Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas

Abstract

Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser surgery between 1989 and 2006 in two Italian institutions. Patient staging was as follows: 2 pTis, 20 pT1, 38 pT2, and 20 pT3. Simultaneous or 1-month delayed neck dissection (ND) was performed on 27 (34%) patients, unilaterally in 10 and bilaterally in 17. The pN category was as follows: 9 pN0, 6 pN1, 8 pN2b, and 4 pN2c. A total of 16 (20%) patients received complementary radiotherapy (RT) and 5 (6%) were subjected to chemo-RT for persistent tumor after re-excision due to positive margins, multiple lymph nodes, and/or extracapsular spread after ND. The last follow-up was in December 2008. The 5-year overall, disease-specific and disease-free survivals, local control with laser alone, and organ preservation rates calculated by Kaplan-Meier analysis were 84.4, 97.4, 88.3, 96, and 97.2%, respectively. Univariate analysis showed a statistically significant impact on disease-free survival, local control with laser alone, and organ preservation of pT category (p = 0.009, p = 0.01, and p = 0.03, respectively), while pN category and tumor stage negatively influenced disease-free survival (p = 0.007 and p = 0.01, respectively). This series confirms the good overall oncologic outcomes obtained by transoral laser surgery for Tis, T1, T2, and selected T3 supraglottic cancer with minimal pre-epiglottic space involvement.

Conservative treatment for advanced T3–T4 laryngeal cancer: meta-analysis of key oncological outcomes

“…In this perspective, post-operative irradiation has been reported to increase the rate of laryngeal preservation [35], accordingly to its previous mentioned indications. However, adjuvant RT is usually discouraged on the primary tumour site after partial laryngeal surgery because of its potential unfavourable functional late effects, including its rate in delaying patients recovery.…”

“…The lowest DFS rate was 52.54% [32], with other two studies both reporting 93.75% of DFS [33,42] and one study showing no recurrence event [35]. The forest plot is shown in Fig.…”

“…This is the reason why close cooperation with expert pathologists is of overwhelming importance. In accordance with these strict indications for adjuvant treatment, some authors such as Wilkie, Pearson and Peretti [34][35][36]42] gained the highest rates of OS and DFS, in contrast to Hinni et al [32], thus highlighting that TLM might reach excellent results when accurate selection of patients is made. Whilst, articles about closed technique showed less homogeneity in their outcome results, papers dealing with open procedures obtained more comparable data.…”

“…Closed techniques differed from the open ones in proposing a second surgical revisions in case of first pathological report indicative for presence of invasive cancers on resection margins; while, in the case of equivocal margins second procedures were not routinely performed. Only after a second pathological report indicative for deep positive margins, adjuvant RT was administered on the primary tumour site [35,36,42]. This is the reason why close cooperation with expert pathologists is of overwhelming importance.…”

Transoral Laser Surgery for Supraglottic Carcinoma

“…The 5-year recurrence-free survival rate was 71%. Peretti et al 27 reported on a series of 80 patients treated with laser microsurgery in which 20 patients with pT3 lesions showing "limited infiltration" of the preepiglottic fat. In 88.2% of patients larynx preservation was achieved, the 5-year disease-free survival was 59.6%.…”