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 journalArticlepeer-review

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

ASJC Scopus subject areas

  • Otorhinolaryngology

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