Innovative laser based approaches to laryngeal cancer: what an engineer and physicist need to know

Abstract

Innovative laser-based approaches to laryngeal cancer include the clinical applications of two new technologies, photoangiolysis using a 532nm wavelength pulsed-KTP laser and fiber-based cutting using a 2µm wavelength thulium laser. Photoangiolysis is well-suited for treatment of minimally invasive glottic cancer and allows maximum preservation of phonatory surfaces needed for optimal voicing. The thulium laser offers an alternative to the carbon dioxide laser as an endolaryngeal cutting tool due to its enhanced hemostatic properties and fiber-based delivery. Clinical examples of pulsed-KTP laser involution of early glottic cancer will be presented in order to highlight the concept of targeting tumor angiogenesis in treating laryngeal cancer. The surgical experience using the thulium laser for complex endoscopic endolaryngeal excisions of large laryngeal cancers is presented to demonstrate the expanded clinical applications of endolaryngeal cutting offered by this laser. The laryngeal tissue effects of various laser power and pulse width (PW) settings, mode of delivery, active cooling to reduce thermal trauma, and wavelength selection have been extensively studied for the KTP and thulium lasers in both ex-vivo and liveperfusing models. The results from these studies, included herein, determine the clinical efficacy and safety of these innovative laser-based approaches to laryngeal cancer.