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Published in: Indian Journal of Otolaryngology and Head & Neck Surgery 2/2023

29-12-2022 | CO2 Laser | Original Article

Treatment of Early Glottic cancer with Transoral Laser Microsurgery: An Australian Experience

Authors: Navid Ahmadi, Danielle Stone, Murray Stokan, Hedley Coleman, Gillian Heller, Mark Smith, Faruque Riffat, Akshay Kudpaje, Michael Veness, Carsten E Palme

Published in: Indian Journal of Otolaryngology and Head & Neck Surgery | Issue 2/2023

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Abstract

Introduction

Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit.

Methods

A review of a prospective patient database of patients with laryngeal SCC, who were treated with CO2 TLM between 2004 and 2019 was carried out.

Results

83 patients with a mean age of 67.7 (SD: 10.6) years underwent primary curative TLM for T1a/b SCC. 5-year overall survival was 93.2% (95%CI 86.9–100%), disease free survival was 86.0% (95%CI 78.1–94.6%), locoregional control was 91.2% (95%CI: 85.1–97.7%) and larynx preservation rate of 95.1% at 5 years.

Conclusion

TLM is an excellent treatment modality for T1 early glottic SCC, with excellent locoregional control and disease-free survival. It is minimally invasive, outpatient-based, and cost-effective procedure preserving upper aerodigestive tract dysfunction for all activities of daily living.
Literature
1.
go back to reference Bray F et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin 68(6):394–424CrossRef Bray F et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin 68(6):394–424CrossRef
2.
go back to reference Australian Institute of Health and Welfare (AIHW) (2019) Cancer in Australia: 2019, in Cancer Series. Canberra Australian Institute of Health and Welfare (AIHW) (2019) Cancer in Australia: 2019, in Cancer Series. Canberra
3.
go back to reference Ramsey T et al (2018) Laryngeal cancer: global socioeconomic trends in disease burden and smoking habits. Laryngoscope 128(9):2039–2053CrossRefPubMed Ramsey T et al (2018) Laryngeal cancer: global socioeconomic trends in disease burden and smoking habits. Laryngoscope 128(9):2039–2053CrossRefPubMed
4.
go back to reference Talamini R et al (2002) Combined effect of tobacco and alcohol on laryngeal cancer risk: a case–control study. Cancer Causes Control 13(10):957–964CrossRefPubMed Talamini R et al (2002) Combined effect of tobacco and alcohol on laryngeal cancer risk: a case–control study. Cancer Causes Control 13(10):957–964CrossRefPubMed
5.
go back to reference Blakeslee D et al (1984) Excisional biopsy in the selective management of T1glottic cancer: a three-year follow‐up study. Laryngoscope 94(4):488–494CrossRefPubMed Blakeslee D et al (1984) Excisional biopsy in the selective management of T1glottic cancer: a three-year follow‐up study. Laryngoscope 94(4):488–494CrossRefPubMed
6.
go back to reference Rosier J-F et al (1998) Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation. Radiother Oncol 48(2):175–183CrossRefPubMed Rosier J-F et al (1998) Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation. Radiother Oncol 48(2):175–183CrossRefPubMed
7.
go back to reference Thurnher D et al (2008) Challenging a dogma–surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy. Eur J Surg Oncol (EJSO) 34(6):692–698CrossRefPubMed Thurnher D et al (2008) Challenging a dogma–surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy. Eur J Surg Oncol (EJSO) 34(6):692–698CrossRefPubMed
8.
go back to reference Spector JG et al (1999) Stage I (T1 N0 M0) squamous cell carcinoma of the laryngeal glottis: therapeutic results and voice preservation. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck 21(8):707–717CrossRef Spector JG et al (1999) Stage I (T1 N0 M0) squamous cell carcinoma of the laryngeal glottis: therapeutic results and voice preservation. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck 21(8):707–717CrossRef
9.
go back to reference Ansarin M et al (2009) Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Archives of Otolaryngology–Head & Neck Surgery 135(4):385–390CrossRef Ansarin M et al (2009) Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Archives of Otolaryngology–Head & Neck Surgery 135(4):385–390CrossRef
10.
go back to reference Schrijvers ML et al (2009) Higher laryngeal preservation rate after CO2 laser surgery compared with radiotherapy in T1a glottic laryngeal carcinoma. Head Neck 31(6):759–764CrossRefPubMed Schrijvers ML et al (2009) Higher laryngeal preservation rate after CO2 laser surgery compared with radiotherapy in T1a glottic laryngeal carcinoma. Head Neck 31(6):759–764CrossRefPubMed
11.
go back to reference Maurizi M et al (2005) Laser carbon dioxide cordectomy versus open surgery in the treatment of glottic carcinoma: our results. Otolaryngology—Head and Neck Surgery 132(6):857–861CrossRefPubMed Maurizi M et al (2005) Laser carbon dioxide cordectomy versus open surgery in the treatment of glottic carcinoma: our results. Otolaryngology—Head and Neck Surgery 132(6):857–861CrossRefPubMed
12.
go back to reference Abdurehim Y et al (2012) Transoral laser surgery versus radiotherapy: systematic review and meta-analysis for treatment options of T1a glottic cancer. Head Neck 34(1):23–33CrossRefPubMed Abdurehim Y et al (2012) Transoral laser surgery versus radiotherapy: systematic review and meta-analysis for treatment options of T1a glottic cancer. Head Neck 34(1):23–33CrossRefPubMed
13.
go back to reference Feng Y, Wang B, Wen S (2011) Laser surgery versus radiotherapy for T1-T2N0 glottic cancer: a meta-analysis. Orl; Journal of Oto-Rhino-Laryngology & its Related Specialties, 73(6): p. 336 – 42 Feng Y, Wang B, Wen S (2011) Laser surgery versus radiotherapy for T1-T2N0 glottic cancer: a meta-analysis. Orl; Journal of Oto-Rhino-Laryngology & its Related Specialties, 73(6): p. 336 – 42
14.
go back to reference Guimarães AV et al (2018) Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: a systematic review and meta-analysis. Sci Rep 8(1):1–7CrossRef Guimarães AV et al (2018) Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: a systematic review and meta-analysis. Sci Rep 8(1):1–7CrossRef
15.
go back to reference Higgins KM et al (2009) Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy.Journal of Otolaryngology–Head & Neck Surgery, 38(6) Higgins KM et al (2009) Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy.Journal of Otolaryngology–Head & Neck Surgery, 38(6)
16.
go back to reference Kinshuck AJ, Shenoy A, Jones TM (2017) Voice outcomes for early laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 25(3):211–216CrossRefPubMed Kinshuck AJ, Shenoy A, Jones TM (2017) Voice outcomes for early laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 25(3):211–216CrossRefPubMed
17.
go back to reference Higgins KM (2011) What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 121(1):116–134CrossRefPubMed Higgins KM (2011) What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 121(1):116–134CrossRefPubMed
18.
go back to reference Smith JC et al (2003) Quality of life, functional outcome, and costs of early glottic cancer. Laryngoscope 113(1):68–76CrossRefPubMed Smith JC et al (2003) Quality of life, functional outcome, and costs of early glottic cancer. Laryngoscope 113(1):68–76CrossRefPubMed
19.
go back to reference Remacle M et al (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. European archives of oto-rhino-laryngology, 257(4): p. 227–231 Remacle M et al (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. European archives of oto-rhino-laryngology, 257(4): p. 227–231
20.
go back to reference Amin MB et al (2017) AJCC Cancer Staging Manual, 8th edn. Springer, New YorkCrossRef Amin MB et al (2017) AJCC Cancer Staging Manual, 8th edn. Springer, New YorkCrossRef
22.
go back to reference Johnson LL, Shih JH, Gallin JI, Ognibene FP, Editors (2007)Academic Press.p 273–282 Johnson LL, Shih JH, Gallin JI, Ognibene FP, Editors (2007)Academic Press.p 273–282
23.
go back to reference Lee M et al (2016) Complications after CO2 laser surgery for early glottic cancer: an institutional experience. Head Neck 38(S1):E987–E990CrossRefPubMed Lee M et al (2016) Complications after CO2 laser surgery for early glottic cancer: an institutional experience. Head Neck 38(S1):E987–E990CrossRefPubMed
24.
go back to reference Strong MS, Jako GJ (1972) Laser surgery in the larynx early clinical experience with continuous CO2 laser. Annals of Otology Rhinology & Laryngology 81(6):791–798CrossRef Strong MS, Jako GJ (1972) Laser surgery in the larynx early clinical experience with continuous CO2 laser. Annals of Otology Rhinology & Laryngology 81(6):791–798CrossRef
25.
go back to reference Steiner W (1984) Transoral microsurgical CO 2-laser resection of laryngeal carcinoma, in Functional Partial Laryngectomy. Springer. p. 121–125 Steiner W (1984) Transoral microsurgical CO 2-laser resection of laryngeal carcinoma, in Functional Partial Laryngectomy. Springer. p. 121–125
26.
go back to reference Eckel HE et al (2000) Transoral laser surgery for early glottic carcinoma. European archives of oto-rhino-laryngology. 257:221–2264 Eckel HE et al (2000) Transoral laser surgery for early glottic carcinoma. European archives of oto-rhino-laryngology. 257:221–2264
27.
go back to reference Motta G et al (2005) CO2 laser surgery in the treatment of glottic cancer. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck. 27:566–5747 Motta G et al (2005) CO2 laser surgery in the treatment of glottic cancer. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck. 27:566–5747
28.
go back to reference Gallo A et al (2002) CO2 laser cordectomy for early-stage glottic carcinoma: a long‐term follow‐up of 156 cases. Laryngoscope 112(2):370–374CrossRefPubMed Gallo A et al (2002) CO2 laser cordectomy for early-stage glottic carcinoma: a long‐term follow‐up of 156 cases. Laryngoscope 112(2):370–374CrossRefPubMed
29.
go back to reference Hartl DM et al (2011) Evidence-based review of treatment options for patients with glottic cancer. Head Neck 33(11):1638–1648CrossRefPubMed Hartl DM et al (2011) Evidence-based review of treatment options for patients with glottic cancer. Head Neck 33(11):1638–1648CrossRefPubMed
30.
go back to reference Allen CT, Lee C-J, Merati AL (2013) Clinical assessment and treatment of the dysfunctional larynx after radiation. Otolaryngology–Head and Neck Surgery 149(6):830–839CrossRefPubMed Allen CT, Lee C-J, Merati AL (2013) Clinical assessment and treatment of the dysfunctional larynx after radiation. Otolaryngology–Head and Neck Surgery 149(6):830–839CrossRefPubMed
31.
go back to reference Vaculik MF et al (2019) Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO 2 transoral laser microsurgery and radiotherapy. J Otolaryngology-Head Neck Surg 48(1):1–11CrossRef Vaculik MF et al (2019) Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO 2 transoral laser microsurgery and radiotherapy. J Otolaryngology-Head Neck Surg 48(1):1–11CrossRef
32.
go back to reference Laccourreye O et al (1997) Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for “early” glottic carcinoma classified as T1-T2N0 invading the anterior commissure. Am J Otolaryngol 18(6):385–390CrossRefPubMed Laccourreye O et al (1997) Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for “early” glottic carcinoma classified as T1-T2N0 invading the anterior commissure. Am J Otolaryngol 18(6):385–390CrossRefPubMed
33.
go back to reference Steiner W et al (2004) Impact of anterior commissure involvement on local control of early glottic carcinoma treated by laser microresection. Laryngoscope 114(8):1485–1491CrossRefPubMed Steiner W et al (2004) Impact of anterior commissure involvement on local control of early glottic carcinoma treated by laser microresection. Laryngoscope 114(8):1485–1491CrossRefPubMed
34.
go back to reference Krespi YP, Meltzer CJ (1989) Laser surgery for vocal cord carcinoma involving the anterior commissure. Annals of Otology Rhinology & Laryngology 98(2):105–109CrossRef Krespi YP, Meltzer CJ (1989) Laser surgery for vocal cord carcinoma involving the anterior commissure. Annals of Otology Rhinology & Laryngology 98(2):105–109CrossRef
35.
go back to reference Chen M-F et al (2003) Radiotherapy of early-stage glottic cancer: analysis of factors affecting prognosis. Annals of Otology Rhinology & Laryngology 112(10):904–911CrossRef Chen M-F et al (2003) Radiotherapy of early-stage glottic cancer: analysis of factors affecting prognosis. Annals of Otology Rhinology & Laryngology 112(10):904–911CrossRef
36.
go back to reference Lee HS et al (2013) Transoral laser microsurgery for early glottic cancer as one-stage single‐modality therapy. Laryngoscope 123(11):2670–2674CrossRefPubMed Lee HS et al (2013) Transoral laser microsurgery for early glottic cancer as one-stage single‐modality therapy. Laryngoscope 123(11):2670–2674CrossRefPubMed
37.
go back to reference Hakeem AH, Tubachi J, Pradhan SA (2013) Significance of anterior commissure involvement in early glottic squamous cell carcinoma treated with trans-oral CO2 laser microsurgery. Laryngoscope 123(8):1912–1917CrossRefPubMed Hakeem AH, Tubachi J, Pradhan SA (2013) Significance of anterior commissure involvement in early glottic squamous cell carcinoma treated with trans-oral CO2 laser microsurgery. Laryngoscope 123(8):1912–1917CrossRefPubMed
38.
go back to reference Ahmadzada S et al (2020) The value of narrowband imaging using the ni classification in the diagnosis of laryngeal cancer. Laryngoscope Invest Otolaryngol 5(4):665–671CrossRef Ahmadzada S et al (2020) The value of narrowband imaging using the ni classification in the diagnosis of laryngeal cancer. Laryngoscope Invest Otolaryngol 5(4):665–671CrossRef
39.
go back to reference Wu J et al (2015) Study of the histopathologic characteristics and surface morphologies of glottic carcinomas with anterior vocal commissure involvement.Medicine, 94(29) Wu J et al (2015) Study of the histopathologic characteristics and surface morphologies of glottic carcinomas with anterior vocal commissure involvement.Medicine, 94(29)
40.
go back to reference Mendelsohn AH et al (2015) CO 2 laser cordectomy for glottic squamous cell carcinoma involving the anterior commissure: voice and oncologic outcomes. Eur Arch Otorhinolaryngol 272(2):413–418CrossRefPubMed Mendelsohn AH et al (2015) CO 2 laser cordectomy for glottic squamous cell carcinoma involving the anterior commissure: voice and oncologic outcomes. Eur Arch Otorhinolaryngol 272(2):413–418CrossRefPubMed
41.
go back to reference Al-Mamgani A et al (2013) Radiotherapy for T 1‐2 N 0 glottic cancer: a multivariate analysis of predictive factors for the long‐term outcome in 1050 patients and a prospective assessment of quality of life and voice handicap index in a subset of 233 patients. Clin Otolaryngol 38(4):306–312CrossRefPubMed Al-Mamgani A et al (2013) Radiotherapy for T 1‐2 N 0 glottic cancer: a multivariate analysis of predictive factors for the long‐term outcome in 1050 patients and a prospective assessment of quality of life and voice handicap index in a subset of 233 patients. Clin Otolaryngol 38(4):306–312CrossRefPubMed
42.
go back to reference van Loon Y et al (2012) Functional outcomes after radiotherapy or laser surgery in early glottic carcinoma: a systematic review. Head Neck 34(8):1179–1189CrossRefPubMed van Loon Y et al (2012) Functional outcomes after radiotherapy or laser surgery in early glottic carcinoma: a systematic review. Head Neck 34(8):1179–1189CrossRefPubMed
43.
go back to reference Stone DB (2014) Voice Outcomes following Transoral Laser Microsurgery for Early Glottic Cancer, in Faculty of Health Sciences. University of Sydney: Sydney Stone DB (2014) Voice Outcomes following Transoral Laser Microsurgery for Early Glottic Cancer, in Faculty of Health Sciences. University of Sydney: Sydney
44.
go back to reference Brandenburg JH (2001) Laser cordotomy versus radiotherapy: an objective cost analysis. Annals of Otology Rhinology & Laryngology 110(4):312–318CrossRef Brandenburg JH (2001) Laser cordotomy versus radiotherapy: an objective cost analysis. Annals of Otology Rhinology & Laryngology 110(4):312–318CrossRef
45.
go back to reference Myers EN, Wagner RL, Johnson JT (1994) Microlaryngoscopic surgery for T1 glottic lesions: a cost-effective option. Annals of Otology Rhinology & Laryngology 103(1):28–30CrossRef Myers EN, Wagner RL, Johnson JT (1994) Microlaryngoscopic surgery for T1 glottic lesions: a cost-effective option. Annals of Otology Rhinology & Laryngology 103(1):28–30CrossRef
46.
go back to reference Forastiere AA et al (2018) Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 36(11):1143–1169CrossRefPubMed Forastiere AA et al (2018) Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 36(11):1143–1169CrossRefPubMed
Metadata
Title
Treatment of Early Glottic cancer with Transoral Laser Microsurgery: An Australian Experience
Authors
Navid Ahmadi
Danielle Stone
Murray Stokan
Hedley Coleman
Gillian Heller
Mark Smith
Faruque Riffat
Akshay Kudpaje
Michael Veness
Carsten E Palme
Publication date
29-12-2022
Publisher
Springer India
Published in
Indian Journal of Otolaryngology and Head & Neck Surgery / Issue 2/2023
Print ISSN: 2231-3796
Electronic ISSN: 0973-7707
DOI
https://doi.org/10.1007/s12070-022-03392-8

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