Abstract
ObjectiveTo assess the oncological and functional outcomes of T1b squamous cell carcinoma (SCC) of the glottic larynx treated with laser in comparison with radiation.DesignA Canadian multicenter cohort study.SettingThree tertiary referral centers for head and neck cancer- Dalhousie University in Halifax, Nova Scotia, Western University in London, Ontario and the University of Manitoba, Winnipeg.MethodsPatients with T1b glottic SCC who underwent transoral laser resection or radiation as the primary modality of treatment.Outcome measuresOncological outcomes were evaluated using local control, laryngeal preservation, disease free survival and disease specific survival. Voice outcomes were assessed using the Voice Handicap Index-10 (VHI-10).Results63 patients met study criteria. 21 were treated with laser and 42 with radiation. Oncologic outcomes at 2 years for laser and radiation demonstrated local control of 95% and 85.9%; laryngeal preservation of 100% and 85.9%; disease free survival of 88.7% and 85.9% and overall survival of 94.1% and 94.8% respectively. VHI-10 data was available for 23/63 patients. During the last follow up visit VHI-10 ranged from 0 to 11 (median 6) in the laser group and 0 to 34 (median 7) in the radiation group.ConclusionT1b SCC of the glottis can be effectively treated with transoral laser microsurgery with oncological outcomes that are at least equivalent to radiation. For patients with VHI scores, voice quality was similar between the two groups. To our knowledge this is the first study directly comparing the oncologic and voice outcomes with laser and radiation for the treatment of glottic cancer involving the anterior commissure.
Highlights
The last decade has seen a significant change in the management of laryngeal cancer
T1b squamous cell carcinoma (SCC) of the glottis can be effectively treated with transoral laser microsurgery with oncological outcomes that are at least equivalent to radiation
Many believe that voice outcome after resection of the anterior commissure with laser is worse than treating with radiation
Summary
The last decade has seen a significant change in the management of laryngeal cancer. In the past, early laryngeal cancers have traditionally been treated with radiation or open partial laryngeal surgery. Transoral laser microsurgery for early stage glottic cancer was originally described by Strong and Jako in 1972 [1]. This was further popularized by Steiner [2]. Anterior commissure involvement is seen in about 20% of all glottic tumours and is generally associated with worse outcomes [4]. Many believe that voice outcome after resection of the anterior commissure with laser is worse than treating with radiation. Uncertainty regarding the voice outcomes and the difficulty in gaining access to the anterior commissure are factors that prevent some surgeons from attempting laser resection of these lesions. We assessed the oncological and voice outcomes after laser resection and radiation of tumours involving this very complex area
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