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      Up-Front and Salvage Transoral Laser Microsurgery for Early Glottic Squamous Cell Carcinoma: A Single Centre Retrospective Case Series

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          Abstract

          Introduction/aim

          Transoral laser microsurgery (TLM) is a minimally invasive surgical alternative for radiotherapy (RT) in the primary management of early glottic cancer. More recently, TLM emerged also as a possible salvage treatment for selected radiorecurrent cancers. We reviewed outcomes of primary and salvage TLM performed in a Belgian tertiary referral center.

          Patients and methods

          A retrospective review of records from 142 consecutive patients who underwent TLM was performed. Oncologic outcomes were evaluated by means of descriptive statistics and Kaplan–Meier estimates. Variation of estimated outcomes between different subgroups was evaluated using Log-Rank analysis.

          Results

          Of 142 patients, 109 (76.8%) underwent TLM as a primary treatment and 33 (23.2%) were treated in a salvage setting for recurrent or second primary glottic cancer. cT classification in the up-front TLM group was cT1a in 72 (66.1%), cT1b in 11 (10.1%), and cT2 in 26 (23.9%) patients. In the salvage group, patients were cT/rT classified as cT1a–rT1a in 17 (51.5%), cT1b–rT1b in 1 (3.0%), cT2–rT2 in 14 (42.4%), and cT3–rT3 in 1 (3.0%) patients. All patients were cN0. Second-look TLM was performed in 28 patients (19.7%), and RT was associated as adjuvant therapy in 5 patients (3.5%). Mean follow-up was 51.6 months (SD = 38.4 months). Three-year overall survival (OS) was 94.1% (SE = 2.2%), 3-year disease-specific survival (DSS) 100%, 3-year disease-free survival (DFS) 80.1% (SE = 3.8%), 3-year local recurrence-free survival (RFS) 81.0% (SE = 3.7%), and 3-year ultimate local control rate with laser alone 89.2% (SE = 3.0%). Upon subgroup analysis, no differences in OS, DSS, and DFS were observed between the up-front and salvage group (log rank; p = 0.306, p = 0.298, and p = 0.061 respectively). However, local RFS and ultimate local control rate with laser alone were significantly higher in the primary treated TLM group (log rank, p = 0.014 and p = 0.012). Five-year laryngeal preservation rate was 89.7% (SE = 3.5%) in the total population, 100% in the upfront group, and 64.9% (SE = 9.8%) in the salvage group, a difference which proved statistically significant (Log-Rank, p < 0.001).

          Conclusion

          This retrospective study confirms excellent oncologic outcomes of up-front TLM for early glottic cancer. In the salvage setting, TLM allows avoidance of total laryngectomy in the majority of cases.

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          Most cited references39

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          TNM seventh edition: what's new, what's changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer.

          C Compton, Leslie Sobin (2010)
          Article 0 comments Cited 163 times – based on 0 reviews     Review now
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            Second primary cancers after an index head and neck cancer: subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer.

            Luc Morris, Andrew G. Sikora, Snehal Patel … (2011)
            Patients with head and neck squamous cell carcinoma (HNSCC) are at elevated risk of second primary malignancies (SPM), most commonly of the head and neck (HN), lung, and esophagus. Our objectives were to identify HNSCC subsite-specific differences in SPM risk and distribution and to describe trends in risk over 3 decades, before and during the era of human papillomavirus (HPV) -associated oropharyngeal SCC. Population-based cohort study of 75,087 patients with HNSCC in the Surveillance, Epidemiology, and End Results (SEER) program. SPM risk was quantified by using standardized incidence ratios (SIRs), excess absolute risk (EAR) per 10,000 person-years at risk (PYR), and number needed to observe. Trends in SPM risk were analyzed by using joinpoint log-linear regression. In patients with HNSCC, the SIR of second primary solid tumor was 2.2 (95% CI, 2.1 to 2.2), and the EAR was 167.7 cancers per 10,000 PYR. The risk of SPM was highest for hypopharyngeal SCC (SIR, 3.5; EAR, 307.1 per 10,000 PYR) and lowest for laryngeal SCC (SIR, 1.9; EAR, 147.8 per 10,000 PYR). The most common SPM site for patients with oral cavity and oropharynx SCC was HN; for patients with laryngeal and hypopharyngeal cancer, it was the lung. Since 1991, SPM risk has decreased significantly among patients with oropharyngeal SCC (annual percentage change in EAR, -4.6%; P = .03). In patients with HNSCC, the risk and distribution of SPM differ significantly according to subsite of the index cancer. Before the 1990s, hypopharynx and oropharynx cancers carried the highest excess risk of SPM. Since then, during the HPV era, SPM risk associated with oropharyngeal SCC has declined to the lowest risk level of any subsite.
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              Laser surgery in the larynx. Early clinical experience with continuous CO 2 laser.

              John M Strong, G. Jako (1972)
              Article 0 comments Cited 60 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jeroen Meulemans: URI : https://frontiersin.org/people/u/343148
                Jacqueline Bijnens: URI : https://frontiersin.org/people/u/543344
                Pierre Delaere: URI : https://frontiersin.org/people/u/410618
                Vincent Vander Poorten: URI : https://frontiersin.org/people/u/340971
                Journal
                Journal ID (nlm-ta): Front Oncol
                Journal ID (iso-abbrev): Front Oncol
                Journal ID (publisher-id): Front. Oncol.
                Title: Frontiers in Oncology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2234-943X
                Publication date (Electronic): 28 May 2018
                Publication date Collection: 2018
                Volume: 8
                Electronic Location Identifier: 186
                Affiliations
                [1] 1Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven , Leuven, Belgium
                [2] 2Department of Oncology, Section Head and Neck Oncology, KU Leuven , Leuven, Belgium
                Author notes

                Edited by: Dietmar Thurnher, Medizinische Universität Graz, Austria

                Reviewed by: Sandro J. Stoeckli, Kantonsspital St. Gallen, Switzerland; Torahiko Nakashima, Kyushu University, Japan

                *Correspondence: Vincent Vander Poorten, vincent.vanderpoorten@ 123456uzleuven.be

                Specialty section: This article was submitted to Head and Neck Cancer, a section of the journal Frontiers in Oncology

                Article
                DOI: 10.3389/fonc.2018.00186
                PMC ID: 5985398
                SO-VID: 384c4f46-3116-4446-a64b-f80336c85a9b
                Copyright © Copyright © 2018 Meulemans, Bijnens, Delaere and Vander Poorten.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 25 March 2018
                Date accepted : 11 May 2018
                Page count
                Figures: 6, Tables: 2, Equations: 0, References: 39, Pages: 11, Words: 7256
                Categories
                Subject: Oncology
                Subject: Original Research

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: conservation surgery,laryngeal cancer,salvage surgery,transoral laser microsurgery,squamous cell carcinoma
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: conservation surgery, laryngeal cancer, salvage surgery, transoral laser microsurgery, squamous cell carcinoma

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