Preliminary results of diode laser surgery for early glottic cancer

The State-of-the-Art and Perspectives of Laser Ablation for Tumor Treatment

Tumors significantly impact individuals' physical well-being and quality of life. With the ongoing advancements in optical technology, information technology, robotic technology, etc., laser technology is being increasingly utilized in the field of tumor treatment, and laser ablation (LA) of tumors remains a prominent area of research interest. This paper presents an overview of the recent progress in tumor LA therapy, with a focus on the mechanisms and biological effects of LA, commonly used ablation lasers, image-guided LA, and robotic-assisted LA. Further insights and future prospects are discussed in relation to these aspects, and the paper proposed potential future directions for the development of tumor LA techniques.

Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience

Backgroud/Objectives: Transoral laser laryngeal microsurgery (LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with LTLM as a single-modality therapy in a single-center study.

METHODS

Patients with early-stage (Tis-1-2/N0) glottic LSCC who underwent LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed.

RESULTS

One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T1 stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of "wait and see" modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001).

CONCLUSION

The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

Medical Applications of Diode Lasers: Pulsed versus Continuous Wave (cw) Regime

The paper deals with the medical application of diode-lasers. A short review of medical therapies is presented, taking into account the wavelength applied, continuous wave (cw) or pulsed regimes, and their therapeutic effects. Special attention was paid to the laryngological application of a pulsed diode laser with wavelength 810 nm, and dermatologic applications of a 975 nm laser working at cw and pulsed mode. The efficacy of the laser procedures and a comparison of the pulsed and cw regimes is presented and discussed.

Prognostic comparison of transoral laser microsurgery for early glottic cancer with or without anterior commissure involvement: A meta-analysis

OBJECTIVES

Transoral laser microsurgery (TLM) has gradually gained approval in the treatment of early glottic cancer. However, the oncological outcomes of TLM for glottic cancer with anterior commissure (AC) involvement are still a controversial topic. We aimed to systematically review the literature on glottic cancer (Tis-T2) with patients who received TLM as first choice therapy and to evaluate several prognostic outcomes in patients with or without AC involvement.

METHODS

A systematic literature retrieval was conducted in PubMed, Medline (Ovid) and Web of Science. Risk ratio (RR) between AC involvement (AC+) or without AC involvement (AC-) was assessed and 95% confidence interval(95%CI) was calculated, which was performed on RevMan 5.3.

RESULTS

A total of 20 literatures were included when comparing the local recurrence (LR) rate of patients with or without AC involvement, and the results suggested LR matters in group AC+ over group AC- (RR = 2.39, 95%CI = 1.99-2.86, p < 0.00001). The 5-year overall survival(5yOS) rate included 10 studies, and there was no significant difference between AC+ and AC- (RR = 0.98, 95%CI = 0.93-1.02, p = 0.35). The laryngeal preservation rate (LPR) of AC+ was lower than that of AC- (RR = 0.97, 95%CI = 0.94-1.00, p = 0.04).

CONCLUSION

The results indicate that the prognosis of early glottic cancer with AC involvement is more likely to have higher local recurrence and lower LPR but no statistical difference in 5yOS rate.

Diode Laser for Laryngeal Cancer: "980 nm" and Beyond the Classic CO2

Lasers have been used in otolaryngology for more than 40 years and are widely considered an established way of addressing laryngeal pathology, benign and malignant. Carbon dioxide (CO₂) laser is considered a gold standard, but over the last 2 decades, a new technology has been developed and established in other medical specialties, not so much in Ear Nose and Throat (ENT), the diode laser. It consists of a flexible fiber that passes through a hollow guidance system and is capable of reaching certain angled spots easier than straight beam systems. Portability, lower cost, easier setup, and improved photocoagulation are just some of the many features rendering it an excellent choice for the surgeon and the patient. The few studies published worldwide for the usage and efficacy of this system show no major differences related to the oncologic outcome and survival rate of patients having an early glottic tumor between diode laser microsurgery and CO₂ laser cordectomy. Nevertheless, the advantages offered by fiber-optic laser surgery render it a worthy and perhaps equal alternative for treating this kind of pathology.

[Features of microsurgery of the vestibular larynx using CO and a diode laser]

The purpose of the study was to evaluate the possibility of using and the effectiveness of CO₂ and diode lasers in the microsurgery of the vestibular larynx. 85 surgical interventions were performed (using CO₂ laser - 45, diode - 40) on the vestibular larynx of 52 patients (papillomatosis, cicatricial stenosis, cysts, hyperplastic laryngitis, initial stage of laryngeal cancer). The complications, duration of the intervention and inflammatory changes after the operation were assessed. In 3 (3.5%) cases, the use of CO₂ laser was complicated by bleeding. The duration of the intervention with the use of a CO₂ laser averaged 24±5.6 minutes, with a diode laser 30±5.4 minutes (p<0.05). In patients with a diode laser, edema, mucosal congestion, fibrin and pain were significantly longer than patients after using a CO₂ laser (p<0.05). Thus, the use of CO₂ laser in the surgical treatment of the vestibular laryngeal region occurs with less time, a less prolonged inflammatory response, but in some cases requires additional methods of hemostasis.

Voice and Quality-of-Life Outcomes of Diode Laser for Tis-T1a Glottic Cancer

The aim of this prospective study was to analyze the voice and quality-of-life outcomes of microscopic diode laser surgery (MDLS). The study was conducted on a series of 46 patients with Tis-T1a glottic carcinoma treated with microscopic endolaryngeal diode laser surgery. Patients were asked to complete the Voice Handicap Index and quality-of-life questionnaires of the European Organization for Research and Treatment of Cancer. When comparing the pre- and postoperative scores, there were significant difference on the physical scores (P = .014) of the patients who underwent type III cordectomy and functional (P = .022), emotional (P = .002), and overall scores (P = .005) of the patients who underwent type IV cordectomy, in the direction of better quality of voice after MDLS. The postoperative functional, physical, emotional, and overall scores of groups were significantly increased with the extension of resection.

Diode Laser for Laryngeal Surgery: a Systematic Review

Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem.

CONCLUSION

The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.

Comparison of Early Oncological Results of Diode Laser Surgery with Radiotherapy for Early Glottic Carcinoma

Objective

To evaluate the oncologic results of transoral endolaryngeal microscopic diode laser surgery (MDLS) and radiotherapy (RT) for T1 and T2 glottic carcinoma.

Study Design

Case series with planned chart review.

Setting

Ankara Oncology Education and Research Hospital.

Subjects and Methods

The study was conducted on a series of 140 cases of early glottic carcinoma (T1, T2) treated with MDLS or RT. The tumors were defined according to T stage and the involvement of the anterior commissure (AC).

Results

The 3-year locoregional control rate of MDLS and RT groups was 93.1% and 89.7%, respectively ( P = .434). There was no difference in 3-year disease-free survival when comparing T1 and T2 tumors treated with MDLS and those treated with RT ( P = .618 for T1, P = .084 for T2). There was no difference in disease-free survival when comparing AC– and AC+ tumors treated with MDLS and those treated with RT ( P = .291 for AC– and P = .530 for AC+ tumors).

Conclusions

Microscopic diode laser surgery in early glottic cancer seems to be an oncologically safe procedure that has similar oncological results with RT. In T2 glottic tumors and AC involvement, the results with either treatment are less satisfactory.