Endoscopic carbon dioxide laser surgery for glottic cancer recurrence after radiotherapy: Oncological results

Mohssen Ansarin, Marek Planicka, Silvana Rotundo, Luigi Santoro, Valeria Zurlo, Fausto Maffini, Daniela Alterio, Augusto Cattaneo, Fausto Chiesa

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate local control, organ preservation, and complications after endoscopic laser surgery for early recurrent glottic cancer after radiotherapy. Design: Retrospective study. Setting: European Institute of Oncology, Milan, Italy. Patients: The study, which was conducted between May 1999 and September 2005, included 37 consecutive patients (33 men and 4 women) with recurrent glottic cancer after radiotherapy. Selection criteria were as follows: rcTis, rcT1, or rcT2 with subglottic or supraglottic involvement of less than 5 mm and no arytenoid invasion; adequate laryngeal exposure; no previous open surgery; no contraindications to general anesthesia; and signed consent. Interventions: Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association. Main Outcome Measures: Five-year actuarial recurrence-free and overall survival, complications, and rate of laryngeal preservation. Results: The clinical classifications of the recurrences were rcTis (n=4), rcT1a (n=10), rcT1b (n=11), and rcT2 (n=12). The pathologic classifications of the recurrences were rpT0 (n=2), rpTis (n=5), rpT1a (n=9), rpT1b (n=3), rpT2 (n=14), and rpT3 (n=4). The median follow-up was 44 months (range, 18-88 months). New recurrences developed in 13 patients (35%): 11 were treated by total laryngectomy, 1 by supracricoid laryngectomy, and 1 by chemotherapy. Three patients died of laryngeal cancer, 1 is alive with disease, and 1 died of a second cancer. Five-year actuarial recurrence-free and overall survival rates were 58% and 86%, respectively. The larynx was preserved in 26 patients (70%). Laryngeal stenosis was the most common major complication (in 3 of 4 women and 1 of 33 men). Conclusions: Endoscopic laser surgery is a safe and effective salvage procedure in selected cases involving glottic recurrence after radiotherapy. Oncological results are satisfactory, and organ preservation can be achieved in a high proportion of cases; however, the risk of laryngeal stenosis is high in women.

Original languageEnglish
Pages (from-to)1193-1197
Number of pages5
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume133
Issue number12
DOIs
Publication statusPublished - Dec 2007

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Tongue Neoplasms
Gas Lasers
Laser Therapy
Radiotherapy
Recurrence
Laryngostenosis
Organ Preservation
Laryngectomy
Survival Rate
Laryngeal Neoplasms
Second Primary Neoplasms
Larynx
Tongue
General Anesthesia
Patient Selection
Italy
Retrospective Studies
Outcome Assessment (Health Care)
Drug Therapy

ASJC Scopus subject areas

  • Otorhinolaryngology

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Endoscopic carbon dioxide laser surgery for glottic cancer recurrence after radiotherapy : Oncological results. / Ansarin, Mohssen; Planicka, Marek; Rotundo, Silvana; Santoro, Luigi; Zurlo, Valeria; Maffini, Fausto; Alterio, Daniela; Cattaneo, Augusto; Chiesa, Fausto.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 133, No. 12, 12.2007, p. 1193-1197.

Research output: Contribution to journalArticle

Ansarin, Mohssen ; Planicka, Marek ; Rotundo, Silvana ; Santoro, Luigi ; Zurlo, Valeria ; Maffini, Fausto ; Alterio, Daniela ; Cattaneo, Augusto ; Chiesa, Fausto. / Endoscopic carbon dioxide laser surgery for glottic cancer recurrence after radiotherapy : Oncological results. In: Archives of Otolaryngology - Head and Neck Surgery. 2007 ; Vol. 133, No. 12. pp. 1193-1197.
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abstract = "Objective: To evaluate local control, organ preservation, and complications after endoscopic laser surgery for early recurrent glottic cancer after radiotherapy. Design: Retrospective study. Setting: European Institute of Oncology, Milan, Italy. Patients: The study, which was conducted between May 1999 and September 2005, included 37 consecutive patients (33 men and 4 women) with recurrent glottic cancer after radiotherapy. Selection criteria were as follows: rcTis, rcT1, or rcT2 with subglottic or supraglottic involvement of less than 5 mm and no arytenoid invasion; adequate laryngeal exposure; no previous open surgery; no contraindications to general anesthesia; and signed consent. Interventions: Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association. Main Outcome Measures: Five-year actuarial recurrence-free and overall survival, complications, and rate of laryngeal preservation. Results: The clinical classifications of the recurrences were rcTis (n=4), rcT1a (n=10), rcT1b (n=11), and rcT2 (n=12). The pathologic classifications of the recurrences were rpT0 (n=2), rpTis (n=5), rpT1a (n=9), rpT1b (n=3), rpT2 (n=14), and rpT3 (n=4). The median follow-up was 44 months (range, 18-88 months). New recurrences developed in 13 patients (35{\%}): 11 were treated by total laryngectomy, 1 by supracricoid laryngectomy, and 1 by chemotherapy. Three patients died of laryngeal cancer, 1 is alive with disease, and 1 died of a second cancer. Five-year actuarial recurrence-free and overall survival rates were 58{\%} and 86{\%}, respectively. The larynx was preserved in 26 patients (70{\%}). Laryngeal stenosis was the most common major complication (in 3 of 4 women and 1 of 33 men). Conclusions: Endoscopic laser surgery is a safe and effective salvage procedure in selected cases involving glottic recurrence after radiotherapy. Oncological results are satisfactory, and organ preservation can be achieved in a high proportion of cases; however, the risk of laryngeal stenosis is high in women.",
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AU - Santoro, Luigi

AU - Zurlo, Valeria

AU - Maffini, Fausto

AU - Alterio, Daniela

AU - Cattaneo, Augusto

AU - Chiesa, Fausto

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N2 - Objective: To evaluate local control, organ preservation, and complications after endoscopic laser surgery for early recurrent glottic cancer after radiotherapy. Design: Retrospective study. Setting: European Institute of Oncology, Milan, Italy. Patients: The study, which was conducted between May 1999 and September 2005, included 37 consecutive patients (33 men and 4 women) with recurrent glottic cancer after radiotherapy. Selection criteria were as follows: rcTis, rcT1, or rcT2 with subglottic or supraglottic involvement of less than 5 mm and no arytenoid invasion; adequate laryngeal exposure; no previous open surgery; no contraindications to general anesthesia; and signed consent. Interventions: Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association. Main Outcome Measures: Five-year actuarial recurrence-free and overall survival, complications, and rate of laryngeal preservation. Results: The clinical classifications of the recurrences were rcTis (n=4), rcT1a (n=10), rcT1b (n=11), and rcT2 (n=12). The pathologic classifications of the recurrences were rpT0 (n=2), rpTis (n=5), rpT1a (n=9), rpT1b (n=3), rpT2 (n=14), and rpT3 (n=4). The median follow-up was 44 months (range, 18-88 months). New recurrences developed in 13 patients (35%): 11 were treated by total laryngectomy, 1 by supracricoid laryngectomy, and 1 by chemotherapy. Three patients died of laryngeal cancer, 1 is alive with disease, and 1 died of a second cancer. Five-year actuarial recurrence-free and overall survival rates were 58% and 86%, respectively. The larynx was preserved in 26 patients (70%). Laryngeal stenosis was the most common major complication (in 3 of 4 women and 1 of 33 men). Conclusions: Endoscopic laser surgery is a safe and effective salvage procedure in selected cases involving glottic recurrence after radiotherapy. Oncological results are satisfactory, and organ preservation can be achieved in a high proportion of cases; however, the risk of laryngeal stenosis is high in women.

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