Elsevier

Auris Nasus Larynx

Volume 37, Issue 3, June 2010, Pages 340-346
Auris Nasus Larynx

Repeated transoral laser microsurgery for early and advanced recurrence of early glottic cancer after primary laser resection

https://doi.org/10.1016/j.anl.2009.07.004Get rights and content

Abstract

Objectives

To analyze the oncological results of repeated transoral laser microresection (TLM) in case of failure after primary laser resection of early glottic cancer (pTis-pT2).

Methods

Fifty-six patients with local or loco-regional recurrence of early glottic cancer were treated between 1988 and 2005 by repeated TLM followed, if necessary, by neck dissection and/or adjuvant radio- or radiochemotherapy. Data on overall survival, disease-specific survival, and loco-regional control rates were analyzed retrospectively and calculated by the Kaplan–Meier method.

Results

Forty-four patients (78.6%) presented with early local recurrence (rTis-rT2N0; Stage I/II) and 12 patients (21.4%) had advanced local or loco-regional recurrence (pT3 and pT4N0/N+; Stage III/IV). Three- and five-year overall survival rates for patients with early and advanced recurrence were 75.1% vs. 51.6% and 61.6% vs. 25.8%, respectively. The corresponding three- and five-year disease-specific survival rates were 87.2% vs. 85.7% and 81.0% vs. 85.7%, respectively. Three- and five-year loco-regional control was significantly higher for patients treated for early recurrence (67.6% vs. 27.5% and 63.6% vs. 27.5%, respectively; p = 0.02). Salvage laryngectomy rates for patients with early and advanced recurrence were 9.1 and 25.0%, respectively. In patients with early local recurrence, anterior commissure involvement (n = 11) did not affect the oncological results.

Conclusions

In case of early local recurrence after primary TLM of early glottic cancer, further TLM seems to be justified as an organ-preserving treatment option. In contrast, salvage laryngectomy should be considered early for patients with advanced local or loco-regional recurrence.

Introduction

In recent years, organ-preserving transoral CO2 laser microsurgery (TLM) of early glottic cancer has achieved considerable popularity because of its minimally invasive nature, with excellent results in local control and voice quality. However, there is still an ongoing debate about the adequate surgical treatment of local recurrence, especially in case of advanced (rT3 and rT4) laryngeal tumors. The majority of recurrence patients can be salvaged by surgery followed, if necessary, by adjuvant radio- or radiochemotherapy, but total laryngectomy is recommended in many cases. Repeated TLM, open partial laryngectomy procedures, and irradiation alone have been advocated as other possible therapeutic options [1], [2], [3], [4], [5], [6] and the choice of therapy in case of recurrence is determined by patient- and tumor-related factors as well as physician preference. It is evident that total laryngectomy may offer improved local control rates but with a reduced quality of life. Open partial laryngectomies are considered as oncologically safe but functionally less favorable compared to TLM and a statistically significantly increased incidence of complications has been reported for patients after salvage open partial laryngectomy [7]. In case of early glottic recurrence (rTiS–rT2N0; Stage I/II), unimodal radiotherapy may lead to good functional results but at the risk of understaging. Furthermore, irradiation cannot be repeated in case of further recurrence.

It was the aim of the present study to evaluate the oncological results of repeated TLM on long-term follow-up for a great cohort of patients presenting with local or loco-regional recurrence of early glottic cancer treated initially by unimodal TLM as detailed data on this subject are rare in the literature. Endpoints of analysis were loco-regional control, organ preservation, overall and disease-specific survival.

Section snippets

Patients and methods

Between March 1988 and August 2005, seventy-six patients presented with local or loco-regional recurrence of early glottic cancer (pTis–pT2) at the Department of Otorhinolaryngology, University of Göttingen, Germany. All patients had undergone previous TLM as the exclusive primary treatment modality. Mean time between primary treatment and the development of the recurrence was 36 (3–163) months. Sixty-seven patients were male and nine patients were female. At the time of the first recurrence,

Results

The treatment results are summarized in Table 1.

Survival

In the literature, data on three- and five-year survival rates for TLM in the treatment of recurrent glottic cancer are rare. In the present study, overall survival was tendencially worse for patients with advanced recurrence, but not disease-specific survival as most patients died from intercurrent disease or a second primary tumor. Intercurrent deaths occurred more often in patients with advanced recurrence, whereas tumor-dependent deaths occurred only in patients with early recurrence.

Loco-regional control after treatment of the first recurrence by TLM

For

Conclusions

In case of early local recurrence after primary TLM of early glottic cancer, further TLM seems to be justified as an organ-preserving salvage procedure enabling favorable disease-specific survival. In case of early local recurrence, anterior commissure involvement does not affect the oncological outcome. For advanced loco-regional recurrence, however, TLM cannot be generally recommended due to its unfavorable loco-regional control and should be restricted to only selected cases suitable for a

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