title: Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes.
abstract: Although vocal fold (VF) leukoplakia is commonly treated with in-office laser, there is no data on its long-term effectiveness. This study hypothesizes that VF leukoplakia treated by serial in-office laser results in long-term disease control with maintenance of voice and minimal morbidity.
  
  
  
  Retrospective review (2008-2015).
  
  
  
  Forty-six patients with VF leukoplakia treated by in-office KTP (potassium titanyl phosphate) or PDL (pulsed dye laser) were included. Median follow-up from final laser treatment was 19.6 months. Main outcomes included: 1) rate of disease control, 2) percentage of disease regression using ImageJ analysis. Secondary outcomes included vocal assessment using the Voice Handicap Index-10 (VHI-10).
  
  
  
  Patients underwent a median of 2 (range: 1-6) in-office laser treatments. Time between treatments was median 7.6 months. After final treatment, 19 patients (41.3%) had no disease; two patients (4.3%) progressed to invasive cancer; overall disease regression was median 77.1% (P < 0.001); and VHI-10 score decreased by median 5 (P = 0.037). Thirty-one patients (67.4%) were responders (controlled with in-office treatment only); failures were 13 patients (28.3%) who required operative intervention and two patients (4%) who underwent radiation. Compared to responders, failures demonstrated significantly shorter duration between treatments (median 2.3 vs. 8.9 months, P = 0.038) and significantly less regression (median 49.3% vs. 100%, P = 0.006).
  
  
  
  Serial outpatient KTP or PDL treatment of VF leukoplakia is effective for disease control with minimal morbidity and preservation of voice quality. We suggest that patients requiring repeated in-office treatment every 6 months may benefit from earlier operative intervention; other factors associated with in-office success remain unclear.
  
  
  
  4. Laryngoscope, 127:1644-1651, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai.
authors.forename: Shira L
authors.initials: SL
authors.lastname: Koss
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center.
authors.forename: Peter
authors.initials: P
authors.lastname: Baxter
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center.
authors.forename: Haig
authors.initials: H
authors.lastname: Panossian
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center.
authors.forename: Peak
authors.initials: P
authors.lastname: Woo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center, New York, New York, U.S.A.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pitman
mesh_terms: D000368:Aged; D000465:Algorithms; D000556:Ambulatory Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D053685:Laser Therapy; D054025:Lasers, Dye / Q000627:therapeutic use*; D007971:Leukoplakia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D014827:Vocal Cords / Q000601:surgery*
keywords: KTP; in-office laser; vocal fold leukoplakia