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Transoral laser microsurgery in early glottic cancer involving the anterior commissure

  • Christian JacobiEmail author
  • Raffaela Freundorfer
  • Maximilian Reiter
Head & Neck
  • 28 Downloads

Abstract

Purpose

Treatment modalities for glottic cancer comprise surgery, (chemo-)radiation, and combined treatment options. Glottic cancer involving the anterior commissure (AC) requires special preoperative assessment and surgical skills, as it is commonly considered a risk factor for local recurrence. The aim of this study is to analyze the oncological effectiveness of transoral laser microsurgery (TLM) in the early glottic cancer involving the AC.

Methods

We retrospectively analyzed the data of all patients with primary, early staged (T1–2) glottic squamous cell carcinoma who were treated between 2004 and 2014. Patients were preferably treated by TLM (rather than open surgical techniques) if appropriated transoral exposure of the endolarynx was ensured. Voice outcomes were not assessed.

Results

186 patients with early glottic cancer were included, 143 were treated by TLM and 43 by other therapy modalities [OT open surgical techniques (n = 32) or primary (chemo-)radiation (n = 11)], respectively. In 84 patients (59%) of the TLM cohort, the AC was involved (OT cohort n = 29 (73%), p = 0.143). The 1-, 3-, and 5-year local control rates after TLM were 91%, 86%, and 81% in patients without AC infiltration and 84%, 74%, and 70% in patients with AC infiltration, respectively, showing no statistical difference (p = 0.180). The 5-year disease-free survival and laryngeal preservation rate (LPR) did not differ with regard to AC infiltration (p = 0.215 and p = 0.261). Comparing the treatment modalities, the 5-year LPR was 90% for TLM and 83% for OT regardless of infiltration of the AC (p = 0,653 and p = 0.267, respectively).

Conclusion

TLM is an effective surgical treatment for early glottic cancer with AC involvement in patients with adequate transoral laryngeal exposure.

Keywords

Head and neck cancer Transoral laser microsurgery Anterior commissure Glottic cancer 

Notes

Compliance with ethical standards

Conflict of interest

All authors state no funding and no financial disclosures.

Supplementary material

405_2018_5261_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 KB)
405_2018_5261_MOESM2_ESM.docx (13 kb)
Supplementary material 2 (DOCX 13 KB)

References

  1. 1.
    Day AT, Sinha P, Nussenbaum B, Kallogjeri D, Haughey BH (2017) Management of primary T1–T4 glottic squamous cell carcinoma by transoral laser microsurgery. Laryngoscope 127(3):597–604.  https://doi.org/10.1002/lary.26207 CrossRefPubMedGoogle Scholar
  2. 2.
    Tamaki A, Miles BA, Lango M, Kowalski L, Zender CA (2018) AHNS Series: Do you know your guidelines? Review of current knowledge on laryngeal cancer. Head Neck 40(1):170–181.  https://doi.org/10.1002/hed.24862 CrossRefPubMedGoogle Scholar
  3. 3.
    Higgins KM (2011) What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 121(1):116–134.  https://doi.org/10.1002/lary.21226 CrossRefPubMedGoogle Scholar
  4. 4.
    Lucioni M, Marioni G, Bertolin A, Giacomelli L, Rizzotto G (2011) Glottic laser surgery: outcomes according to 2007 ELS classification. Eur Arch Otorhinolaryngol 268(12):1771–1778.  https://doi.org/10.1007/s00405-011-1695-7 CrossRefPubMedGoogle Scholar
  5. 5.
    Hoffmann C, Cornu N, Hans S, Sadoughi B, Badoual C, Brasnu D (2016) Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy. Laryngoscope 126(8):1817–1822.  https://doi.org/10.1002/lary.25757 CrossRefPubMedGoogle Scholar
  6. 6.
    Spector JG, Sessions DG, Chao KS, Haughey BH, Hanson JM, Simpson JR, Perez CA (1999) Stage I (T1 N0 M0) squamous cell carcinoma of the laryngeal glottis: therapeutic results and voice preservation. Head Neck 21(8):707–717CrossRefGoogle Scholar
  7. 7.
    Johansen LV, Grau C, Overgaard J (2002) Glottic carcinoma–patterns of failure and salvage treatment after curative radiotherapy in 861 consecutive patients. Radiother Oncol 63(3):257–267CrossRefGoogle Scholar
  8. 8.
    Warner L, Chudasama J, Kelly CG, Loughran S, McKenzie K, Wight R, Dey P (2014) Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database Syst Rev 12:CD002027.  https://doi.org/10.1002/14651858.CD002027.pub2 CrossRefGoogle Scholar
  9. 9.
    Al-Mamgani A, van Rooij PH, Woutersen DP, Mehilal R, Tans L, Monserez D, Baatenburg de Jong RJ (2013) Radiotherapy for T1-2N0 glottic cancer: a multivariate analysis of predictive factors for the long-term outcome in 1050 patients and a prospective assessment of quality of life and voice handicap index in a subset of 233 patients. Clin Otolaryngol 38(4):306–312.  https://doi.org/10.1111/coa.12139 CrossRefPubMedGoogle Scholar
  10. 10.
    Rucci L, Gammarota L, Gallo O (1996) Carcinoma of the anterior commissure of the larynx: II. Proposal of a new staging system. Ann Otol Rhinol Laryngol 105(5):391–396.  https://doi.org/10.1177/000348949610500512 CrossRefPubMedGoogle Scholar
  11. 11.
    Piazza C, Filauro M, Paderno A, Marchi F, Perotti P, Morello R, Taboni S, Parrinello G, Incandela F, Iandelli A, Missale F, Peretti G (2018) Three-dimensional map of isoprognostic zones in glottic cancer treated by transoral laser microsurgery as a unimodal treatment strategy. Front Oncol 8:175.  https://doi.org/10.3389/fonc.2018.00175 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mo HL, Li J, Yang X, Zhang F, Xiong JW, Yang ZL, Tan J, Li B (2017) Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and meta-analysis. Lasers Med Sci 32(2):461–467.  https://doi.org/10.1007/s10103-016-2103-8 CrossRefPubMedGoogle Scholar
  13. 13.
    Remacle M, Hantzakos A, Eckel H, Evrard AS, Bradley PJ, Chevalier D, Djukic V, de Vincentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J (2009) Endoscopic supraglottic laryngectomy: a proposal for a classification by the working committee on nomenclature, European Laryngological Society. Eur Arch Otorhinolaryngol 266(7):993–998.  https://doi.org/10.1007/s00405-008-0901-8 CrossRefPubMedGoogle Scholar
  14. 14.
    Gallo A, de Vincentiis M, Manciocco V, Simonelli M, Fiorella ML, Shah JP (2002) CO2 laser cordectomy for early-stage glottic carcinoma: a long-term follow-up of 156 cases. Laryngoscope 112(2):370–374.  https://doi.org/10.1097/00005537-200202000-00030 CrossRefPubMedGoogle Scholar
  15. 15.
    Mendelsohn AH, Kiagiadaki D, Lawson G, Remacle M (2015) CO2 laser cordectomy for glottic squamous cell carcinoma involving the anterior commissure: voice and oncologic outcomes. Eur Arch Otorhinolaryngol 272(2):413–418.  https://doi.org/10.1007/s00405-014-3368-9 CrossRefPubMedGoogle Scholar
  16. 16.
    Aaltonen LM, Rautiainen N, Sellman J, Saarilahti K, Makitie A, Rihkanen H, Laranne J, Kleemola L, Wigren T, Sala E, Lindholm P, Grenman R, Joensuu H (2014) Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy. Int J Radiat Oncol Biol Phys 90(2):255–260.  https://doi.org/10.1016/j.ijrobp.2014.06.032 CrossRefPubMedGoogle Scholar
  17. 17.
    Peretti G, Piazza C, Cocco D, De Benedetto L, Del Bon F, Redaelli De Zinis LO, Nicolai P (2010) Transoral CO(2) laser treatment for T(is)-T(3) glottic cancer: the University of Brescia experience on 595 patients. Head Neck 32(8):977–983.  https://doi.org/10.1002/hed.21278 CrossRefPubMedGoogle Scholar
  18. 18.
    Sachse F, Stoll W, Rudack C (2009) Evaluation of treatment results with regard to initial anterior commissure involvement in early glottic carcinoma treated by external partial surgery or transoral laser microresection. Head Neck 31(4):531–537.  https://doi.org/10.1002/hed.20997 CrossRefPubMedGoogle Scholar
  19. 19.
    Carta F, Bandino F, Olla AM, Chuchueva N, Gerosa C, Puxeddu R (2018) Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients. Eur Arch Otorhinolaryngol 275(5):1199–1210.  https://doi.org/10.1007/s00405-018-4890-y CrossRefPubMedGoogle Scholar
  20. 20.
    Ansarin M, Cattaneo A, De Benedetto L, Zorzi S, Lombardi F, Alterio D, Rocca MC, Scelsi D, Preda L, Chiesa F, Santoro L (2017) Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery. Head Neck 39(1):71–81.  https://doi.org/10.1002/hed.24534 CrossRefPubMedGoogle Scholar
  21. 21.
    Sjogren EV (2017) Transoral laser microsurgery in early glottic lesions. Curr Otorhinolaryngol Rep 5(1):56–68.  https://doi.org/10.1007/s40136-017-0148-2 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Steiner W, Ambrosch P, Rodel RM, Kron M (2004) Impact of anterior commissure involvement on local control of early glottic carcinoma treated by laser microresection. Laryngoscope 114(8):1485–1491.  https://doi.org/10.1097/00005537-200408000-00031 CrossRefPubMedGoogle Scholar
  23. 23.
    Huang Z, Han D, Yu Z, Ni X, Ge X (2002) Evaluate the curative effect of CO2 laser in treatment of glottic carcinoma. Zhonghua Er Bi Yan Hou Ke Za Zhi 37(3):219–222PubMedGoogle Scholar
  24. 24.
    Wolber P, Schwarz D, Stange T, Ortmann M, Balk M, Anagiotos A, Gostian AO (2018) Surgical treatment for early stage glottic carcinoma with involvement of the anterior commissure. Otolaryngol Head Neck Surg 158(2):295–302.  https://doi.org/10.1177/0194599817728476 CrossRefPubMedGoogle Scholar
  25. 25.
    Yoo J, Lacchetti C, Hammond JA, Gilbert RW, Head, Neck Cancer Disease Site G (2014) Role of endolaryngeal surgery (with or without laser) versus radiotherapy in the management of early (T1) glottic cancer: a systematic review. Head Neck 36(12):1807–1819.  https://doi.org/10.1002/hed.23504 CrossRefPubMedGoogle Scholar
  26. 26.
    Higgins KM, Shah MD, Ogaick MJ, Enepekides D (2009) Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy. J Otolaryngol Head Neck Surg 38(6):603–612PubMedGoogle Scholar
  27. 27.
    Abdurehim Y, Hua Z, Yasin Y, Xukurhan A, Imam I, Yuqin F (2012) Transoral laser surgery versus radiotherapy: systematic review and meta-analysis for treatment options of T1a glottic cancer. Head Neck 34(1):23–33.  https://doi.org/10.1002/hed.21686 CrossRefPubMedGoogle Scholar
  28. 28.
    Smee RI, Meagher NS, Williams JR, Broadley K, Bridger GP (2010) Role of radiotherapy in early glottic carcinoma. Head Neck 32(7):850–859.  https://doi.org/10.1002/hed.21262 CrossRefPubMedGoogle Scholar
  29. 29.
    Rucci L, Romagnoli P, Casucci A, Ferlito A (2004) Embryological study of the glottic site and clinical implications. Oral Oncol 40(10):1017–1025.  https://doi.org/10.1016/j.oraloncology.2004.05.004 CrossRefPubMedGoogle Scholar
  30. 30.
    Rucci L, Gammarota L, Borghi Cirri MB (1996) Carcinoma of the anterior commissure of the larynx: I. Embryological and anatomic considerations. Ann Otol Rhinol Laryngol 105(4):303–308.  https://doi.org/10.1177/000348949610500412 CrossRefPubMedGoogle Scholar
  31. 31.
    Rucci L, Bocciolini C, Romagnoli P, Olofsson J (2003) Risk factors and prognosis of anterior commissure versus posterior commissure T1–T2 glottic cancer. Ann Otol Rhinol Laryngol 112(3):223–229.  https://doi.org/10.1177/000348940311200306 CrossRefPubMedGoogle Scholar
  32. 32.
    Hoffmann C, Hans S, Sadoughi B, Brasnu D (2016) Identifying outcome predictors of transoral laser cordectomy for early glottic cancer. Head Neck 38(Suppl 1):E406–E411.  https://doi.org/10.1002/hed.24007 CrossRefPubMedGoogle Scholar
  33. 33.
    Rucci L, Romagnoli P, Scala J (2010) CO(2) laser therapy in Tis and T1 glottic cancer: indications and results. Head Neck 32(3):392–398.  https://doi.org/10.1002/hed.21200 CrossRefPubMedGoogle Scholar
  34. 34.
    Comert E, Tuncel U, Dizman A, Guney YY (2014) Comparison of early oncological results of diode laser surgery with radiotherapy for early glottic carcinoma. Otolaryngol Head Neck Surg 150(5):818–823.  https://doi.org/10.1177/0194599814521775 CrossRefPubMedGoogle Scholar
  35. 35.
    Goor KM, Peeters AJ, Mahieu HF, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM, van Agthoven M (2007) Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas: costs, local control, survival, quality of life, and voice quality. Head Neck 29(2):128–136.  https://doi.org/10.1002/hed.20500 CrossRefPubMedGoogle Scholar
  36. 36.
    Ansarin M, Santoro L, Cattaneo A, Massaro MA, Calabrese L, Giugliano G, Maffini F, Ostuni A, Chiesa F (2009) Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Arch Otolaryngol Head Neck Surg 135(4):385–390.  https://doi.org/10.1001/archoto.2009.10 CrossRefPubMedGoogle Scholar
  37. 37.
    Crespo AN, Chone CT, Gripp FM, Spina AL, Altemani A (2006) Role of margin status in recurrence after CO2 laser endoscopic resection of early glottic cancer. Acta Otolaryngol 126(3):306–310.  https://doi.org/10.1080/00016480500316985 CrossRefPubMedGoogle Scholar
  38. 38.
    Steiner W (1993) Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 14(2):116–121CrossRefGoogle Scholar
  39. 39.
    Sigston E, de Mones E, Babin E, Hans S, Hartl DM, Clement P, Brasnu DF (2006) Early-stage glottic cancer: oncological results and margins in laser cordectomy. Arch Otolaryngol Head Neck Surg 132(2):147–152.  https://doi.org/10.1001/archotol.132.2.147 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryTechnical University MunichMunichGermany
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryLudwig-Maximilians-University MunichMunichGermany

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