Audit of transoral laser-assisted microsurgical resection of early laryngeal cancer

2015 ◽  
Vol 129 (4) ◽  
pp. 372-376
Author(s):  
I Amir ◽  
G A Vernham
Keyword(s):  
Survival Rates ◽  
Disease Free Survival ◽  
Oncological Outcome ◽  
Glottic Cancer ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Free Survival ◽  
Early Glottic Cancer ◽  
Kaplan Meier ◽  
Microsurgical Resection

AbstractObjective:This study aimed to report our current practice of transoral laser microsurgery for early glottic cancer against the standards outlined by the ENT UK Head and Neck Group and assess the oncological outcome.Method:A retrospective review of case notes of patients diagnosed with early glottic cancer (tumour stages Tis, T1 and T2) who underwent transoral laser microsurgery as a primary curative treatment. The minimum follow-up period was two years.Results:Thirty-one patients had transoral laser microsurgery for early glottic cancer during the study period. Eighty-four per cent of cases were discussed by a multidisciplinary team prior to transoral laser microsurgery. Complete circumferential excision was achieved in 77 per cent of cases. Sixty-five per cent of specimens were subjected to histological analysis; they complied with standard pathology reporting for margins. Within 12 months of transoral laser microsurgery, there were 10 residual cases and 2 recurrences. Kaplan–Meier survival analysis gave disease-free survival rates of 96.8 per cent at 18 months and 93.5 per cent at 24 months. The laryngectomy-free survival rate was 96.8 per cent at two years.Conclusion:The findings of this audit are encouraging and have highlighted areas for further discussions, recommendations, training and education.

Transoral laser microsurgery outcomes with early glottic cancer: the Dalhousie University experience

2011 ◽  
Vol 125 (5) ◽  
pp. 509-512 ◽  
Author(s):  
S E Lester ◽  
M H Rigby ◽  
S M Taylor
Keyword(s):  
Overall Survival ◽  
Disease Free Survival ◽  
Glottic Cancer ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Free Survival ◽  
Early Glottic Cancer ◽  
Kaplan Meier ◽  
Disease Free

AbstractObjective:To report the results of transoral laser microsurgery for the treatment of early glottic cancer at our institution.Design:Cohort study. Retrospective review of charts of patients diagnosed with tumour stage 1 or 2 (early stage; no nodes or metastases), previously untreated, primary glottic cancer, treated with transoral laser microsurgery at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. The minimum follow-up period was two years.Setting:Tertiary care head and neck cancer centre.Participants:Fifty-three patients treated between January 2002 and November 2007.Outcome measure:Kaplan–Meier survival analysis for disease-free survival, overall survival and laryngectomy-free survival, at five years.Results:The group comprised 46 men and seven women, with a mean age of 66 years (range 30–84 years). Mean follow up was 40 months (range 12–89 months). There were four cases of complications (7.5 per cent). Kaplan–Meier survival analysis revealed a five-year disease-free survival (including salvage) of 96.2 per cent, a five-year overall survival (all causes) of 88.8 per cent and a five-year laryngectomy-free survival of 98.1 per cent.Conclusion:Transoral laser microsurgery is a safe and effective initial treatment for early laryngeal cancer, and has high rates of laryngeal preservation and disease-free survival.

Outcomes of transoral laser microsurgery for recurrent head and neck cancer

2013 ◽  
Vol 127 (10) ◽  
pp. 982-986 ◽  
Author(s):  
L F Reynolds ◽  
M H Rigby ◽  
J Trites ◽  
R Hart ◽  
S M Taylor
Keyword(s):  
Oropharyngeal Cancer ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Health Science ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Free Survival ◽  
Science Centre ◽  
Recurrent Head

AbstractObjective:To report our outcomes with salvage CO2 laser surgery following recurrence of laryngeal and oropharyngeal cancer after radiotherapy.Method:This study entailed a prospective review of patients treated with transoral laser microsurgery for recurrent laryngeal and oropharyngeal cancer between 2002 and 2010 at the Queen Elizabeth II Health Science Centre in Canada.Results:Sixteen patients were identified, with a mean follow up of 30.6 months. Five patients died of recurrence. Complications were common in patients with oropharyngeal cancer. The overall survival and disease-free survival rates at an average of 29.8 months follow up were 50 per cent and 68.8 per cent respectively.Conclusion:Salvage surgery using transoral laser microsurgery should be considered in the management of patients with recurrent laryngeal and oropharyngeal cancer. This technique offers acceptable salvage rates with less comorbidity than other treatments.

scholarly journals Transoral Laser Microsurgery vs Radiotherapy for Early Glottic Cancer: Study at Tertiary Care Center in India

2017 ◽  
Vol 8 (1) ◽  
pp. 15-20
Author(s):  
Rajshekar Halkud ◽  
Purushottam Chavan ◽  
Ashok M Shenoy ◽  
Vikas Sharma ◽  
Namrata Ranganath ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Glottic Cancer ◽  
P Value ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Free Survival ◽  
Early Glottic Cancer ◽  
Laryngeal Preservation ◽  
Preservation Rate

ABSTRACT Aim To compare laryngeal preservation rates, survival rates, and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT). Materials and methods A review of oncologic results was performed on a consecutive series of individuals with early-stage glottic carcinoma (T1 and T2) who were treated between 2011 and 2014 at Kidwai Memorial Institute of Oncology and had received either RT or TLM. Data were collected with a view to assess overall survival, disease-specific survival, laryngectomyfree survival, and laryngeal preservation rates. The Voice Handicap Index-30 (VHI-30) was used as the measure of voice quality after treatment. Results Two-year overall survival for TLM group was 93.8% and for RT group was 90.5%, p = 0.643. Disease-free survival (TLM = 90.6% vs RT = 76.2%) was not found to be significant (p-value = 0.104). Laryngeal preservation rate was 79.5% in TLM and 71.4% in RT group (p-value = 0.003). Laryngectomy- free survival was better in TLM (TLM = 96.9% vs RT = 76.2%, p = 0.003). Substage analysis showed equivalent voice for TLM (VHI = 6–12) and RT (VHI = 6–14) in T1a patients (p = 0.94), whereas voice outcome was better for RT in T1b (VHI = 10–16 for TLM vs VHI = 11–18 for RT, p = 0.044) and T2 (VHI = 21–29 for TLM vs VHI = 16–23 for RT, p = 0.002) stages. Conclusion Transoral laser microsurgery can be considered the treatment of choice for early glottic cancer in view of better laryngeal preservation rate and laryngectomy-free survival with added advantage of low treatment cost and shorter hospital stay compared with RT. Clinical significance Laryngeal cancers represent the most common malignancy of head and neck, with estimated worldwide incidence of 120,000 cases annually. Optimal treatment modality has generated significant controversy in literature. External beam RT, open partial laryngectomy, and TLM are various treatment options available. This study depicts TLM as a preferred modality for early glottic cancer. How to cite this article Shenoy AM, Sharma V, Chavan P, Halkud R, Ranganath N, Pasha T, Shenoy P, Ravikumar B, Narayana SM, Sharif MI, Vijay CR. Transoral Laser Microsurgery vs Radiotherapy for Early Glottic Cancer: Study at Tertiary Care Center in India. Int J Head Neck Surg 2017;8(1):15-20.

scholarly journals T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO2-Laser Microsurgery Using the VEM

2021 ◽  
Vol 10 (6) ◽  
pp. 1250
Author(s):  
Wen Song ◽  
Felix Caffier ◽  
Tadeus Nawka ◽  
Tatiana Ermakova ◽  
Alexios Martin ◽  
...  
Keyword(s):  
Function Analysis ◽  
Survival Rates ◽  
Severity Index ◽  
Glottic Cancer ◽  
Vocal Performance ◽  
Laser Microsurgery ◽  
Kaplan Meier ◽  
Objective Parameter ◽  
Oncological Results ◽  
Perceptual Assessment

Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO2 transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year recurrence-free, overall, and disease-specific survival rates (Kaplan–Meier method) were 71.4%, 94.4%, and 100.0%. Voice function was preserved; the objective parameter VEM (64 ± 33 vs. 83 ± 31; mean ± SD) and subjective vocal measures (G: 1.9 ± 0.7 vs. 1.3 ± 0.7; VHI-9i: 18 ± 8 vs. 9 ± 9) even improved significantly (p < 0.001). The VEM best reflected self-perceived voice impairment. It represents a sensitive measure of voice function for quantification of vocal performance.

Low expression of pRB predicts disease relapse in early glottic cancer treated with transoral laser microsurgery

2018 ◽  
Vol 129 (6) ◽  
pp. E220-E226
Author(s):  
Li‐Ang Lee ◽  
Tuan‐Jen Fang ◽  
Hsueh‐Yu Li ◽  
Chung‐Guei Huang ◽  
Tse‐Ching Chen ◽  
...  
Keyword(s):  
Glottic Cancer ◽  
Transoral Laser Microsurgery ◽  
Disease Relapse ◽  
Laser Microsurgery ◽  
Early Glottic Cancer ◽  
Low Expression

Longitudinal analysis of Voice Handicap Index in early glottic cancer patients treated with transoral laser microsurgery: age, gender, stage and time dependence

2019 ◽  
Vol 133 (4) ◽  
pp. 318-323 ◽  
Author(s):  
C Lane ◽  
M Rigby ◽  
R Hart ◽  
J Trites ◽  
E Levi ◽  
...  
Keyword(s):  
Voice Handicap Index ◽  
Glottic Cancer ◽  
Glottic Carcinoma ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Early Glottic Cancer ◽  
Related Quality ◽  
The Voice

AbstractObjectivesTransoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10.MethodsPrimary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments.ResultsVoice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression.ConclusionAge and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.

Repeated transoral laser microsurgery for early and advanced recurrence of early glottic cancer after primary laser resection

2010 ◽  
Vol 37 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Ralph M.W. Roedel ◽  
Christoph Matthias ◽  
Hendrik A. Wolff ◽  
Hans Christiansen
Keyword(s):  
Glottic Cancer ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Early Glottic Cancer ◽  
Laser Resection

Voice outcomes following transoral laser microsurgery for early glottic squamous cell carcinoma

2007 ◽  
Vol 121 (12) ◽  
pp. 1184-1188 ◽  
Author(s):  
J T Kennedy ◽  
P M Paddle ◽  
B J Cook ◽  
P Chapman ◽  
T A Iseli
Keyword(s):  
Glottic Cancer ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Early Glottic Cancer ◽  
Primary Radiotherapy ◽  
Second Procedure ◽  
European Laryngological Society ◽  
Choice Of Therapy ◽  
Salvage Laryngectomy

AbstractIntroduction:Early glottic cancer may be treated with primary radiotherapy or transoral laser microsurgery with comparable survival. The choice of therapy therefore depends on patient preference after discussion of risks, benefits and alternatives.Materials and methods:All previously untreated patients undergoing transoral laser microsurgery for T1 or T2 glottic cancer at St Vincent's Hospital between July 1997 and December 2004 had their staging and demographics recorded. Surgery was categorised according to the European Laryngological Society. A voice recording was made pre-operatively then at 12 weeks post-operatively and scored by two independent speech therapists on the Oates Russell Voice Profile – a scale of zero (normal) to five (severe dysphonia). Follow up was for a minimum of two years.Results and analysis:Fifty-three patients with a mean age of 56 were included. The observed survival was T1 89.4 per cent and T2 85.3 per cent after a mean follow up of 47 months. Nineteen patients staged T1 underwent cordectomy. A second procedure was required in 22.2 per cent, however, none required a laryngectomy. Thirty-four patients staged T2 underwent hemilaryngectomy. A second procedure was required in 41.2 per cent including 8.8 per cent requiring salvage laryngectomy. One patient died with unresectable nodal disease. The mean Oates Russell Voice Profile for T1 disease was 2.37 and for T2 2.68 (range 1 to 4) indicating a mild (2) to moderate (3) degree of voice impairment.Conclusions:Survival outcomes following transoral laser microsurgery are comparable to treatment with radiotherapy. Voice impairment is usually mild to moderate following transoral laser microsurgery for early glottic cancer but overall may be greater than in radiotherapy patients. The repeatability of transoral laser microsurgery may result in a lower laryngectomy rate compared with published series using radiotherapy.

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