头颈部鳞状细胞癌(HNSCC)是世界范围内众所周知的严重健康问题,特别是在低收入国家或资源有限的国家,比如拉丁美洲的大多数国家。国际准则不能总是适用于有特定条件的大区域人口。这项研究建立了拉丁美洲的头颈部癌症患者护理指南,并提出了考虑可用性和肿瘤学益处的HNSCC管理证据。一个由41名头颈部癌症专家组成的小组根据修改后的Delphi程序系统地进行了工作,以(1)文件汇编了针对拉丁美洲(资源有限和/或无法获得所有必要的医疗保健系统基础设施)的不同问题的基于证据的答案。(2)对所有建议的答案和证据等级的分类和建议程度进行修订,(3)通过两轮在线调查验证共识,和(4)手稿组成。共识包括12个部分:头颈癌分期,头颈部癌的组织病理学评估,头颈外科-口腔,临床肿瘤学-口腔,头颈部手术-口咽,临床肿瘤学-口咽,头颈部手术-喉部,头颈部手术-喉/下咽,临床肿瘤学-喉/下咽,临床肿瘤学-复发和转移性头颈癌,头颈部手术-重建和康复,和放射治疗。考虑到资源的可用性并着重于肿瘤学益处,本共识就HNSCC患者护理提出了48条建议。这些建议也可用于制定拉丁美洲国家等其他区域的战略。
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International
guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American
guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the
consensus through two rounds of online surveys, and (4) manuscript composition. The
consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present
consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.