title: Transoral laser microsurgery for recurrence after primary radiotherapy of early glottic cancer.
abstract: OBJECTIVE
  To analyze oncological results of transoral laser microsurgery (TLM) on recurrent early glottic cancer after primary radiotherapy.
  
  
  METHODS
  The records of 53 patients treated by TLM for early (rTis-rT2) and advanced (rT3, rT4) recurrence after curative radiotherapy were retrospectively analyzed. Data on loco-regional control, overall survival, and disease specific survival were calculated by the Kaplan-Meier method. The larynx preservation rates were given absolutely.
  
  
  RESULTS
  Mean post-therapeutic follow-up time after TLM for patients alive was 87.9 months. Twenty-two patients (42%) were cured by the first TLM procedure, but one of them underwent total laryngectomy after TLM due to chondronecrosis without evidence of residual tumor. Thirty-one patients (58%) developed another recurrence after TLM. Ten of them were cured by further laser procedures alone. Therefore, in 31 patients (58%), local recurrences were successfully treated by TLM alone. In 20 patients, recurrences could not be controlled by TLM: 14 patients underwent salvage laryngectomy and six palliative treatment. Three- and five-year loco-regional control rates for all patients were 46.1 and 38.8%. Three- and five-year overall survival rates were 67.5 and 53.3%. The corresponding 3- and 5-year disease specific survival rates were 68.6%, each. There was no statistically significant difference in loco-regional control or survival between patients presenting initially with early and advanced recurrence. Further recurrence after the first TLM procedure was associated with a statistically significant decrease in 3- and 5-year overall (56.6% vs. 81.8% and 40.2% vs. 70.5%; p=0.03) and disease specific (48.9% vs. 100%, each; p=0.001) survival. Ultimate local control rate including repeated TLM and salvage laryngectomy was 77.4%.
  
  
  CONCLUSIONS
  Many patients with recurrent glottic carcinoma after primary radiotherapy can be cured by single or repeated TLM as an organ-preserving procedure. However, in case of failure after TLM for the first recurrence, salvage laryngectomy should be considered early as local control by further laser surgery is unfavorable.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, 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: Phillip
authors.initials: P
authors.lastname: Schindler
authors.forename: Tomas
authors.initials: T
authors.lastname: Aydin
authors.forename: Hans
authors.initials: H
authors.lastname: Christiansen
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005931:Glottis / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D009055:Mouth; D009336:Necrosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D011878:Radiotherapy / Q000009:adverse effects; D016879:Salvage Therapy / Q000379:methods