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Factors leading to the use of alternate treatment modalities following transoral laser excision of T1 and T2 glottic squamous cell carcinoma
Author(s) -
Pham Truong An,
De Freitas Ryan,
Sigston Elizabeth,
Vallance Neil
Publication year - 2012
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2012.06138.x
Subject(s) - medicine , treatment modality , basal cell , modalities , larynx , surgery , social science , sociology
Background CO 2 transoral laser surgery and radiotherapy are both recognized as acceptable treatments for early glottic squamous cell carcinoma ( SCC ) with similar rates of cure. The reasons why some of the patients in our series undergoing laser resection as their primary modality of treatment subsequently underwent radiotherapy or chemoradiotherapy will be discussed. Methods Retrospective study between J anuary 2003 and A ugust 2010 of all T1 and T2 glottic SCCs treated with laser resection at a major tertiary centre. T is lesions were excluded. A review of the cases in which primary control with laser resection was not achieved was undertaken. Failure was defined as patients treated initially with laser resection who subsequently received radiotherapy, combined chemoradiotherapy or open surgery for the same tumour. Factors leading to failure were analysed, including tumour location, histology, stage and patient factors. Results Thirty‐one patients were identified, with the majority (27) having T1 disease. Mean number of laser excisions per patient was 1.7. Local control rate was 71% with laser alone. One patient had nodal recurrence with no primary recurrence. Mean follow‐up was 32 months. Of the nine patients in whom local control was not achieved with laser alone, all had tumour at or crossing the anterior commissure. Four patients were deemed potentially curable with further excision but chose radiotherapy. Two patients were deemed appropriate for radiotherapy and chemoradiotherapy. Three patients had loco‐regional recurrence and underwent laryngectomy. All had anterior commissure involvement. Conclusion Transoral laser excision is a safe, function‐preserving treatment of early glottic SCC . Anterior commissure involvement was the major factor for potential failure with laser resection in T1 and T2 glottic tumours.