To evaluate long-term disease-specific survival (DSS) and organ preservation (OP) rates in patients affected by Tis-T2 glottic squamous cell carcinoma (SCC) treated by carbon dioxide transoral laser microsurgery (CO2 TOLMS).
Study Design
Single-center retrospective cohort study.
Setting
Tertiary academic hospital.
Methods
The study included patients treated by CO2 TOLMS for Tis-T2 glottic SCC at the Department of Otorhinolaryngology–Head and Neck Surgery of the University of Brescia, Italy, from 1988 to 2018. The male:female ratio was 11.2:1, and the mean age was 64 years (range, 31-95). T categories were distributed as follows: 124 (10%) Tis, 646 (54%) T1a, 172 (15%) T1b, and 246 (21%) T2.
Results
Ten- and 20-year DSS rates were 97.6% and 96.3%, respectively, and 10- and 20-year OP rates were 94.7% and 93%. During the follow-up, 91% of patients were treated by CO2 TOLMS alone, while the remaining needed adjunctive treatments. Assessing the impact of multiple sessions of CO2 TOLMS, DSS showed no significant difference in terms of patients treated by 1, 2, or >2 procedures. Conversely, patients treated by >2 sessions of CO2 TOLMS showed a significantly worse OP rate.
Conclusions
Our series validates CO2 TOLMS as a long-term treatment strategy for early glottic SCC. Salvage CO2 TOLMS provided optimal results in terms of DSS and OP in patients with recurrence after previous transoral surgery.
RemacleMArensCEldinMB, et al. Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society. Eur Arch Otorhinolaryngol. 2017;274(10):3723-3727.
2.
SuccoGPerettiGPiazzaC, et al. Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society. Eur Arch Otorhinolaryngol. 2014;271(9):2489-2496.
3.
WarnerLChudasamaJKellyCG, et al. Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database Syst Rev. 2014;(12):CD002027.
4.
Ogol’tsovaEPachesAMatiakinE, et al. Comparative evaluation of the effectiveness of radiotherapy, surgery and combined treatment of stage I-II laryngeal cancer (T1-2NoMo) based on the data of a cooperative randomized study. Vestn Otorinolaringol. 1990;(3):3-7.
5.
PiazzaCMangiliSBonFD, et al. Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the Laryngoscore. Laryngoscope. 2014;124(11):2561-2567.
6.
PiazzaCPadernoAGrazioliP, et al. Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery. Laryngoscope. 2018;128(5):1146-1151.
7.
IncandelaFPadernoAMissaleF, et al. Glottic exposure for transoral laser microsurgery: proposal of a mini-version of the laryngoscore. Laryngoscope. 2019;129(7):1617-1622.
8.
ZeitelsSMBurnsJADaileySH.Suspension laryngoscopy revisited. Ann Otol Rhinol Laryngol. 2004;113(1):16-22.
9.
BlakesleeDVaughanCWShapshaySMSimpsonGTStrongMS.Excisional biopsy in the selective management of T1 glottic cancer: a three-year follow-up study. Laryngoscope. 1984;94(4):488-494.
10.
PerettiGCappielloJNicolaiPSmussiCAntonelliAR.Endoscopic laser excisional biopsy for selected glottic carcinomas. Laryngoscope. 1994;104(10):1276-1279.
11.
RemacleMEckelHEAntonelliA, et al. Endoscopic cordectomy: a proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol. 2000;257(4):227-231.
12.
MendelsohnAHRemacleMJ.Vocal fold cancer transoral laser microsurgery following European Laryngological Society laser cordectomy classification. Front Oncol. 2018;8:231.
13.
HarrisATTanyiAHartRD, et al. Transoral laser surgery for laryngeal carcinoma: has Steiner achieved a genuine paradigm shift in oncological surgery?Ann R Coll Surg Engl. 2018;100(1):2-5.
14.
DingYWangB.Efficacy of laser surgery versus radiotherapy for treatment of glottic carcinoma: a systematic review and meta-analysis. Lasers Med Sci. 2019;34(5):847-854.
15.
GioacchiniFMTulliMKaleciSBondiSBussiMReM.Therapeutic modalities and oncologic outcomes in the treatment of T1b glottic squamous cell carcinoma: a systematic review. Eur Arch Otorhinolaryngol. 2017;274(12):4091-4102.
16.
GuimaraesAVDedivitisRAMatosLLAiresFTCerneaCR.Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: a systematic review and meta-analysis. Sci Rep. 2018;8(1):11900.
17.
HendriksmaMHeijnenBJSjogrenEV.Oncologic and functional outcomes of patients treated with transoral CO2 laser microsurgery or radiotherapy for T2 glottic carcinoma: a systematic review of the literature. Curr Opin Otolaryngol Head Neck Surg. 2018;26(2):84-93.
18.
MoHLLiJYangX, et al. Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and meta-analysis. Lasers Med Sci. 2017;32(2):461-467.
19.
VaculikMFMacKayCATaylorSMTritesJRBHartRDRigbyMH.Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO2 transoral laser microsurgery and radiotherapy. J Otolaryngol Head Neck Surg. 2019;48(1):44.
20.
WarnerLLeeKHomerJJ.Transoral laser microsurgery versus radiotherapy for T2 glottic squamous cell carcinoma: a systematic review of local control outcomes. Clin Otolaryngol. 2017;42(3):629-636.
21.
BairdBJSungCKBeadleBMDiviV.Treatment of early-stage laryngeal cancer: a comparison of treatment options. Oral Oncol. 2018;87:8-16.
22.
LucioniMBertolinALionelloMGiacomelliLRizzottoGMarioniG.Salvage transoral laser microsurgery for recurrent glottic carcinoma after primary laser-assisted treatment: analysis of prognostic factors. Head Neck. 2016;38(7):1043-1049.
23.
GalletPRumeauCNguyenDTTeixeiraPABaumannCToussaintB.“Watchful observation” follow-up scheme after endoscopic CO2 laser treatment for small glottic carcinomas: a retrospective study of 93 cases. Clin Otolaryngol. 2017;42(6):1193-1199.
24.
MarchiFPiazzaCRavanelliM, et al. Role of imaging in the follow-up of T2-T3 glottic cancer treated by transoral laser microsurgery. Eur Arch Otorhinolaryngol. 2017;274(10):3679-3686.
25.
SimoRBradleyPChevalierD, et al. European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer. Eur Arch Otorhinolaryngol. 2014;271(9):2469-2479.
26.
HorwichPRigbyMHMacKayC, et al. Laryngeal recurrence sites in patients previously treated with transoral laser microsurgery for squamous cell carcinoma. J Otolaryngol Head Neck Surg. 2018;47(1):14.
27.
PuxedduRPiazzaCMensiMCLeddaGPArgiolasFPerettiG.Carbon dioxide laser salvage surgery after radiotherapy failure in T1 and T2 glottic carcinoma. Otolaryngol Head Neck Surg. 2004;130(1):84-88.
28.
Del BonFPiazzaCMangiliSRedaelliDeZinisLONicolaiPPerettiG.Transoral laser surgery for recurrent glottic cancer after radiotherapy: oncologic and functional outcomes. Acta Otorhinolaryngol Ital. 2012;32(4):229-237.
29.
VilasecaINogues-SabateAAviles-JuradoFX, et al. Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas: CHAID decision-tree analysis. Head Neck. 2019;41(3):756-764.
30.
AnsarinMCattaneoADe BenedettoL, et al. Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery. Head Neck. 2017;39(1):71-81.
31.
CanisMIhlerFMartinAMatthiasCSteinerW.Transoral laser microsurgery for T1a glottic cancer: review of 404 cases. Head Neck. 2015;37(6):889-895.
32.
CanisMMartinAIhlerF, et al. Transoral laser microsurgery in treatment of pT2 and pT3 glottic laryngeal squamous cell carcinoma—results of 391 patients. Head Neck. 2014;36(6):859-866.
33.
DingSHuangJHuangZXuHGuoWZhangY.Variation in prognosis of early laryngeal carcinoma after different types of cordectomy with transoral laser microsurgery. Acta Otolaryngol. 2018;138(8):741-745.
34.
PerettiGPiazzaCCoccoD, et al. Transoral CO(2) laser treatment for T(is)-T(3) glottic cancer: the University of Brescia experience on 595 patients. Head Neck. 2010;32(8):977-983.
35.
MaYGreenRPanSMcCabeDGoldbergLWooP.Long-term voice outcome following radiation versus laser microsurgery in early glottic cancer. J Voice. 2019;33(2):176-182.
36.
HendriksmaMvan LoonYKlopWMC, et al. Quality of life and voice outcome of patients treated with transoral CO2 laser microsurgery for early glottic carcinoma (T1-T2): a 2-year follow-up study. Eur Arch Otorhinolaryngol. 2019;276(3):805-814.
37.
BuiATYong JiKSPhamCTLeKMTongTXLeeWT.Longitudinal evaluation of quality of life in laryngeal cancer patients treated with surgery. Int J Surg. 2018;58:65-70.
38.
Valls-MateusMOrtegaABlanchJLSabaterFBernal-SprekelsenMVilasecaI.Long-term quality of life after transoral laser microsurgery for laryngeal carcinoma. J Surg Oncol. 2016;114(7):789-795.
39.
KonoTSaitoKYabeHUnoKOgawaK.Comparative multidimensional assessment of laryngeal function and quality of life after radiotherapy and laser surgery for early glottic cancer. Head Neck. 2016;38(7):1085-1090.
40.
McNeilMLWilkeDRTaylorSM.Patient preferences in early glottic cancer treatment. Ear Nose Throat J. 2016;95(7):281-283.
41.
van LoonYHendriksmaMLangeveldTPMde JongMABaatenburg de JongRJSjogrenEV.Treatment preferences in patients with early glottic cancer. Ann Otol Rhinol Laryngol. 2018;127(3):139-145.
42.
ZahoorTDawsonRSenMMakuraZ.Transoral laser resection or radiotherapy? Patient choice in the treatment of early laryngeal cancer: a prospective observational cohort study. J Laryngol Otol. 2017;131(6):541-545.
43.
PrettyjohnsMWinterSKerawalaCPaleriV.Transoral laser microsurgery versus radiation therapy in the management of T1 and T2 laryngeal glottic carcinoma: which modality is cost-effective within the UK?Clin Otolaryngol. 2017;42(2):404-415.
44.
National Institute for Clinical Excellence. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. Accessed December 7, 2019. http://www.nice.org.uk/NG36
ZhanCYangXSongXYanL.Radiotherapy vs surgery for T1-2N0M0 laryngeal squamous cell carcinoma: a population-based and propensity score matching study. Cancer Med. 2018;7(7):2837-2847.
