman, K., Sobin, L. H.: Histological typing of tumours of the upper respiratory tract and ear. WHO international classification of tumours. 2^nd ed., Springer, Berlin-Heidelberg-New York, 1991.

28. Steel, G. G.: Basic Clinical Radiobiology. Edward Arnold Publishers, London (GB), 1993.

29. Zargi, M., Fajdiga, I., Smid, L.: Autofluorescence imaging in the diagnosis of laryngeal cancer. Eur Arch Otorhinolaryngol, 257, 2000, pp. 17-23.