目的:上消化道恶性肿瘤的治疗是一个复杂的专业。提供更新以建立最佳护理至关重要。在INCa的倡议下,在SFORL的主持下,科学委员会,由BéatrixBarry教授领导,GillesDolivet博士,还有DominiqueDeRaucourt博士,决定制定一个参考框架,旨在定义,以科学和基于共识的方式,适用于所有亚位置的上消化道癌症的一般治疗原则。
方法:要开发此框架,形成了一个多学科的从业者团队。对文献进行了系统分析,以产生按年级分类的建议,根据法国国家卫生局(HAS)的标准。
结果:根据HAS标准对建议进行分级,可以根据几个标准为患者护理建立参考。在这个框架中,患者受益于基于他们存在的预后因素的差异化护理(年龄,合并症,TNM状态,HPV状态,等。),实施条件,和指示手术的质量标准(可操作性,可切除性,保证金质量,残害,抢救手术),以及放射治疗的质量标准(目标体积,实施时间,等。).还根据特定标准评估了药物和术后治疗的作用。最后,支持性护理必须从一开始就组织起来,并贯穿患者的整个护理过程。
结论:所有收集的数据都导致制定了一个全面的框架,旨在协调全国的做法,促进多学科协商会议的决策,促进实践中的平等,并为评估护理质量提供最先进的参考实践。这个新框架打算每5年更新一次,以最好地反映该领域的最新进展。
OBJECTIVE: The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations.
METHODS: To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS).
RESULTS: The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients\' care journey.
CONCLUSIONS: All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.