title: Salvage endoscopic angiolytic KTP laser treatment of early glottic cancer after failed radiotherapy.
abstract: OBJECTIVE
  Management of early glottic cancer subsequent to failed radiotherapy is challenging, especially in balancing oncological control and function preservation. Patients frequently have been incentivized against surgical management and thus have undergone radiotherapy as initial treatment. This history compounds the difficulty of discussions about surgical management after recurrence. Typically, endoscopic salvage has less morbidity than transcervical partial laryngectomy and is clearly desirable over total laryngectomy. However, there are appropriate concerns about the efficacy of endoscopic salvage and the overarching impact on larynx preservation and survival. Given our success with endoscopic angiolytic KTP laser treatment of previously nonirradiated T1 and T2 glottic cancers, we examined our results from treating similar-sized lesions after failed radiotherapy.
  
  
  METHODS
  We performed a retrospective chart review of 20 patients from our cancer database who had undergone failed radiation therapy elsewhere for early glottic cancer and then underwent endoscopic angiolytic KTP laser treatment.
  
  
  RESULTS
  Analysis of the geographic tumor recurrence of the 20 patients revealed T1a N0 M0 cancer in 4 patients, T1b N0 M0 cancer in 1 patient, T2a N0 M0 cancer in 1 patient, and T2b N0 M0 cancer in 14 patients. After KTP laser salvage treatment, 4 patients (20%) had local recurrence (all T2b) and required subsequent total laryngectomy, and 3 of these patients (15%) ultimately died of disease. The remaining 16 patients (80%) were free of disease at least 2 years after endoscopic salvage (average follow-up, 39 months).
  
  
  CONCLUSIONS
  Our investigation provides preliminary evidence that angiolytic KTP laser salvage treatment of early glottic cancer is an effective treatment after failed irradiation. Studies with larger cohorts and longer follow-up will be necessary to establish incontrovertible evidence of its efficacy.
authors.affiliation: Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anca M
authors.initials: AM
authors.lastname: Barbu
authors.forename: James A
authors.initials: JA
authors.lastname: Burns
authors.forename: Gerardo
authors.initials: G
authors.lastname: Lopez-Guerra
authors.forename: Tali
authors.initials: T
authors.lastname: Landau-Zemer
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Friedman
authors.forename: Steven M
authors.initials: SM
authors.lastname: Zeitels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000098:blood supply / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000098:blood supply / Q000532:radiotherapy / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome