Abstract
PurposeTo provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT].MethodsExpert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process.ResultsThe expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up.ConclusionManagement of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.
Highlights
Radiotherapy (RT) and chemoradiation (CRT) are wellestablished treatments for laryngeal squamous cell carcinoma (LSCC), with oncologic outcomes comparable with those obtained by surgery when appropriate patient selection has been accomplished
Recurrent lesions after RT originating from a primary tumor initially categorized as cT1 or cT2 without impairment of vocal fold mobility and/or anterior transcommissural extension can be considered for salvage C O2 TOLMS
Tumors initially categorized as cT2 with impaired vocal cord mobility, anterior transcommissural extension, cT3 for vocal cord/arytenoid fixation, or thyroid cartilage erosion, and failed after (C)RT should be considered suboptimal candidates for salvage CO2 TOLMS
Summary
Radiotherapy (RT) and chemoradiation (CRT) are wellestablished treatments for laryngeal squamous cell carcinoma (LSCC), with oncologic outcomes comparable with those obtained by surgery when appropriate patient selection has been accomplished. Open-neck conservative options are hampered by RT-induced tissue modifications that frequently lead to complications and unpredictable recurrence patterns, possibly reducing the rates of laryngeal preservation and disease control. This prevented their widespread acceptance and application, while different groups confirmed their effectiveness in very selected cases even in the rescue setting [9,10,11]. In most instances, total laryngectomy is still considered the standard salvage treatment for patients previously treated with (C) RT experiencing LSCC recurrence In such cases, ensuing complications and unavoidable functional sequelae (i.e., loss of physiologic phonation and swallowing impairment) almost invariably lead to a decreased quality of life
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