Abstract
Transoral laser microsurgery (TLM) is a minimally invasive surgical alternative for radiotherapy (RT) in the primary management of early glottic cancer. More recently, TLM emerged also as a possible salvage treatment for selected radiorecurrent cancers. We reviewed outcomes of primary and salvage TLM performed in a Belgian tertiary referral center. A retrospective review of records from 142 consecutive patients who underwent TLM was performed. Oncologic outcomes were evaluated by means of descriptive statistics and Kaplan-Meier estimates. Variation of estimated outcomes between different subgroups was evaluated using Log-Rank analysis. Of 142 patients, 109 (76.8%) underwent TLM as a primary treatment and 33 (23.2%) were treated in a salvage setting for recurrent or second primary glottic cancer. cT classification in the up-front TLM group was cT1a in 72 (66.1%), cT1b in 11 (10.1%), and cT2 in 26 (23.9%) patients. In the salvage group, patients were cT/rT classified as cT1a-rT1a in 17 (51.5%), cT1b-rT1b in 1 (3.0%), cT2-rT2 in 14 (42.4%), and cT3-rT3 in 1 (3.0%) patients. All patients were cN0. Second-look TLM was performed in 28 patients (19.7%), and RT was associated as adjuvant therapy in 5 patients (3.5%). Mean follow-up was 51.6 months (SD = 38.4 months). Three-year overall survival (OS) was 94.1% (SE = 2.2%), 3-year disease-specific survival (DSS) 100%, 3-year disease-free survival (DFS) 80.1% (SE = 3.8%), 3-year local recurrence-free survival (RFS) 81.0% (SE = 3.7%), and 3-year ultimate local control rate with laser alone 89.2% (SE = 3.0%). Upon subgroup analysis, no differences in OS, DSS, and DFS were observed between the up-front and salvage group (log rank; p = 0.306, p = 0.298, and p = 0.061 respectively). However, local RFS and ultimate local control rate with laser alone were significantly higher in the primary treated TLM group (log rank, p = 0.014 and p = 0.012). Five-year laryngeal preservation rate was 89.7% (SE = 3.5%) in the total population, 100% in the upfront group, and 64.9% (SE = 9.8%) in the salvage group, a difference which proved statistically significant (Log-Rank, p < 0.001). This retrospective study confirms excellent oncologic outcomes of up-front TLM for early glottic cancer. In the salvage setting, TLM allows avoidance of total laryngectomy in the majority of cases.
Highlights
In the US and North-western European countries, early (T1–T2) glottic squamous cell carcinoma (SCC) has traditionally been treated most commonly with primary external beam radiotherapy (RT), yielding excellent functional and oncologic results
We review the outcomes of primary and salvage transoral laser microsurgery (TLM) performed in a Belgian tertiary referral center
No neck dissections were performed in accordance with current practice in treatment of early glottic SCC
Summary
In the US and North-western European countries, early (T1–T2) glottic squamous cell carcinoma (SCC) has traditionally been treated most commonly with primary external beam radiotherapy (RT), yielding excellent functional and oncologic results. Transection of the tumor reveals the depth of tumor invasion and allows for clear visualization of tumor margins, resecting the tumor with an adequate margin while leaving as much healthy tissue as possible, the anatomy of the organ being less disturbed as compared with open transcervical/translaryngeal approaches. This minimizes the adverse functional impact, while leaving all salvage options open, including (chemo)radiotherapy or radical surgery. We review the outcomes of primary and salvage TLM performed in a Belgian tertiary referral center
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