Role of lasers in glottic malignancies: our experience
Keywords:Lasers, Glottic malignancies, Radiation
Background: Laryngeal malignancy is one of the commonest head and neck cancers encountered in India. Most tumors are glottic in origin. Radiation, partial or total laryngectomy gives very good cure rates for these tumors. Lasers have emerged as an integral part of the treatment paradigm for patients with laryngeal cancer. Laser surgery is one of the primary treatment options for early-stage glottic tumors and can also be used for advanced laryngeal tumors.
Methods: Fifty patients with laryngeal cancer were treated with laser over a 10-year period. Majority of patients were males with an average age of 46 years. Most patients had early (T1, T2) laryngeal malignancy (90%). There were a few patients with advanced laryngeal tumor (10%). All patients had tumor biopsy and simultaneous laserization of the tumor followed by radiation in T1 and T2 disease and chemo radiation in T3 disease. A few patients who had recurrence of disease after radiation (4%) were medically unfit for laryngectomy and underwent laserization of the tumor.
Results: Laser surgery proved to be an important tool in the management of glottic tumors and is commonly utilized in the treatment of early-stage disease. It has also been successful for debulking of large tumors. Careful case selection is important for good outcomes.
Conclusions: Transoral laser microsurgery and radiotherapy are useful treatment modalities in the management of early glottic malignancies. Lasers have proved to be effective in glottic malignancies with excellent oncologic and functional outcomes.
Ahmed J, Ibrahim ASG, Freedman LM, Rosow DE. Oncologic Outcomes of KTP Laser Surgery Versus Radiation for T1 Glottic Carcinoma. Laryngoscope. 2018;128:1052-6.
Sandulache VC, Kupferman ME. Transoral Laser Surgery for Laryngeal Cancer. Rambam Maimonides Med J. 2014;5(2):e0012.
Harris AT, Tanyi A, Hart RD, Trites J, Rigby MH, Lancaster J, Nicolaides A, Taylor SM. Transoral laser surgery for laryngeal carcinoma: has Steiner achieved a genuine paradigm shift in oncological surgery? Ann R Coll Surg Engl. 2018;100(1):2-5.
Zhan C, Yang X, Song X, Yan L. Radiotherapy vs surgery for T1-2N0M0 laryngeal squamous cell carcinoma: A population-based and propensity score matching study. Cancer Med. 2018;7(7):2837-47.
Mendelsohn AH, Remacle MJ. Vocal Fold Cancer Transoral Laser Microsurgery Following European Laryngological Society Laser Cordectomy Classification. Front Oncol. 2018; 22(8):231.
Rubinstein M, Armstrong WB. Transoral laser microsurgery for laryngeal cancer: a primer and review of laser dosimetry. Lasers Med Sci. 2011;26(1):113-24.
Arroyo HH, Neri L, Fussuma CY, Imamura R. Diode Laser for Laryngeal Surgery: A Systematic Review. Int Arch Otorhinolaryngol. 2016;20(2):172-9.
Vilaseca I, Bernal-Sprekelsen M. Transoral laser microsurgery for locally advanced laryngeal cancer. Acta Otorhinolaringol Esp.2013;64(2):140-9.
Guimarães AV, Dedivitis RA, Matos LL, Aires FT, Cernea CR. Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: A systematic review and meta-analysis. Sci Rep. 2018;8(1):11900.
Eckel HE, Thumfart WF. Laser surgery for the treatment of larynx carcinomas: indications, techniques, and preliminary results. Ann Otol Rhinol Laryngol. 1992;101(2):113-8.
Waghmare CM. Management of an early stage carcinoma of the true vocal cord. Pravara Med Rev. 2017;9(2):4-12.
Cernea CR, Dias FL, Fliss D, Lima RA, Myers EN, Wei WI. Pearls and Pitfalls in Head and Neck Surgery. Basel, Karger; 2008: 72-73.
Shim YS. Recent Advances in Management of Laryngeal Cancer. Cancer Res Treat. 2004;36(1):13-8.
Taylor SM, Kerr P, Fung K, Aneeshkumar MK, Wilke D, Jiang Y, et al. Treatment of T1b glottic SCC: laser vs. radiation--a Canadian multicenter study. J Otolaryngol Head Neck Surg. 2013;42:22.
McClelland L, Carr E, Kamani T, Cade J, Young K, Mortimore S. Transoral laser microsurgery for early glottic cancer. ISRN Otolaryngol. 2011:750676.
Horwich P, Rigby MH, MacKay C, Melong J, Williams B, Bullock M, Hart R, Trites J, Taylor SM. Laryngeal recurrence sites in patients previously treated with transoral laser microsurgery for squamous cell carcinoma. J Otolaryngol Head Neck Surg. 2018;47:14.
Siddiq S, Paleri V. Transoral surgery in early-stage laryngeal cancer. J Head Neck Physicians Surg. 2017;5:3-12.
Shapshay SM, Hybels RL, Bohigian RK. Laser excision of early vocal cord carcinoma: indications, limitations, and precautions. Ann Otol Rhinol Laryngol. 1990;99(1):46-50.
Pradhan SA, Kannan R. Treatment Decision in the Management of Laryngeal Cancer: An Overview. Otorhinolaryngol Clin: Int J. 2010;2(3):191-4.
Hinni, ML, Salassa JR, Grant DG, Pearson BW, Hayden RE, Martin A, Steiner W. Transoral Laser Microsurgery for Advanced Laryngeal Cancer. Arch Otolaryngol Head Neck Surg. 2007;133(12):1198-204.
Zhong A, Xu X, Fan H, Wang L, Niu Y. Transoral laser microsurgery for recurrent laryngeal carcinoma after primary treatment: A systematic review and meta-analysis. J Can Res Ther. 2015;11:173-8.