HN05 ADVANCES IN THE MANAGEMENT OF LARYNGEAL DYSPLASIA AND CARCINOMA IN‐SITU

   Pre‐cancerous lesions of the larynx are common and can progress to invasive carcinoma. Such lesions, usually of the true vocal folds, may then require surgical resection or irradiation with subsequent morbidity of treatment. There is currently no gold standard treatment of glottal dysplasia. Instead, one adopts “watchful waiting” until intervention is deemed necessary at the point of malignant degeneration. Recently, evolving photoangiolytic laser techniques utilizing the pulsed potassium‐titanyl‐phosphate (KTP) laser have provided a successful treatment modality in place of “watchful waiting” minimizing progression to invasive carcinoma. Methods:   The treatment process and outcome in 4 months of consecutive patients with dysplasia/carcinoma in‐situ was studied. Videophotographic analysis was performed at presentation, during treatments and with follow‐up. Acoustic voice measurements were conducted. Patient treatment consisted of operating theatre and office‐based pulsed‐KTP laser photoangiolysis to involute the disease. The end point was percentage of macroscopic disease regression. Results:   Five patients underwent initial office assessment, 1–2 operating theatre treatments and 1–2 office‐based treatments depending on disease response. All patients showed complete or near‐complete involution of dysplasia/CIS and the underlying pliability was preserved or improved. Since the institution of this treatment in Australia 6 months ago, no patient has progressed to invasive cancer. Discussion:   Pulsed‐KTP photoangiolysis provides a new approach to manage pre‐malignant lesions of the true vocal folds. This enables the trained surgeon to adopt cancer prevention in place of currently practiced watchful waiting.