Local recurrence after CO2 laser cordectomy for early glottic carcinoma.
OBJECTIVE
To point out prognosis factors of local recurrence after endoscopic cordectomies for Tis, T1a, T1b, and T2 glottic squamous cell carcinomas.


METHODS
A cohort of 110 patients treated from January 1990 to December 2000 at a single institution was retrospectively analyzed: 21 had Tis, 76 T1a, 7 T1b, and 6 T2 (mean follow-up 42 mo; range 1-160 mo).


METHODS
The depth and extension of the excision were graded according to the European Laryngological Society Classification. Univariate analysis was used to review the impact on disease-free survival of factors related to the host, the tumor, and the treatment.


RESULTS
According to the Kaplan-Meier method, the 5 year overall survival and the disease-free survival were 87% and 75%, respectively. The rates of cause-specific survival, ultimate local control with laser alone, and laryngeal preservation were 97%, 84%, and 90%, respectively. Univariate analysis by the log rank test revealed that vocal muscle infiltration (P = .001) and subglottic involvement (P = .02) have a significant impact on disease-free survival. Of the 22 patients with local recurrence (17 T1a, 1 T1b, and 4 T2), 9 were managed with total laryngectomy, 5 with partial laryngectomy, 4 with further laser cordectomy, 2 with radiotherapy, and 2 had no curative treatment.


CONCLUSIONS
Transoral laser surgery for early glottic carcinoma is a valid alternative to radiotherapy and partial laryngectomy in terms of oncologic results. It offers low morbidity and excellent retreatment options in case of local failure. Careful patient selection for laser surgery is essential to secure good results.
Mortuaire
G
G
Department of Otorhinolaryngology and Head and Neck Surgery, Huriez Hospital, University of Lille, Lille, France. mortuaire.g@club-internet.fr
Francois
J
J
Wiel
E
E
Chevalier
D
D
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005931:Glottis / Q000473:pathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014827:Vocal Cords / Q000473:pathology / Q000601:surgery*
D002245:Carbon Dioxide