Transoral laser microsurgery for T1a glottic cancer: review of 404 cases

Abstract

Background: Various therapeutic options exist for treatment of T1a glottic squamous cell cancer (SCC). Radiotherapy (RT) has been favored over surgical excision. This has been challenged by transoral laser microsurgery (TLM) showing low morbidity and good functional results.

Methods: A retrospective chart review was carried out. Patients with untreated T1a glottic SCC were included in the study. Endpoints were locoregional control, overall survival, disease-specific survival, and absolute rate of larynx preservation.

Results: Four hundred four patients were included in this study. Five-year Kaplan-Meier estimates were: local control 86.8%, overall survival 87.8%, disease-specific survival 98.0%, recurrence-free survival 76.1%, and larynx preservation 97.3%. The complication rate was 1%; the majority of patients had either normal or mildly dysphonic voices.

Conclusion: Low complication rates, excellent functional outcome, and high rates of organ preservation favor TLM. In agreement with the literature, TLM should be the treatment of choice for patients presenting with T1a glottic SCC.

Keywords: carbon dioxide laser; early glottic squamous cell carcinoma; larynx; organ preservation; transoral laser microsurgery (TLM).