Transoral laser microsurgery for early and moderately advanced laryngeal cancers: outcomes from a single centralised United Kingdom centre

Abstract

Transoral laser microsurgery (TLM) represents an important treatment for selected laryngeal cancers. Utilisation of TLM, however, is highly variable between United Kingdom (UK) centres, and published data relating to its use in the UK is scarce. We report outcomes from our tertiary referral centre, and highlight lessons learned. Patients undergoing primary TLM for laryngeal cancer with curative intent (2007-2011) were studied retrospectively. Survival analyses were evaluated using the Kaplan-Meier method and log-rank statistics used to examine the influence of several variables. Overall, 170 cases were included-153 glottic and 17 supraglottic. Median follow-up was 39 months (range 14-79 months). Respective 3-year local control (LC), overall survival (OS), disease-specific survival (DSS), and disease-free survival were 92, 92, 98, and 86 % for glottic carcinomas. Three-year LC and OS were both 88 % for supraglottic carcinomas. For glottic cases, a significant impact of pT stage on DSS was observed, and of age on OS. Median hospital stay was one and 19 days for glottic and supraglottic cases respectively, with respective 3-year laryngeal preservation rates of 97 and 94 %, and tracheostomy rates of 0 and 29 %. One patient in the glottic group and four in the supraglottic group failed to regain swallowing function post-operatively, remaining either PEG dependent or undergoing functional total laryngectomy. Our series confirms the oncological and functional efficacy of TLM, offering a unique large-scale UK perspective. Our experience indicates, however, that treatment of larger supraglottic tumours should be considered carefully, as functional outcomes may be compromised.

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

“…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.…”

“…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.…”

“…Heterogeneity tests revealed significant heterogeneity (I 2 = 90.4%) which is to be expected given the wide spectrum of operations, outcomes and follow-up times reported. The lowest OS rate was 49.80% [32], with two studies reporting 94 and 93.80% OS rates [34,42]. The forest plot is shown in Fig.…”

“…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.…”

Tumor bed brachytherapy for locally advanced laryngeal cancer: a feasibility assessment of combination with ferromagnetic hyperthermia

“…Integration of new treatment approaches such as organ preservation surgery (Sperry et al, 2013, Wilkie et al, 2015, Vasil'chenko et al, 2011, HDR brachytherapy (Obinata et al, 2007), and hyperthermia (Paulides et al, 2007a, Paulides et al, 2010, Falk and Issels, 2001) have been proposed to improve quality of life in advanced head and neck cases by saving larynx function as well as increasing survival. Local tumor hyperthermia (temperatures of 40-45°C) is a promising adjuvant treatment method in cancer therapy, contributing to a significant improvement of therapeutic efficacy in sites where adequate heating is possible (Overgaard et al, 1996, Sneed et al, 1998, Valdagni and Amichetti, 1994, Datta et al, 2016b, Datta et al, 2016a, Issels et al, 2010).…”