Applications of Carbon Dioxide Laser Surgery and Radiation: A Preliminary Report

Abstract

DDS \s=b\Ten patients with advanced or recurrent squamous cell carcinomas of the upper airway were treated with a combination of carbon dioxide laser surgery and radiation therapy to evaluate the tolerance to rapid sequencing of both modalities in a variety of clinical situations. Other considerations were to accurately stage infiltrating tumors, to provide cytoreduction for T3 and T4 tumors, and to facilitate the optimal placement of intracavitary radium applicators. Because of minimal postoperative pain or dysfunction associated with thel aser, patients were able to receive irradiation considerably sooner than with conventional surgery. Local tolerance was good to excellent in seven of the ten patients treated and, based on preliminary results, the combination would appear to offer advantages in curative approaches to advanced head and neck tumors. (Arch Otolaryngol 1983;109:240-242) The advantages of combining con¬ servative surgery and postopera¬ tive adjuvant radiation for patients with advanced resectable head and neck carcinomas have been de¬ scribed.14 Clinical experience has demonstrated the ability of moderate, well-tolerated doses of supervoltage radiotherapy in the order of 5,000 rad in five weeks, delivered in daily frac¬ tions of 180 to 200 rad five times a week to provide optimal local control (Dr Feldman). by complementing the surgical proce¬ dure that removes gross disease.Although previously there were theo¬ retical radiobiologic considerations and clinical studies advancing the pre¬ operative rather than the postopera¬ tive administration of radiotherapy,5-6 recent randomized prospective clini¬ cal trials do not support one approach over the other.7It would appear that the more con¬ servative the surgery, the sooner the patient with residual micrometastatic or subclinical disease can be treated by radiation. Vikram et al8 noted an increasing incidence of postoperative local recurrence in patients who expe¬ rienced a delay of longer than six weeks in the application of adjuvant radiation therapy. One-or two-stage head and neck surgical procedures have inherent two-to three-month postoperative delays due to healing, rehabilitation, and psychosocial con¬ siderations.9" Our experience with the carbon dioxide laser indicates that gross tumor ablation can be achieved with such minimal morbidity and rap¬ id healing that potentially an ideal complementary relationship can be established between the surgeon and the radiotherapist in the combined treatment of patients with head and neck cancer. MATERIALS AND METHODSThirty-eight patients with upper airway squamous cell carcinomas were treated and observed by the

Hazard to Endotracheal Tubes by CO 2 Laser Beam

“…In the field of the ENT department, CO2 laser beam sur gery is indicated not only for carcinoma in situ or Tl, but also for advanced carcinomas of the upper aerodigestive tract [2], because patients are able to receive irradiation quicker than with conventional surgery and with a minimum of postoperative pain or dysfunction.…”