Salvage transoral laser microsurgery for early recurrent glottic carcinoma after primary laser treatment

Abstract

Conclusion: Salvage transoral laser microsurgery (TLM) may be a curative organ-preserving treatment for early recurrent glottic carcinoma after primary laser resection. However, failure after TLM seems to be associated with decrease of survival and larynx preservation rates. Objective: To evaluate the oncological results of salvage TLM for early recurrent glottic carcinoma after primary laser treatment. Methods: Records of 50 patients with local recurrences of glottic carcinoma treated by salvage TLM between January 1994 and December 2008 were retrospectively analyzed. Results: Thirty-six rT1 and 14 rT2 lesions were treated with salvage TLM. Mean follow-up was 68.3 months. Thirty-one patients were cured by first salvage TLM and four by further laser procedures. The other 15 patients were finally salvaged by laryngectomy or radiotherapy. Five-year overall survival, disease-specific survival, local control, and loco-regional control rates were 89.9%, 97.9%, 62.3%, and 60.1%, respectively. Larynx preservation rate after long-term follow-up was 86%. In univariate analysis, second local recurrence showed a statistically significant impact on disease-specific survival rate ( p = 0.049) and larynx preservation rate ( p = 0.006). In multivariate analysis, it was associated with a statistically significant decrease in larynx preservation rate ( p = 0.016). There was no statistically significant difference in oncological results between patients with and without anterior commissure involvement.

Keywords::

• Laryngeal carcinoma
• minimally invasive surgery
• survival analysis
• prognostic factors

Acknowledgments

The authors wish to thank the numerous individuals who participated in this study. The study was supported by the National Natural Science Foundation of China (grant no. 30973293) and a High-level Health Technical Personnel Training grant from Beijing Health System (2009-3-30).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.