1 / 26

20 plus % of patients consulting a general practionner have ENT problems

Otolaryngology beyond Laser and Scalpel W. Mann Almaty Dec 2012 Dept. of ORL-HNS, Mainz Medical School, Germany. 20 plus % of patients consulting a general practionner have ENT problems. Otolaryngology today. Infections and tumors of the ears, nose, throat and head and neck

razi
Download Presentation

20 plus % of patients consulting a general practionner have ENT problems

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Otolaryngology beyond Laser and ScalpelW. MannAlmaty Dec 2012Dept. of ORL-HNS, Mainz Medical School, Germany

  2. 20 plus % of patients consulting a general practionner have ENT problems

  3. Otolaryngology today • Infections and tumors of the ears, nose, throat and head and neck • Problems with hearing, speech, smell and deglutition • Neurootology for vestibulo-cochlear disorders • Endocrinology for thyroid disease • Facial reconstruction after trauma • Cosmetic surgery including skin tumors and vascular lesions

  4. As a consequence otolaryngologist today must be: • Diagnostician including ultrasound, CT-scan and MRI • Neurophysiologist • Endoscopist • Immunologist • Microbiologist • Oncologist • Therapist • Surgeon

  5. HNSCC approx. 600 000 new cases/year Worlwide USA EU France 8 16 18 37 Yearly rate per 100 000inhabitants

  6. Malignant Head and Neck Tumors Mostly squamous cell carcinomas Etiology: alcohol, tobacco, HPV 16/18

  7. Männer Frauen Männer Frauen Frankreich Frankreich Inzidenz Luxemburg Spanien Deutschland Belgien Mortalität Italien Italien Europäische Union Portugal Spanien Luxemburg Portugal Europäische Union Belgien Griechenland Dänemark Dänemark Österreich Österreich Schweden Niederlande Niederlande Irland Finnland Deutschland Irland Großbritannien Großbritannien Schweden Griechenland Finnland 50 40 30 20 10 0 10 20 30 40 50 25 20 15 10 5 0 5 10 15 20 25 HNSCC incidence and mortality in Europe Oropharynx Larynx

  8. Therapy Standard: surgery and/or radiotherapy or: neoadjuvant chemotherapy radiochemotherapy antibodies salvage surgery

  9. Therapy In breast, gastric and rectal tumors, neoadjuvant chemotherapy is new goldstandard, increasing R0-resection, progression free survival and overall survival.

  10. Hypopharyngeal carcinoma before after 3 cycles TPF

  11. Overall survival Primary surgery VALSG OS (2J): 68% EORTC 24891 OS (3J): 43%, OS (5J): 32,6% Neoadjuvant VALSG OS (2J): 68% EORTC 24891 OS (3J): 57%, OS (5J): 38% RTOG 91:11 OS (2J): 76%, OS (5J): 55% GORTEC 2000-01 OS (3J): 60% Mainz study OS (2J): 78%

  12. Overall survivalMainz study

  13. HPV infection While HPV infection in females with cervical carcinomas yields better prognosis, this is still debated in head & neck tumors.

  14. pt 1 cm 2 cm Role of histologic clear margins

  15. CGH-analysis of primary tumors

  16. The vast majority of gains and losses observed at 1 cm distance were also present in the corresponding primary tumors.

  17. D3S3689 D3S3575 D3S1268 D3S3886 D3S3712 D3S1614 D3S3715 D3S3565 D3S3609 D3S1580 D3S1601 3q25.31 3q25.32 3q26.1 3q26.1 3q26.2 3q26.32 3q26.33 3q27.2 3q28 3q28 Primer 3q26.1 Locus  3q26.1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Imbalances on 3q26 in 2cm Imbalances are frequently observed Imbalances are also seen at 2 cm distance by LOH-analysis, while no gains or losses were detected by CGH-analysis! Yellow: gains not previously detected by CGH

  18. Erbitux Iressa Avastin The increasing role of biomarkers in oncology • HER-2/new • K-RAS • BRAF • MAP-Kinase • EGFR • Alk

  19. P< 0.05 P< 0.05 Cetuximab for the therapy of HNSCClocoregional control and overall survival + 9.5 months + 20 months Bonner et al, New Engl J Med 2006

  20. Cetuximab Cetuximab is relevant for head and neck tumors independent of EGFR expression when given together with chemo- or radiotherapy

  21. K-RAS K-RAS mutation is of prognostic relevance only in colo-rectal tumors while not in head and neck cancer.

  22. K-RAS K-RAS negative, so called wild-type tumors respond to Cetuximab with better prognosis.

  23. BRAF BRAF mutations in papillary thyroid carcinomas are indicators of poor prognosis, while in anaplastic thyroid carcinoma (70% BRAF positive) BRAF inhibitors may be beneficial.

  24. BRAF BRAF mutation in melanoma is predictive for good response to Vemurafinib, however because of fast development of resistance it has to be combined with Kinase-inhibitors.

  25. BRAF Although BRAF mutations are „negative“ they offer further therapeutic options.

  26. Laser and scalpel remain essential surgical tools in otolaryngology, however they have to be seen in the framework of recently developed therapeutic strategies.

More Related