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. 2018 May 9:8:158.
doi: 10.3389/fonc.2018.00158. eCollection 2018.

Transoral Laser Microsurgery for Supraglottic Cancer

Petra Ambrosch  1 , Mireia Gonzalez-Donate  1 , Asita Fazel  1 , Claudia Schmalz  2 , Jürgen Hedderich  3
Affiliations

Transoral Laser Microsurgery for Supraglottic Cancer

Petra Ambrosch et al. Front Oncol. .

Abstract

Introduction: Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas. Early supraglottic carcinoma has excellent outcomes independently of the treatment approach. The role of TLM for the treatment of locally advanced tumors is debated. Particularly, the functional outcomes after TLM have to be proven by functional assessment of large cohorts of patients. This study analyzes the oncologic and functional outcomes after TLM for supraglottic carcinomas.

Patients and methods: Ninety-one patients with pT1-pT4a supraglottic carcinomas treated between January 2002 and December 2012 were analyzed. Distribution of tumors (UICC 2010) was 11 patients with pT1, 31 patients with pT2, 36 patients with pT3, and 13 patients with pT4a tumors. Node status was positive in 40 (43.6%) patients; 61 (67.1%) patients had stage III or IVa disease. Local control and survival were estimated using the Kaplan-Meier method. For the assessment of functional outcomes, the MD Anderson Dysphagia Inventory (MDADI), the Voice Handicap Index-10 (VHI-10), and the performance status scale for head and neck cancer [Performance Status Scale for Head and Neck (PSS-HN)] were used.

Results: The median age was 62 years (range, 33-88 years). Fourteen (15.4%) patients developed a local or locoregional recurrence. The 5-year local control rate and 5-year ultimate local control rate were 72 and 92%, respectively. The 5-year overall survival rate was 63%. Twelve (13.2%) patients needed temporary tracheostomy. Sixty-eight (74.0%) patients had a nasogastric feeding tube post-operatively. At 1-year post-operative follow-up, only three patients were PEG dependent. The median VHI-10 score was 35, the median MDADI composite score was 80, and the median score of the domain "normalcy of diet" in the PSS-HN was 91.

Conclusion: The oncologic outcomes are comparable to the results of open surgery for early and advanced supraglottic carcinomas. Functional swallowing outcome is superior to open surgery and to concomitant chemoradiation. Patients treated with TLM perceive low levels of voice- and swallowing-related quality of life impairment.

Keywords: functional outcomes; larynx preservation; oncologic outcomes; supraglottic cancer; transoral laser microsurgery.

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Figures

Figure 1
Figure 1
Distribution of the MDADI composite score in long-term survivors after TLM (n = 19) and after TLM + adjuvant RT (n = 10).
Figure 2
Figure 2
Distribution of the VHI in long-term survivors after TLM (n = 18) and after TLM + adjuvant RT (n = 10).
See this image and copyright information in PMC

References

    1. Steiner W. Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol (1993) 14:116–21.10.1016/0196-0709(93)90050-H - DOI - PubMed
    1. Ambrosch P, Kron M, Steiner W. Carbon dioxide laser microsurgery for early supraglottic carcinoma. Ann Otol Rhinol Laryngol (1998) 107:680–8.10.1177/000348949810700810 - DOI - PubMed
    1. Swanson MS, Low G, Sinha UK, Kokot N. Transoral surgery vs intensity-modulated radiotherapy for early supraglottic cancer: a systematic review. Curr Opin Otolaryngol Head Neck Surg (2017) 25:133–41.10.1097/MOO.0000000000000345 - DOI - PubMed
    1. Iro H, Waldfahrer F, Altendorf-Hofmann A, Weidenbecher M, Sauer R, Steiner W. Transoral laser surgery of supraglottic cancer. Arch Otolaryngol Head Neck Surg (1998) 124:1245–50.10.1001/archotol.124.11.1245 - DOI - PubMed
    1. Grant DG, Salassa JR, Hinni ML, Pearson BW, Hayden RE, Perry WC. Transoral laser microsurgery for carcinoma of the supraglottic larynx. Otolaryngol Head Neck Surg (2007) 136:900–6.10.1016/j.otohns.2006.12.015 - DOI - PubMed

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