Abstract
Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas. Early supraglottic carcinoma has excellent outcomes independently of the treatment approach. The role of TLM for the treatment of locally advanced tumors is debated. Particularly, the functional outcomes after TLM have to be proven by functional assessment of large cohorts of patients. This study analyzes the oncologic and functional outcomes after TLM for supraglottic carcinomas. Ninety-one patients with pT1-pT4a supraglottic carcinomas treated between January 2002 and December 2012 were analyzed. Distribution of tumors (UICC 2010) was 11 patients with pT1, 31 patients with pT2, 36 patients with pT3, and 13 patients with pT4a tumors. Node status was positive in 40 (43.6%) patients; 61 (67.1%) patients had stage III or IVa disease. Local control and survival were estimated using the Kaplan-Meier method. For the assessment of functional outcomes, the MD Anderson Dysphagia Inventory (MDADI), the Voice Handicap Index-10 (VHI-10), and the performance status scale for head and neck cancer [Performance Status Scale for Head and Neck (PSS-HN)] were used. The median age was 62 years (range, 33-88 years). Fourteen (15.4%) patients developed a local or locoregional recurrence. The 5-year local control rate and 5-year ultimate local control rate were 72 and 92%, respectively. The 5-year overall survival rate was 63%. Twelve (13.2%) patients needed temporary tracheostomy. Sixty-eight (74.0%) patients had a nasogastric feeding tube post-operatively. At 1-year post-operative follow-up, only three patients were PEG dependent. The median VHI-10 score was 35, the median MDADI composite score was 80, and the median score of the domain "normalcy of diet" in the PSS-HN was 91. The oncologic outcomes are comparable to the results of open surgery for early and advanced supraglottic carcinomas. Functional swallowing outcome is superior to open surgery and to concomitant chemoradiation. Patients treated with TLM perceive low levels of voice- and swallowing-related quality of life impairment.
Highlights
Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas
There is consensus that early supraglottic carcinomas can be effectively treated by open-neck supraglottic laryngectomy (SGL), transoral laser microsurgery (TLM), and radiotherapy (RT)
The aim of this study is to present the oncologic and functional treatment results of TLM combined with selective neck dissection and adjuvantradiotherapy for early and locally advanced supraglottic carcinomas
Summary
Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas. A recent meta-analysis of key oncological outcomes following TLM or open-neck conservation surgery for advanced T3–T4 laryngeal cancer confirmed both techniques as valid surgical options for larynx preservation [15]. Recent studies have suggested that late toxicities are likely to contribute to high numbers of tumor-unrelated deaths years after treatment [17, 19] Another worrisome observation is that US cancer registry studies have shown that the increasing use of non-surgical larynx pre servation strategies is accompanied by decreasing survival for patients with laryngeal cancer [20, 21]. The aim of this study is to present the oncologic and functional treatment results of TLM combined with selective neck dissection and adjuvant (chemo-)radiotherapy for early and locally advanced supraglottic carcinomas. The results are compared with results obtained with open-neck partial laryngeal resection and non-surgical larynx preservation with concurrent chemoradiotherapy
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