Páginas: 38 (9400 palavras) Publicado: 25 de outubro de 2012

David W. Eisele, MD, Section Editor

Dana M. Hartl, MD, PhD,1,2 Alfio Ferlito, MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP,3 Daniel F. Brasnu, MD,4 Johannes A. Langendijk, MD, PhD,5 Alessandra Rinaldo, MD, FRCSEd ad hominem, FRCS(Eng, Ir) ad eundem, FRCSGlasg,3 Carl E. Silver, MD,6 Gregory T. Wolf, MD7

Department of Otolaryngology–Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France. E-mail: 2 ´ Laboratoire de Phonetique et de Phonologie, Sorbonne Nouvelle, Paris, France 3 Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy 4 Department of Otolaryngology–Head andNeck Surgery, and Voice, Biomaterials and Head and Neck Oncology Research Laboratory, University Paris V, European Hospital Georges Pompidou, Paris, France 5 Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 6 Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore MedicalCenter, Bronx, New York 7 Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan

Accepted 21 May 2010 Published online 6 January 2011 in Wiley Online Library ( DOI: 10.1002/hed.21528

Abstract: Evidence-based medicine integrates the best available data in decision making, with the goal of minimizing physicians’ and patients’subjectivity. In 2006, the American Society of Clinical Oncology edited clinical practice guidelines for the use of larynx preservation strategies. The objective of this review was to evaluate the current levels of evidence for glottic squamous cell carcinoma. Current guidelines for early stage glottic cancer are based on low-level evidence. Conservation surgery (open or transoral) and radiation therapyare all valid options for T1 and selected T2 lesions. For advanced lesions, surgery and combined chemotherapy and radiation are options. High-level evidence favors combined chemotherapy and radiation therapy or altered fractionation radiation therapy as nonsurgical strategies for organ preservation, compared with radiation therapy alone. The optimal combination of chemotherapy, targeted therapy,and radiation therapy remains to be demonstrated, however, and for high-volume C tumors, total laryngectomy may still be warranted. V 2011 Wiley Periodicals, Inc. Head Neck 33: 1638–1648, 2011 Keywords: glottic cancer; surgery; transoral laser; radiotherapy; chemotherapy

Evidence-based medicine is the ‘‘conscientious, explicit and judicious use of current best evidence in making decisions aboutthe care of individual patients,’’ and ‘‘integrating experience with the best available data in decision making.’’1 The role of clinical research is to allow us to rationalize and refine
Correspondence to: D. M. Hartl
C V 2011 Wiley Periodicals, Inc.

our practices for the benefit of our patients: ‘‘Experience is good but wisdom is better. On what should we rely for treatment decisions—anecdotes,opinions, and persuasion, or more objective data, systematic reviews, and thoughtful interpretation of available clinical reports? Use of the best information, thus minimizing bias and opinion, is the key element that separates ethical medical practitioners from quacks and charlatans.’’2 But why do we need evidence-based medicine? As technology advances, there is an increasing number of therapeuticoptions at our disposal. As globalization advances, we see the spectrum of the variations in clinical practice expand. Modern medicine includes the patient in therapeutic decision making, with informed consent obtained based on objective information and sound communication with healthcare providers. Finally, as knowledge in decision psychology progresses, it has become increasingly apparent that...
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