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Korkmaz MH, Bayır Ö, Hatipoğlu EB, Tatar EÇ, Han Ü, Öcal B, Keseroğlu K, Karahan S, Saylam G. Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience. Eur Surg Res 2021; 63:132-144. [PMID: 34818662 DOI: 10.1159/000519718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/16/2021] [Indexed: 12/09/2022]
Abstract
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.
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Affiliation(s)
- Mehmet Hakan Korkmaz
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey.,Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ömer Bayır
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey,
| | | | - Emel Çadalli Tatar
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ünsal Han
- Department of Pathology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Bülent Öcal
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kemal Keseroğlu
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Bridhikitti J, Chotigavanich C, Apiwarodom N. Voice Outcomes after Radiotherapy for Laryngeal Cancer. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1729497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objective The study was aimed to assess changes in voice outcomes after radiotherapy in laryngeal cancer patients.
Materials and Methods The study included 60 laryngeal cancer patients treated with definitive radiotherapy or chemoradiotherapy between 2005 and 2012. The primary endpoint of this study was to assess abnormalities of the patients’ voices after the treatment. The Thai version of the Voice Handicap Index (VHI) and xerostomia questionnaire were conducted by telephone. Videostroboscopic examination was done to objectively assess voice outcomes.
Results The median age of patients was 63 years. Most patients had glottic cancer (84.1%) and T1–2 disease (84.1%). The median time from treatment to the study was 46 months. In terms of the total VHI score, most patients were in the normal and slight handicap groups (22% and 71.4%, respectively). Only 4.8% and 1.6% of the patients were in moderate and severe handicap group, respectively. Twenty-eight patients had significant xerostomia. Videostroboscopy examination was done in 23 patients and most common findings were telangiectasia (95.7%), abnormal mucosal wave (47.8%), and abnormal glottic closure configuration (34.8%). Regarding total VHI score, lower radiation dose, conventional radiation dose per fraction, longer period after treatment, and significant xerostomia status were significantly correlated with worse voice outcomes. There were no statistically significant correlations between the videostroboscopic findings and VHI scores.
Conclusion Voice outcomes in most of laryngeal cancer patients treated with radiotherapy had a normal or mild handicap at more than 1 year of follow-up. Only 4.8% and 1.6% of the patients had moderate and severe voice outcome handicap, respectively.
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Affiliation(s)
- Jidapa Bridhikitti
- Department of Radiation Oncology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chanticha Chotigavanich
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nantakan Apiwarodom
- Department of Radiation Oncology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Karkos PD, Koskinas I, Stavrakas M, Triaridis S, Constantinidis J. Diode Laser for Laryngeal Cancer: "980 nm" and Beyond the Classic CO 2. EAR, NOSE & THROAT JOURNAL 2020; 100:19S-23S. [PMID: 32529850 DOI: 10.1177/0145561320932043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Petros D Karkos
- Department of Otolaryngology, 37788AHEPA University Hospital, Thessaloniki, Greece
| | - Ioannis Koskinas
- Department of Otolaryngology, 37788AHEPA University Hospital, Thessaloniki, Greece
| | - Marios Stavrakas
- Department of Otolaryngology, 37788AHEPA University Hospital, Thessaloniki, Greece
| | - Stefanos Triaridis
- Department of Otolaryngology, 37788AHEPA University Hospital, Thessaloniki, Greece
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Elicin O, Giger R. Comparison of Current Surgical and Non-Surgical Treatment Strategies for Early and Locally Advanced Stage Glottic Laryngeal Cancer and Their Outcome. Cancers (Basel) 2020; 12:cancers12030732. [PMID: 32244899 PMCID: PMC7140062 DOI: 10.3390/cancers12030732] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
For the treatment of early and locally advanced glottic laryngeal cancer, multiple strategies are available. These are pursued and supported by different levels of evidence, but also by national and institutional traditions. The purpose of this review article is to compare and discuss the current evidence supporting different loco-regional treatment approaches in early and locally advanced glottic laryngeal cancer. The focus is kept on randomized controlled trials, meta-analyses, and comparative retrospective studies including the treatment period within the last twenty years (≥ 1999) with at least one reported five-year oncologic and/or functional outcome measure. Based on the equipoise in oncologic and functional outcome after transoral laser surgery and radiotherapy, informed and shared decision-making with and not just about the patient poses a paramount importance for T1-2N0M0 glottic laryngeal cancer. For T3-4aN0-3M0 glottic laryngeal cancer, there is an equipoise regarding the partial/total laryngectomy and non-surgical modalities for T3 glottic laryngeal cancer. Patients with extensive and/or poorly functioning T4a laryngeal cancer should not be offered organ-preserving chemoradiotherapy with salvage surgery as a back-up plan, but total laryngectomy and adjuvant (chemo) radiation. The lack of high-level evidence comparing contemporary open or transoral robotic organ-preserving surgical and non-surgical modalities does not allow any concrete conclusions in terms of oncological and functional outcome. Unnecessary tri-modality treatments should be avoided. Instead of offering one-size-fits-all approaches and over-standardized rigid institutional strategies, patient-centered informed and shared decision-making should be favored.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland;
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
- Correspondence:
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Advantages of Transoral Endoscopic Diode Laser Microsurgery for the Treatment of Early-Stage Glottic Laryngeal Cancers. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.97928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mihashi R, Chitose SI, Sato F, Tanaka H, Sato K, Ono T, Fukahori M, Sueyoshi S, Kurita T, Sato K, Umeno H. Endoscopic Sealing With a Polyglycolic Acid Sheet for Restoration of Vocal Fold Mucosa in Dogs. Laryngoscope 2019; 130:E436-E443. [PMID: 31693183 DOI: 10.1002/lary.28357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/23/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Voice outcomes of cordectomy for early glottic cancer are often poor due to vocal fold scarring and tissue defects. Improvements in this aspect could make cordectomy a more acceptable treatment option than radiotherapy. We hypothesized that a polyglycolic acid (PGA) sheet could be used to cover vocal fold defects. The present study aimed to prevent vocal fold scarring after cordectomy using the PGA sheet. STUDY DESIGN Animal experiment. METHODS Nine male beagles were divided into three groups including a control group (n = 3). Following cordectomy, the vocal fold defect was covered with the PGA sheet plus fibrin glue (PGA group; n = 3) or with the PGA sheet plus fibrin glue containing basic fibroblast growth factor (bFGF; the PGA-bFGF group, n = 3). Vocal folds were chronologically observed, and larynges were removed 6 months after surgery. Mucosal amplitude was measured using a high-speed camera, and histological analysis was performed. RESULTS The re-epithelialization process was delayed in the PGA and PGA-bFGF groups compared with the control group. The mucosal amplitude was significantly more normalized and the thickness ratio significantly higher in the PGA and PGA-bFGF groups compared with the control group. The PGA-bFGF group had the highest elastic fiber density, followed by the PGA group and then the control group, with a significant difference between the PGA-bFGF and control groups. CONCLUSIONS The PGA sheet plus fibrin glue could serve as an effective regenerative scaffold for reconstructing vocal fold morphology and function after cordectomy, with the potential benefit of establishing an endoscopic sealing method for vocal fold defects. LEVEL OF EVIDENCE NA Laryngoscope, 130:E436-E443, 2020.
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Affiliation(s)
- Ryota Mihashi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shun-Ichi Chitose
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Fumihiko Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hisaichiro Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiminori Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Mioko Fukahori
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shintaro Sueyoshi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takashi Kurita
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiminobu Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohito Umeno
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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CO 2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review. MEDICINES 2019; 6:medicines6030077. [PMID: 31336581 PMCID: PMC6789531 DOI: 10.3390/medicines6030077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Abstract
Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis–T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique.
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Salas-Salas BG, Domínguez-Nuez DJ, Cabrera R, Ferrera-Alayón L, Lloret M, Lara PC. Hypofractionation vs. conventional radiotherapy fractionation in the conservative treatment of T1 glottic cancer: a prospective cohort study. Clin Transl Oncol 2019; 22:151-157. [DOI: 10.1007/s12094-019-02118-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
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9
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Şencan Z, Cömert E, Tunçel Ü, Kılıç C. Voice and Quality-of-Life Outcomes of Diode Laser for Tis-T1a Glottic Cancer. EAR, NOSE & THROAT JOURNAL 2019; 99:229-234. [PMID: 31012346 DOI: 10.1177/0145561319839868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Ziya Şencan
- Department of Otolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Ela Cömert
- Department of Otolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Ümit Tunçel
- Ankara Oncology Education and Research Hospital, Clinic of Otolaryngology, Ankara, Turkey
| | - Caner Kılıç
- Ankara Oncology Education and Research Hospital, Clinic of Otolaryngology, Ankara, Turkey
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Effects of diode laser setting for laryngeal surgery in a rabbit model. Eur Arch Otorhinolaryngol 2019; 276:1431-1438. [DOI: 10.1007/s00405-019-05344-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
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Jacobi C, Freundorfer R, Reiter M. Transoral laser microsurgery in early glottic cancer involving the anterior commissure. Eur Arch Otorhinolaryngol 2019; 276:837-845. [DOI: 10.1007/s00405-018-5261-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
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12
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Oncological Outcomes Following Transoral CO 2 Laser Microsurgery for T1 Glottic Cancer. Indian J Otolaryngol Head Neck Surg 2018; 71:542-547. [PMID: 31742018 DOI: 10.1007/s12070-018-1394-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022] Open
Abstract
The objective of this study is to analyze oncological outcomes for treatment of Tis and T1 glottic squamous cell carcinoma after transoral laser microsurgery. This study is retrospective analysis of previously untreated, suspected lesion of glottis, staged cT1a and cT1b squamous cell carcinoma in a tertiary care hospital and 53 patients were included in the study. End points for analysis were local control, overall and disease specific survival rates. The local control, ultimate local control with laser alone, 3-year overall survival, 3-year disease specific survival and organ preservation rates were 86.7, 90.5, 92.4, 98.1 and 98.1% respectively. The involvement of anterior commissure did not show any significant impact on local control or survival. TLM is safe and effective treatment of early glottis cancer, associated with less morbidity and a high percentage of local control, survival and organ preservation rates.
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Huang G, Luo M, Zhang J, Liu H. The voice quality after laser surgery versus radiotherapy of T1a glottic carcinoma: systematic review and meta-analysis. Onco Targets Ther 2017; 10:2403-2410. [PMID: 28496338 PMCID: PMC5422574 DOI: 10.2147/ott.s137210] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objectives The voice quality assessment of laser surgery (LS) in comparison with radiotherapy (RT) remains uncertain in T1a glottic carcinoma treatment. This systematic review and meta-analysis were conducted to compare the voice quality of the two treatments. Methods Searches were conducted in PubMed, EMBASE, and Cochrane with the following index words: glotti*, layn*, vocal cord, vocal, surgery, cordectomy, laser, radiation, irradiation, radiotherapy, cancer, and carcinoma for relative studies that compared the voice quality between LS and RT. Random-effect models were used, and heterogeneity was assessed. Results A total of 14 studies were included in the analysis, consisting of 1 randomized controlled trial, 1 prospective study, and 12 retrospective studies. RT has increased the maximum phonation time (MPT; mean difference [MD] =−1.89, 95% confidence interval [CI] =−3.66 to −0.11, P=0.04) and decreased the fundamental frequency (MD =14.06, 95% CI =10.30–17.83, P<0.00001) in comparison with LS. No statistical difference was observed between the two groups in terms of Voice Handicap Index, Jitter, Shimmer, and airflow rate. Conclusion RT may be a better choice for T1a glottic carcinoma treatment compared with LS because patients undergoing RT may have the advantage of increased MPT and decreased fundamental frequency. However, more multicenter, randomized, controlled trials are urgently needed to verify these differences.
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Affiliation(s)
| | - Mengsi Luo
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | | | - Hongbing Liu
- Department of Otolaryngology - Head and Neck Surgery
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Abstract
PURPOSE OF REVIEW To give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature. RECENT FINDINGS The indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future. SUMMARY TLM for early glottic carcinoma (Tis-T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.
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Affiliation(s)
- E V Sjögren
- Department of ENT and Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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15
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Warner L, Lee K, Homer JJ. Transoral laser microsurgery versus radiotherapy for T2 glottic squamous cell carcinoma: a systematic review of local control outcomes. Clin Otolaryngol 2016; 42:629-636. [PMID: 27863075 DOI: 10.1111/coa.12790] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systematic reviews comparing treatment of early glottic cancer with transoral surgery or radiotherapy demonstrate similar oncological outcomes. Most studies of 'early-stage' laryngeal cancer include Tis, T1a, T1b and T2 cases. The data are dominated by patients with T1 and Tis tumours, although extrapolating these results and applying them for T2 cases may be inappropriate. No previous systematic reviews have focused on T2 cancers as a separate group. OBJECTIVE OF REVIEW This review compares local control outcomes for T2 glottic squamous cell carcinoma, treated with transoral microsurgery or external beam radiotherapy. TYPE OF REVIEW This is a systematic review of case series and comparison studies, focusing on oncological outcomes. SEARCH STRATEGY Independent searches of MEDLINE, EMBASE and the Cochrane Database were conducted by two authors, using the search terms: laryngeal/glottic/vocal cord combined with carcinoma/cancer/tumour and laser/microsurgery or radiotherapy. Studies of adult patients treated for primary T2N0 glottic squamous cell carcinoma (SCC) with laser surgery or curative radiotherapy were included. EVALUATION METHOD Full text of studies satisfying the inclusion criteria were reviewed with extraction of local control and survival data and laryngeal preservation rates. The primary endpoint is local control at 5 years. RESULTS Initial searches identified 3252 studies. Following full-text review of 183 papers, 59 studies met the inclusion criteria, all level IV evidence. A total of 48 studies specified 5-year local control for 1156 patients treated with transoral laser surgery and 3191 patients treated with radiotherapy. Weighted averages of local control at 5 years demonstrated similar results: 75.81% for radiotherapy versus 77.26% for transoral laser surgery. CONCLUSIONS The results of this review indicate no difference in 5-year local control between radiotherapy and transoral surgery for T2 glottic SCC. The data demonstrated higher rates of local failure for T2b compared with T2a cases, although outcomes were similar between laser excision and radiotherapy for each substage. Further research focusing upon functional outcomes for T2 glottic tumours is imperative to guide decision-making, ideally with subgroup analysis of T2a and T2b cases.
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Affiliation(s)
- L Warner
- Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Manchester Head and Neck Centre, Manchester Royal Infirmary, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - K Lee
- Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Manchester Head and Neck Centre, Manchester Royal Infirmary, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - J J Homer
- Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Manchester Head and Neck Centre, Manchester Royal Infirmary, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
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16
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Arroyo HH, Neri L, Fussuma CY, Imamura R. Diode Laser for Laryngeal Surgery: a Systematic Review. Int Arch Otorhinolaryngol 2016; 20:172-9. [PMID: 27096024 PMCID: PMC4835333 DOI: 10.1055/s-0036-1579741] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/11/2015] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- Helena Hotz Arroyo
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Neri
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Carina Yuri Fussuma
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Rui Imamura
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
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17
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Hoffmann C, Cornu N, Hans S, Sadoughi B, Badoual C, Brasnu D. Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy. Laryngoscope 2015; 126:1817-22. [DOI: 10.1002/lary.25757] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/16/2015] [Accepted: 10/02/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Babak Sadoughi
- The Sean Parker Institute for the Voice; Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
| | - Cécile Badoual
- Department of Pathology; Hôpital Européen Georges Pompidou; Paris France
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18
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Hoffmann C, Hans S, Sadoughi B, Brasnu D. Identifying outcome predictors of transoral laser cordectomy for early glottic cancer. Head Neck 2015; 38 Suppl 1:E406-11. [DOI: 10.1002/hed.24007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Caroline Hoffmann
- Department of Otolaryngology-Head and Neck Surgery; Hôpital Européen Georges Pompidou; Paris France
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery; Hôpital Européen Georges Pompidou; Paris France
| | - Babak Sadoughi
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Beth Israel; New York NY
| | - Daniel Brasnu
- Department of Otolaryngology-Head and Neck Surgery; Hôpital Européen Georges Pompidou; Paris France
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19
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Mau T, Palaparthi A, Riede T, Titze IR. Effect of resection depth of early glottic cancer on vocal outcome: an optimized finite element simulation. Laryngoscope 2015; 125:1892-9. [PMID: 26010240 DOI: 10.1002/lary.25267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To test the hypothesis that subligamental cordectomy produces superior acoustic outcome than subepithelial cordectomy for early (T1-2) glottic cancer that requires complete removal of the superficial lamina propria but does not involve the vocal ligament. STUDY DESIGN Computer simulation. METHODS A computational tool for vocal fold surgical planning and simulation (the National Center for Voice and Speech Phonosurgery Optimizer-Simulator) was used to evaluate the acoustic output of alternative vocal fold morphologies. Four morphologies were simulated: normal, subepithelial cordectomy, subligamental cordectomy, and transligamental cordectomy (partial ligament resection). The primary outcome measure was the range of fundamental frequency (F0 ) and sound pressure level (SPL). A more restricted F0 -SPL range was considered less favorable because of reduced acoustic possibilities given the same range of driving subglottic pressure and identical vocal fold posturing. RESULTS Subligamental cordectomy generated solutions covering an F0 -SPL range 82% of normal for a rectangular vocal fold. In contrast, transligamental and subepithelial cordectomies produced significantly smaller F0 -SPL ranges, 57% and 19% of normal, respectively. CONCLUSION This study illustrates the use of the Phonosurgery Optimizer-Simulator to test a specific hypothesis regarding the merits of two surgical alternatives. These simulation results provide theoretical support for vocal ligament excision with maximum muscle preservation when superficial lamina propria resection is necessary but the vocal ligament can be spared on oncological grounds. The resection of more tissue may paradoxically allow the eventual recovery of a better speaking voice, assuming glottal width is restored. Application of this conclusion to surgical practice will require confirmatory clinical data. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anil Palaparthi
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah
| | - Tobias Riede
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah.,Department of Physiology, Midwestern University, Glendale, Arizona
| | - Ingo R Titze
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa, U.S.A
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