Carbon Dioxide Laser Microsurgery versus Low-Temperature Plasma Radiofrequency Ablation for T1a Glottic Cancer: A Single-Blind Randomized Clinical Trial

Abstract

Background Very few studies have been conducted to compare carbon dioxide laser microsurgery (CO2-LS) with low-temperature plasma radiofrequency ablation (LTP-RFA) in treating T1a glottic cancer. Therefore, we conducted this study to compare the efficacy of CO2-LS and LTP-RFA to define a superior therapeutic modality for T1a glottic cancer. Methods Patients (n=131) with T1a glottic cancer were recruited between January 2010 and September 2014. The included patients were randomly assigned to either receive CO2-LS (n=65) or LTP-RFA (n=66). We conducted the following multidimensional vocal assessments: (i) videostroboscopic evaluation; (ii) auditory-perceptual evaluation; (iii) aerodynamics/ efficiency; (iv) acoustics; and (v) self-assessment questionnaires. Meanwhile, the surgery time and three-year overall survival rates in two groups were recorded. The predefined primary endpoint was overall survival, and the minimum follow-up time was set to six months. Results After treatment, we found that the structure and vibration of vocal cord might recover more quickly in patients receiving LTP-RFA than in patients receiving CO2-LS, and moreover, the patients in the LTP-RFA group had the better vocal functions. Meanwhile, the surgery time was significantly less in the LTP-RFA group (8.83±1.59 minutes) than in the CO2-LS group (12.49±1.40 minutes) (p<0.00001). In addition, the two intervention methods had the similar three-year overall survival rates (94% versus 96%, p=0.58). Conclusion These results indicated that both LTP-RFA and CO2-LS could effectively treat T1a glottic cancer, and LTP-RFA might have some advantages in voice function. Limited by the relatively small sample size, future studies were needed to validate our conclusion.

Prognostic factors of patients with initially diagnosed T1a glottic cancer

“…Primary site surgery is quick, inexpensive, and repeatable after the event of recurrence. [ 28 , 30 ] But it requires a foundation of solid surgical expertise and the feasibility of surgery will depend on patients anatomy. While, radiation can avoid general anesthesia and lead to a possibility of better functional outcomes, but is actually a longer treatment and may lead to adjacent tissues with some sequelae such as fibrosis, mucosal edema, and laryngeal chondronecrosis.…”

Lasers and Robots: Recent Developments in Transoral Laser and Transoral Robotic Surgery

“…Aside from laser-based energy devices, radiofrequency ablation (RFA) have also been utilized for transoral microsurgery. 18,19 This technique is performed by inserting a needle probe for deploying tines into the tumor mass. Half of the tines are electrodes for delivery of radiofrequency current while the remaining tines are thermocouples for monitoring temperature.…”

“…A recent study has proven RFA to be advantageous compared to CO2 TLM for treating glottic cancer. 19 Benefits of using RFA include improved infiltration depth into the tumor mass, enhanced probe maneuverability allowing for improved ablation or resection, ease of operation, faster recovery, and low energy consumption. The low thermal efficiency of RFA compared to other techniques makes it less effective when presented with intraoperative bleeding and would require secondary hemostatic intervention.…”

Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium

“…Recently, low-temperature plasma (LTP) has been distinguished as a new energy device used in surgeries. 8 – 10 LTP is composed of a variety of active particles (electrons, photons, and positive ionization). It is generated at a relatively low temperature (<40°C) to avoid thermal effects on living structures.…”

“… 11 LTP has been used for a variety of applications, such as wound healing 12 and anticancer therapy. 10 Moreover, LTP has several advantages when it is applied in surgeries, including clear visualization of the surgical field, thorough removal of tissue, minimal bleeding, and less postoperative inflammation. 9 , 13 Plasma energy ablates the bonds of biological macromolecules, breaking them into small molecular fragments.…”