Transoral laser microsurgery in early glottic carcinoma: an Egyptian experience

Background This is a prospective study evaluating oncologic outcomes of early glottic carcinoma treated with transoral laser micro-laryngeal (TLM) surgery in two tertiary referral hospital. Patients who underwent TLM for early glottic carcinoma at the Otolaryngology Department and National Cancer Institute-Cairo University during the period between January 2016 and July 2019 who met inclusion criteria were included in the study. Operative and postoperative complications were assessed. Patients were followed up to assess loco-regional control. Results Thirty-three patients were included in the study. There were no operative complications. Median postoperative pain score was 3. Median duration of procedure was 15 min. None of the patients experienced postoperative bleeding or airway complications. There was no return to hospital within 30 days for complications. Median follow-up was 24 months. Disease-free survival was 97%. Overall survival was 100%. Conclusion Transoral laser microsurgery is a secure and successful choice for the treatment of glottic carcinomas, related to negligible morbidity and great local control.

Videolaryngostroboscopy in early vocal fold carcinoma diagnosis

Introduction/Objective. Vocal folds are the most common primary site of laryngeal carcinoma. Advancement in diagnostic and therapeutic modalities have provided better prognosis for patients with early glottic carcinoma. We aimed to report the role of videolaryngostroboscopy (VLS) in early diagnosis of vocal fold carcinoma. Methods. Prospective controlled study included 300 dysphonic patients admitted to the tertiary medical center for microlaryngoscopy with biopsy. All patients underwent stroboscopic examination prior to biopsy. VLS findings were classified according to Hirano into 4 stages, with a adynamic vocal fold segment and absence of vocal fold vibration, suspected for vocal fold carcinoma as a stage IV. Histopathological findings have been graded according to Ljubljana classification into simple hyperplasia, abnormal hyperplasia, atypical hyperplasia and carcinoma in situ. Results. Analysis of VLS findings showed that 41.67% of patients (n = 125/300) had asymmetrical and irregular vocal fold vibration with a mucosal wave reduction (VLS stage III) while adynamic vocal fold segment and absence of vocal fold vibration (VLS stage IV), suspected for vocal fold carcinoma, was noticed in 17.33% of patients (n = 52/300). HP report showed that vocal fold carcinoma was verified in 5.6% of patients in VLS stage III (n = 7/125), while in VLS stage IV carcinoma was detected in 26.92% of patients (n = 14/52). Adynamic segment or entire nonvibrating vocal fold finding predicts early glottic carcinoma with a sensitivity of 66.77%, specificity of 86.4%, and moderate diagnostic accuracy (AUC = 0.844). Conclusion. VLS plays an important role as a timely indicator for microlaryngoscopy with biopsy in diagnosis of vocal fold carcinoma.

T1 Glottic Cancer: Does Anterior Commissure Involvement Worsen Prognosis?

Radiotherapy (RT) and transoral laser microsurgery (TLM) represent the main treatment modalities for early glottic carcinoma. Local failure is notoriously more frequent in T1b glottic cancer in comparison to T1a and T2 tumors. In this scenario, the role of anterior commissure (AC) involvement is still controversial. The aim of the present study was therefore to determine its potential prognostic power in worsening patients’ survival and outcomes. We categorized different tumor glottic fold locations with respect to the involvement of one (T1a) or both vocal cords, with or without AC involvement. We analyzed a retrospective cohort of 74 patients affected by Stage I glottic cancer, treated between 2011 and 2018 by TLM or RT at a single academic institution. There were 22 T1a (30%) and 52 T1b (70%) cases. The median follow-up period was 30 months (mean, 32.09 ± 18.738 months; range, 12–79). Three-year overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and laryngectomy-free survival (LFS) were compared according to tumor location, extension, and cT category. According to both uni- and multivariate analyses, an increased risk for recurrence in T1b with AC involvement and T1a tumors was 7.31 and 9.45 times, respectively (p-values of 0.054 and 0.030, respectively). Among the 17 recurrences, T1b with AC involvement experienced 15 tumor relapses (88.2%), thus significantly affecting both the RFS and LFS in comparison to the other two tumor subcategories (T1a, p = 0.028 and T1b without AC involvement, p = 0.043). The deteriorating prognosis in the presence of AC involvement likely reflects the need to power the hazard consistency and discrimination of the T1b category when associated with such a risk factor, thus deserving an independent T category.