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      Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO 2 laser microsurgery, on local control

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          Abstract

          Purpose

          To assess the impact of surgical margins status on local control in patients with primary early glottic (Tis-T2) squamous cell carcinoma after treatment with transoral CO 2 laser microsurgery (TLM) and to assess the significance of additional wound bed biopsies.

          Methods

          Patients with Tis-T2 tumours treated with TLM type I–III resections according to the European Laryngological Society classification between 2009 and 2013 were included in retrospective analysis. Recurrence rate was determined in patients with free versus non-free specimen margins and wound biopsies. Five-year survival rates were determined using the Kaplan–Meier method. Prognostic impact of pT-category, resection margin status, tumour differentiation, wound bed biopsy status, and number of biopsies on local control (LC) were tested with the log-rank test.

          Results

          Eighty-four patients were included in the analysis. Positive margins were seen in 68 patients (81.0%). Margin status after TLM did not significantly influence LC ( p = 0.489), however, additional wound bed biopsies were significantly associated with lower LC ( p = 0.009). Five-year LC, disease-specific survival, overall survival and laryngeal preservation were 78.6, 78.0, 98.6 and 100%, respectively.

          Conclusions

          Additional wound bed biopsies can help predict local recurrence in patients treated with TLM for early glottic carcinoma. We propose that there is enough evidence to support a wait-and-see policy in patients with positive specimen margins and negative wound bed biopsies. For patients with positive wound bed biopsies, further treatment is warranted.

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          Transoral CO(2) laser treatment for T(is)-T(3) glottic cancer: the University of Brescia experience on 595 patients.

          G. PERETTI, D. COCCO, Luca O Redaelli de Zinis … (2010)
          Transoral CO(2) laser surgery has been accepted as a valuable therapeutic option for glottic cancer. This was a retrospective analysis of 595 patients. Five-year overall and disease-specific survivals, local control with laser, locoregional, regional control, and organ preservation rates were calculated. The impact of different variables was calculated by univariate analysis. Overall, disease-specific and disease-free survivals, local control with laser, locoregional, regional control, and organ preservation rates were 87.5%, 99%, 81.3%, 92.7%, 98.9%, 98.2%, and 97.1%, respectively. Univariate analysis showed a significant impact of pT category on local control with laser, organ preservation, locoregional and regional control, of endoscopic re-treatment for positive deep surgical margins on local control with laser and organ preservation, and recurrence after endoscopic re-treatment on local control with laser and organ preservation. This series confirms the good oncologic outcomes of endoscopic laser surgery for T(is), T(1), and selected T(2) and T(3) glottic tumors. 2009 Wiley Periodicals, Inc. Head Neck, 2010.
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            Transoral laser surgery versus radiotherapy: systematic review and meta-analysis for treatment options of T1a glottic cancer.

            Yalkun Yasin, Ayihen Xukurhan, Z Hua … (2011)
            The objective of this study was to conduct a systematic review and meta-analysis to compare the oncologic and functional outcomes between transoral laser surgery (TLS) and radiotherapy (RT). An electronic library search of the relevant English- and Chinese-language literature was conducted. Potentially eligible articles were reviewed. Qualified articles were selected and evaluated. No significant differences were identified between TLS and RT with respect to local control, overall survival, disease-specific survival, and posttreatment voice quality. However, larynx preservation was significantly higher in patients initially treated with TLS than those initially treated with RT. The approach for optimal treatment of T1a glottic cancer remains unanswered. This results from the relatively inconclusive evidence obtained from the current literature. Properly designed, prospective, randomized, or well-controlled studies will be required. Similar methodologies for treatment and reporting need to be established to make a valid and meaningful comparison between studies. Copyright © 2011 Wiley Periodicals, Inc.
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              Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation.

              Gioacchino Giugliano, Joseph Massaro, Fausto Maffini … (2009)
              To assess the impact of margin status on disease-free survival, overall survival, and organ preservation in early glottic cancer treated by endoscopic laser surgery. Prospective nonrandomized study. Tertiary referral center. A total of 274 patients with untreated (possibly biopsied) cTis, cT1a/b, cT2, cN0 glottic cancer; adequate exposure of the glottic region; no contraindications to general anesthesia; and the ability to give informed consent. European Laryngological Society laser cordectomy. Patients with negative margins (>1 mm) were followed, patients with close margins (< or =1 mm) or 1 positive margin (tumor on margin) had another operation, and patients with more than 1 positive margin had postoperative radiotherapy. Median follow-up was 58 months. Eight-year disease-free survival, 5-year overall survival, and organ preservation rate. Margins were negative in 180 patients, close in 40, and positive in 54. A second laser resection was performed in 36 of 94 patients with close or positive margins. Radiotherapy was administered to 36 patients. Patients with close or positive margins who did not undergo further treatment had a greater recurrence risk (hazard ratio, 2.53; 95% confidence interval, 0.97-6.59, P = .06) than did those with negative margins, mainly owing to relapses in 5 of the 8 protocol breakers with positive margins not treated further. Eight-year relapse-free survival was 88.2%, 5-year overall survival was 90.9%, and the larynx was preserved in 97.1%. Laser removal of early glottic cancer is oncologically adequate with margins greater than 1 mm from the tumor edge. Positive margins require further treatment; close margins may require further treatment depending on tumor characteristics.
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                Author and article information

                Contributors
                Martine Hendriksma:
                ORCID: http://orcid.org/0000-0001-5254-8842
                0031 71 526 1179 , m.hendriksma@lumc.nl
                Journal
                Journal ID (nlm-ta): Eur Arch Otorhinolaryngol
                Journal ID (iso-abbrev): Eur Arch Otorhinolaryngol
                Title: European Archives of Oto-Rhino-Laryngology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0937-4477
                ISSN (Electronic): 1434-4726
                Publication date (Electronic): 19 July 2018
                Publication date PMC-release: 19 July 2018
                Publication date (Print): 2018
                Volume: 275
                Issue: 9
                Pages: 2333-2340
                Affiliations
                [1 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Otorhinolaryngology, Head and Neck Surgery, , Leiden University Medical Center, ; Leiden, The Netherlands
                [2 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Pathology, , Leiden University Medical Center, ; Leiden, The Netherlands
                Author information
                http://orcid.org/0000-0001-5254-8842
                Article
                Publisher ID: 5070
                DOI: 10.1007/s00405-018-5070-9
                PMC ID: 6096566
                PubMed ID: 30027440
                SO-VID: 5a71f107-4509-48c9-bbba-676afe8195b3
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 24 April 2018
                Date accepted : 18 July 2018
                Categories
                Subject: Laryngology
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2018

                ScienceOpen disciplines: Otolaryngology
                Keywords: local control,surgical margins,laser surgery,early glottic cancer,wound bed biopsy
                Data availability:
                ScienceOpen disciplines: Otolaryngology
                Keywords: local control, surgical margins, laser surgery, early glottic cancer, wound bed biopsy

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