title: Repeated transoral laser microsurgery for early and advanced recurrence of early glottic cancer after primary laser resection.
abstract: OBJECTIVE
  To analyze the oncological results of repeated transoral laser microresection (TLM) in case of failure after primary laser resection of early glottic cancer (pTis-pT2).
  
  
  METHODS
  Fifty-six patients with local or loco-regional recurrence of early glottic cancer were treated between 1988 and 2005 by repeated TLM followed, if necessary, by neck dissection and/or adjuvant radio- or radiochemotherapy. Data on overall survival, disease-specific survival, and loco-regional control rates were analyzed retrospectively and calculated by the Kaplan-Meier method.
  
  
  RESULTS
  Forty-four patients (78.6%) presented with early local recurrence (rTis-rT2N0; Stage I/II) and 12 patients (21.4%) had advanced local or loco-regional recurrence (pT3 and pT4N0/N+; Stage III/IV). Three- and five-year overall survival rates for patients with early and advanced recurrence were 75.1% vs. 51.6% and 61.6% vs. 25.8%, respectively. The corresponding three- and five-year disease-specific survival rates were 87.2% vs. 85.7% and 81.0% vs. 85.7%, respectively. Three- and five-year loco-regional control was significantly higher for patients treated for early recurrence (67.6% vs. 27.5% and 63.6% vs. 27.5%, respectively; p=0.02). Salvage laryngectomy rates for patients with early and advanced recurrence were 9.1 and 25.0%, respectively. In patients with early local recurrence, anterior commissure involvement (n=11) did not affect the oncological results.
  
  
  CONCLUSIONS
  In case of early local recurrence after primary TLM of early glottic cancer, further TLM seems to be justified as an organ-preserving treatment option. In contrast, salvage laryngectomy should be considered early for patients with advanced local or loco-regional recurrence.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Robert-Koch-Strasse 40, Göttingen, Germany. rroedel@med.uni-goettingen.de
authors.forename: Ralph M W
authors.initials: RM
authors.lastname: Roedel
authors.forename: Christoph
authors.initials: C
authors.lastname: Matthias
authors.forename: Hendrik A
authors.initials: HA
authors.lastname: Wolff
authors.forename: Hans
authors.initials: H
authors.lastname: Christiansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005931:Glottis / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D009055:Mouth; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate