Abstract
Transoral laser microsurgery (TLM) was pioneered in the early 1970s as an approach to treat laryngeal pathology with precision and minimal thermal damage to the vocal cords. Over the last four decades, TLM has become an integral part of the treatment paradigm for patients with laryngeal cancer. TLM is one of the primary treatment options for early-stage laryngeal tumors. However, in recent years, surgeons have begun to develop TLM into a more versatile approach which can be used to address advanced laryngeal tumors. Although functional outcomes following TLM for advanced laryngeal disease are scarce, survival outcomes appear to be comparable with those reported for organ preservation strategies employing external beam radiation therapy (EBRT) and chemotherapy. In addition, TLM plays an important role in the setting of recurrent laryngeal cancer following primary irradiation. TLM has been demonstrated to decrease the need for salvage total laryngectomy resulting in improved functionality while retaining comparable oncologic outcomes. The aim of this review is to elucidate the indications, techniques, and oncological outcomes of TLM for advanced laryngeal cancers.
Highlights
CLINICAL OUTCOMES FOR TLMLaryngeal Cancers Transoral laser microsurgery (TLM) represents an important tool in the management of laryngeal tumors and is commonly utilized in the treatment of early-stage disease
Transoral laser microsurgery (TLM) was pioneered in the early 1970s as an approach to treat laryngeal pathology with precision and minimal thermal damage to the vocal cords
This is in part driven by the propensity of laryngeal squamous cell carcinoma (SCC) to develop through a field cancerization phenomenon driven by generalized exposure to conventional carcinogens.[33]
Summary
Laryngeal Cancers Transoral laser microsurgery (TLM) represents an important tool in the management of laryngeal tumors and is commonly utilized in the treatment of early-stage disease. One current point of debate among physicians treating laryngeal tumors is whether TLM can offer similar clinical outcomes compared to organ preservation treatment consisting of external beam radiation therapy (EBRT).[14,15,16,17,18] Feng et al conducted a large meta-analysis comparing outcomes and costs associated with treatment of T1–T2 glottic cancers in 2011.16 Their analysis included 11 studies and 1,135 patients and demonstrated no significant difference in cure rates between TLM and EBRT. Based on the current literature, it is clear that TLM is increasingly becoming part of the treatment paradigm for laryngeal tumors throughout the world and represents an alternative to definitive EBRT that offers equivalent local control and functional outcomes
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