Endoscopic carbon dioxide laser surgery for glottic cancer recurrence after radiotherapy: oncological results.
OBJECTIVE
To evaluate local control, organ preservation, and complications after endoscopic laser surgery for early recurrent glottic cancer after radiotherapy.


METHODS
Retrospective study.


METHODS
European Institute of Oncology, Milan, Italy.


METHODS
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.


METHODS
Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association.


METHODS
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.
Ansarin
Mohssen
M
Division of Head and Neck Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milano, Italy. mohssen.ansarin@ieo.it
Planicka
Marek
M
Rotundo
Silvana
S
Santoro
Luigi
L
Zurlo
Valeria
V
Maffini
Fausto
F
Alterio
Daniela
D
Cattaneo
Augusto
A
Chiesa
Fausto
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate