Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers

Peretti, Giorgio; Piazza, Cesare; Penco, Sara; Santori, Gregorio; Bon, Francesca Del; Garofolo, Sabrina; Paderno, Alberto; Guastini, Luca; Nicolai, Piero

doi:10.1002/hed.24424

Cited by 35 publications

(29 citation statements)

References 36 publications

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“…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.…”

Section: Discussionmentioning

confidence: 97%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Mannelli

Lazio

Luparello

et al. 2017

Eur Arch Otorhinolaryngol

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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

Mannelli

Lazio

Luparello

et al. 2017

Eur Arch Otorhinolaryngol

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“…7 Many series have reported the outcomes of TLM in laryngeal cancer, pointing out some of the risks and complications of this type of surgery. [12][13][14][15][16][17][18] With such controversial evidence, it is difficult sometimes to decide between TLM and other therapeutic approaches. 11 For this reason, some authors recommend TLM only in early or selected intermediate cases, 11 whereas others have published large series with good results in locally advanced cases.…”

Section: Discussionmentioning

confidence: 99%

Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

et al. 2018

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Background Indications of transoral laser microsurgery (TLM) are conditioned by the risk of local relapse. Objective To evaluate prognostic factors of local relapse and local control with TLM (LC‐TLM). Methods Local relapse and LC‐TLM were evaluated in 1119 patients. Logistic regression and CHAID decision tree analysis were performed. Results Local relapse correlated to previous radiotherapy failure (8.45, CI 95%: 2.64‐27.03; P < .001), paraglottic involvement (2.42, CI: 1.41‐4.15; P = .001), anterior commissure involvement (2.12, CI: 1.43‐3.14; P < .001), grade of differentiation (1.74, CI: 1.18‐2.57; P = .005), and alcohol consumption (1.4, CI: 0.99‐1.98; P = .057). Local relapse tended to inversely correlate with experience (0.73, CI: 0.51‐1.03; P = .078). The most important factors for local relapse were previous radiotherapy failure and anterior commissure involvement. LC‐TLM inversely correlated with previous radiotherapy failure (0.09, CI: 0.03‐0.28; P < .001), paraglottic involvement (0.25, CI: 0.14‐0.43; P < .001), anterior commissure involvement (0.49, CI: 0.32‐0.77; P = .007), margins (0.56, CI: 0.30‐1.04; P = .068), and differentiation (0.68, CI: 0.44‐1.05; P = .087). LC‐TLM correlated with experience (1.71, CI: 1.13‐2.55; P = .010). The most important factors for LC‐TLM were previous radiotherapy failure and paraglottic involvement. Conclusion Previous radiotherapy failure is the most important factor for local relapse and LC‐TLM. In primary treatments, anterior commissure involvement and paraglottic involvement are the most important factors for local relapse and LC‐TLM, respectively.

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“…Based on the idea of organ preservation, TLM and open/endoscopic partial laryngectomies have been proposed as therapeutic alternatives to radiotherapy or chemoradiotherapy in several publications [28,29]. Canis et al and Peretti and colleagues have reported five-year OS of 64.4% and 63.3% in two studies where TLM was used as the primary approach to T3 glottic and supraglottic LSCC, respectively [30,31]. Both authors highlighted the favorable functional outcome but stressed the importance of careful patient selection.…”

Section: Discussionmentioning

confidence: 99%

Impact of stage, management and recurrence on survival rates in laryngeal cancer

et al. 2017

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A retrospective, longitudinal study of 1,616 patients with primary laryngeal squamous cell carcinoma (LSCC) at a single center in Norway during 1983–2010 was undertaken to investigate overall survival, disease specific survival, disease-free survival, prognostic factors for overall survival, and impact of recurrence among all-stage laryngeal cancer patients over 15 years' follow-up. The prognostic impact of gender, age, smoking/alcohol, subsite, tumour, node and metastasis staging, period and modality of treatment were evaluated using Kaplan-Meier and Cox proportional hazard analyses. The importance of recurrence on survival was assessed based on case fatality rates. Five-year overall survival was 56.8%, 64.0% and 38.8%, and disease-specific survival was 80.2%, 87% and 61.6%, respectively, for the entire cohort and for glottic and supraglottic LSCC. Old age, advanced-stage LSCC and supraglottic cancer were associated with lower overall survival. The risk of disease-specific death plateaued after five years and varied significantly by subsite. Multivariate analysis of glottic LSCC revealed that surgical treatment improved overall survival, whereas old age, alcohol, T3-T4 status, positive N-status and no treatment were associated with worse survival. In supraglottic LSCC, age, alcohol, and positive N-status had a significant impact on overall survival by multivariate analysis. Five-year overall survival and disease-specific survival among patients with recurrent disease were 34% and 52%, respectively. In conclusion, marked difference in overall survival between glottic and supraglottic LSCC underline the importance of subsite-specific survival analysis. T-status and primary surgical management is essential only for glottic LSCC, emphasizing the importance of correct disease classification. Inferior outcomes in supraglottic LSCC are associated with old age, positive N-status, and improved follow-up routines are necessary. Primary tumor control is essential since recurrence impairs survival considerably in all subsites. The potential benefit of a primary surgical approach towards T3 LSCC awaits further investigation.

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Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers

Cited by 35 publications

References 36 publications

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

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

Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

Impact of stage, management and recurrence on survival rates in laryngeal cancer

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