Salvage Endoscopic Angiolytic KTP Laser Treatment of Early Glottic Cancer after Failed Radiotherapy

Objectives: The primary objectives were to report oncologic outcomes of transoral laser microsurgery with potassium-titanyl-phosphate (KTP) laser (TLM-KTP) ablation of early glottic cancer (EGC). The secondary objectives were to report vocal outcomes and to analyze factors that might influence outcomes. Methods: A multi-institutional, retrospective analysis of consecutive patients treated for T1 or T2 glottic squamous cell carcinoma undergoing TLM-KTP ablation with at least 2 years of follow-up was performed. Patients with prior radiation or surgery for laryngeal disease were excluded. Primary outcome measures included: surgical failures requiring radiation or laryngectomy, disease-specific survival (DSS), and overall survival (OS). Secondary outcome measures included: pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. The effects of smoking status, stage, and anterior commissure involvement on outcomes were analyzed. Results: Overall 88 patients met inclusion criteria (83% male, 79.5% current or former smokers). Mean age was 68 (standard deviation (SD): 12). Mean follow-up was 39.5 months (SD: 15.3). Staging included 50 T1a, 21 T1b, and 20 T2 tumors, including three metachronous second primaries. Radiation and/or laryngectomy avoidance was achieved in 87/88 (98.9%) of patients, inclusive of 24 patients requiring KTP re-treatments. Two patients had biopsy-proven recurrence (2.3%), but only 21 of 24 re-treated patients received a formal biopsy. No patients died from laryngeal cancer. DSS and OS were 100% and 92.3%, respectively. The mean VHI-10 scores were 19.3 preoperatively, 3.8 at 6-months postop, and 3.8 at 2-years postop. Smokers had a longer interval to re-treatment ( P = .03), patients with T2 lesions had a shorter interval to re-treatment (0.02), and patients with T2 lesions presented with worse initial VHI-10 scores (0.002). Conclusions: A multi-institutional, retrospective case series of TLM-KTP ablation of EGC demonstrated excellent oncologic outcomes when close surveillance and proactive re-treatments were utilized. Disease-specific survival, overall survival, and vocal function were excellent. Additional studies are necessary to further analyze the merits and risks of this treatment approach.

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CO 2 Laser Cordectomy Versus KTP Laser Tumor Ablation for Early Glottic Cancer: A Randomized Controlled Trial

Lasers in Surgery and Medicine ◽

10.1002/lsm.23202 ◽

2019 ◽

Vol 52 (7) ◽

pp. 612-620 ◽

Cited By ~ 1

Author(s):

Yonatan Lahav ◽

Oded Cohen ◽

Yael Shapira‐Galitz ◽

Doron Halperin ◽

Hagit Shoffel‐Havakuk

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Tumor Ablation ◽

Glottic Cancer ◽

Ktp Laser ◽

Early Glottic Cancer ◽

Randomized Controlled ◽

Laser Cordectomy

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Vocal Fold Cyst Formation after Photoangiolytic KTP Laser Treatment of Early Glottic Cancer

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211022233 ◽

2021 ◽

pp. 000348942110222

Author(s):

Kenneth Yan ◽

Aaron D. Friedman

Keyword(s):

Vocal Fold ◽

Retrospective Chart Review ◽

Cyst Formation ◽

Glottic Cancer ◽

Ktp Laser ◽

Glottic Carcinoma ◽

Early Glottic Cancer ◽

Vocal Process ◽

Tumor Distribution

Objective: The incidence of post-operative glottic cyst (POGC) formation in patients treated with transoral laser microsurgery with potassium-titanyl-phosphate laser (TLM-KTP) photoablation of early glottic carcinoma (EGC) has not previously been described. Methods: A retrospective chart review was performed to identify all patients with early glottic cancer who underwent with single-modality TLM-KTP at our institution. Each patient received regular follow up with videostroboscopy for tumor surveillance. New glottic cysts seen on surveillance examinations were noted and their management was documented. Results: A total of 33 patients met inclusion criteria. Eight patients (24%) developed POGC’s within the original geographic perimeter of the cancerous vocal fold(s): 6 in the infraglottic region and 2 near the vocal process, at an average of 8 months after their initial cancer surgery. Of these 8 POGC’s, 7 were at the periphery of the original tumor distribution and 1 was in the center of it. No POGC’s were associated with any change in voice. Four of the 8 POGC’s were phonosurgically excised, all without evidence of malignancy on pathology. The remaining 4 were monitored: 2 were stable for an average of 49 months of follow up; the remaining 2 resolved spontaneously by 7 and 31 months after first identification. Conclusions: POGC’s are a frequent sequela of TLM-KTP for EGC. While these results suggest that they are unlikely to represent submucosal recurrences, surgeons should have a low threshold to biopsy if there is clinical concern for such and should counsel patients pre-operatively about the potential for their formation.

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Photoangiolytic Laser Treatment of Early Glottic Cancer: A New Management Strategy

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894081170s701 ◽

2008 ◽

Vol 117 (7_suppl) ◽

pp. 3-24 ◽

Cited By ~ 51

Author(s):

Steven M. Zeitels ◽

James A. Burns ◽

Gerardo Lopez-Guerra ◽

R. Rox Anderson ◽

Robert E. Hillman

Keyword(s):

Laser Treatment ◽

Management Strategy ◽

Glottic Cancer ◽

Early Glottic Cancer

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Result of Laser Cordectomy in Early Glottic Cancer and Observation of Malignant Transformation from Precancerous Lesion

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2010.53.7.425 ◽

2010 ◽

Vol 53 (7) ◽

pp. 425

Author(s):

Dongbin Ahn ◽

Ji Hyun Park ◽

Sung Jae Heo ◽

Chang Mook Park ◽

Da Jung Jung ◽

...

Keyword(s):

Malignant Transformation ◽

Precancerous Lesion ◽

Glottic Cancer ◽

Early Glottic Cancer ◽

Laser Cordectomy

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Comparison of Voice Outcomes in Early Glottic Cancer Patients after Laser Surgery or Radiotherapy

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2012.55.11.701 ◽

2012 ◽

Vol 55 (11) ◽

pp. 701 ◽

Cited By ~ 1

Author(s):

Su Hyun Ahn ◽

Jun Hyun Kim ◽

Su Hyun Lee ◽

Woo Jin Kim ◽

Dong-Hoon Kim ◽

...

Keyword(s):

Cancer Patients ◽

Laser Surgery ◽

Glottic Cancer ◽

Early Glottic Cancer

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Evolution of voice after transoral laser cordectomy for precancerous lesions and early glottic cancer

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06751-3 ◽

2021 ◽

Author(s):

Lucia Staníková ◽

Karol Zeleník ◽

Martin Formánek ◽

Jana Seko ◽

Radana Walderová ◽

...

Keyword(s):

Precancerous Lesions ◽

Voice Quality ◽

Quality Parameters ◽

Substantial Improvement ◽

Glottic Cancer ◽

Early Glottic Cancer ◽

Post Surgery ◽

Group I ◽

Group Ii ◽

Laser Cordectomy

Abstract Purpose To evaluate voice quality evolution after a transoral laser cordectomy (TLC) for precancerous lesions and early glottic cancer. Methods This prospective study enrolled 18 patients scheduled for TLC for high-grade dysplasia, Tis, T1, and T2 glottic squamous cell cancers, from May 2017 to March 2020. Patients were grouped according to the extent of TLC: Group I (n = 11, 61.1%): unilateral subepithelial or subligamental cordectomy; Group II (n = 7, 38.9%): unilateral transmuscular, total, or extended cordectomy. Voice quality parameters, including dysphonia grade (G), roughness (R), breathiness (B), maximal phonation time (MPT), jitter, and shimmer, were evaluated before, and at 6 weeks and 6 months after the TLC. Results In Group I, the degree of G and R items remained without substantial improvement 6 weeks after surgery; however, improved above the pre-surgery level up to 6 months after surgery. The MPT, jitter, and shimmer did not change significantly at 6 weeks or 6 months post-TLC. In Group II, G, R, and B remained significantly impaired even 6 months post-surgery. Jitter, and shimmer worsened at 6 weeks, but reached preoperative levels at 6 months post-surgery. MPT was significantly worse at 6 weeks and remained deteriorated at 6 months post-surgery. All measured parameters were significantly worse in Group II than in Group I at 6 weeks and 6 months post-surgery. No patient required a phonosurgical procedure. Conclusion After a TLC, voice quality evolution depended on the extent of surgery. It did not improve at 6 weeks post-surgery. Improvements in less extent cordectomies occurred between 6 weeks and 6 months post-surgery. Understanding voice development over time is important for counseling patients when considering phonosurgical procedures.

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