Endoscopic laser surgery in the treatment of radiation failure of early laryngeal carcinoma

Quer, Miquel; León, Xavier; Orús, César; Venegas, Pradi; López, Montserrat; Burgués, Joaquim

doi:10.1002/1097-0347(200008)22:5<520::aid-hed13>3.0.co;2-k

Cited by 56 publications

(72 citation statements)

References 24 publications

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“…The reconstructive ladder in general begins with healing by secondary intension (granulation tissue) followed by primary closure, skin grafts, local flaps, regional flaps, and microvascular free flaps [21][22][23][24][25][26][27][28][29][30]. In recurrent head and neck cancer surgery, the resulting defect is usually large and complex.…”

Section: Head and Neck Reconstructionsupporting

confidence: 91%

Untitled

2017

JOENTR

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Short CommunicationJ Otolaryngol ENT Res 2017, 7(6): 00229 treatment options including supportive therapy. Literature regarding this topic is not extensive considering the fact that a significant number of squamous cell cancers of the head and neck recur. This is also rarely covered in conferences and major medical meetings as well. Head and neck cancer recurrence can be quite devastating to the patients and their families. Around 50 to 60% of stage III and IV head and neck cancers recur, which makes it more or less common condition faced by head and neck oncologic specialists [1,2]. The survival rate ranges between 15 and 40%. Survival time after local and regional recurrence is 6 to 9 months and 60% are due to local and regional recurrence [3,4]. 90% of the patients with metastases die from uncontrolled disease on the primary site or the neck [4].Old recurrent head and neck cancers present at an advanced stage with poor prognosis. As an example, recurrent early laryngeal cancers such as T1 and T2 vocal fold squamous cell carcinomas have a favorable survival rate if discovered early and treated appropriately (85-95%). More advanced cancers of the larynx, recurrent oropharyngeal cancers, nasopharyngeal and hypopharyngeal cancers have a lower survival rate.The goals of treatment include the following: Figure 1, the modality of choice for treating recurrent head and neck squamous cell carcinoma is usually complete surgical resection. The decision to operate on patients with advanced complex tumors requires thorough planning in the context of a multidisciplinary medical team that includes otolaryngologists, reconstructive surgeons, medical oncologists, radiation oncologists, speech/swallowing therapists, psychologists, pathologists, radiologists and others. In this decision analysis tree, the first question that we have to ask ourselves is when to say no.

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Section: Head and Neck Reconstructionsupporting

confidence: 91%

Untitled

2017

JOENTR

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“…There are several advantages to using ELS for salvage surgery in recurrent laryngeal cancer compared with open conservative surgery, 10,[22][23][24][25][26] including shortened hospital stay with consequently reduced costs, low complication rate, possibility of avoiding tracheostomy, good functional results (especially in swallowing), and fewer [16][17][18][19][20][21][22] The reported rates for salvage ELS are as follows: local relapses, 6% to 59%; 3-year RFS, 91% to 100%; and preservation of larynx, 50% to 71%. 10,[23][24][25][26] Our experience of about 35% recurrence after salvage ELS is consistent with the rates published in previous studies.…”

Section: Commentmentioning

confidence: 99%

“…10,[23][24][25][26] Our experience of about 35% recurrence after salvage ELS is consistent with the rates published in previous studies. High recurrence rates after ELS are probably the result of understaging of the cancer both before radiotherapy and before ELS, which can lead to undertreatment and positive or close resection margins.…”

Section: Commentmentioning

confidence: 99%

Endoscopic Carbon Dioxide Laser Surgery for Glottic Cancer Recurrence After Radiotherapy

Ansarin

Planicka

Rotundo

et al. 2007

Arch Otolaryngol Head Neck Surg

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Patients:The study, which was conducted between May 1999 and September 2005, included 37 consecutive patients (33 men and 4 women) with recurrent glottic cancer after radiotherapy. Selection criteria were as follows: rcTis, rcT1, or rcT2 with subglottic or supraglottic involvement of less than 5 mm and no arytenoid invasion; adequate laryngeal exposure; no previous open surgery; no contraindications to general anesthesia; and signed consent.Interventions: Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association.Main Outcome Measures: Five-year actuarial recurrence-free and overall survival, complications, and rate of laryngeal preservation. Results:The clinical classifications of the recurrences were rcTis (n=4), rcT1a (n=10), rcT1b (n=11), and rcT2 (n = 12). The pathologic classifications of the recurrences were rpT0 (n=2), rpTis (n=5), rpT1a (n=9), rpT1b (n=3), rpT2 (n=14), and rpT3 (n=4). The median follow-up was 44 months (range, 18-88 months). New recurrences developed in 13 patients (35%): 11 were treated by total laryngectomy, 1 by supracricoid laryngectomy, and 1 by chemotherapy. Three patients died of laryngeal cancer, 1 is alive with disease, and 1 died of a second cancer. Five-year actuarial recurrence-free and overall survival rates were 58% and 86%, respectively. The larynx was preserved in 26 patients (70%). Laryngeal stenosis was the most common major complication (in 3 of 4 women and 1 of 33 men).

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“…The results we report herein compare favorably with those of prior endoscopic CO2 laser salvage treatment strategies. 2,6,7,[9][10][11][12][13][14] We believe that many surgeons will find the fiber-based KTP laser easier to use than a line-of-sight mirror-based CO2 laser. Wave-guide CO2 laser delivery is now available 22 ; however, the wave guide is substantially larger and significantly more cumbersome than the 0.3-to 0.6-mm glass fibers that are used with the KTP laser.…”

Section: Resultsmentioning

confidence: 99%