Laser Salvage Surgery for Recurrent Glottic Cancer after Radiotherapy

Choi, So Hee; Lee, Kang Dae; Mun, Hyo Sung; Kim, Sung Won; Kim, Young Rok; Yu, Tai Hyun

Abstract

BACKGROUND AND OBJECTIVES
Salvage surgery for recurrent glottic cancer after radiation failure has been reported in the literature as a treatment for total laryngectomy and partial laryngectomy (vertical partial laryngectomy, supracriocoid partial laryngectomy) in selected cases. Also, CO2 laser cordectomy has also been reported as a successful primary treatment for early glottic cancer. However, salvage laser surgery for recurrent glottic cancer has been rarely reported. Our experience of transoral laser cordectomy on recurrent glottic cancer after radiotherapy is reported.
SUBJECTS AND METHOD
Twelve patients with early recurrent glottic cancer after full-course radiotherapy (rT1a, n=4 ; rT1b, n=1 ; rT2, n=7) underwent laser cordectomy between October, 2002 and January, 2005. According to the European Laryngological Society Classification, they were found to have two type III, one type IV, and eight type V performed. One patient underwent type II at one side and type III at the other. Surgery in all the cases were performed at one stage with curative intent.
RESULTS
The mean follow-up interval was 30 months (range 17-44 months) with five out of 12 cases (42%) having local recurrence. Four of the five cases with local recurrence underwent total laryngectomy. Three cases were salvaged while one had additional recurrence. The other one was under palliative treatment. The local control rate was 58%, overall survival and disease specific survival rate was 100%. The mean hospitalized period was 6.4 days (range 2-26 days) after surgery, and tracheotomy was performed in four cases (duration : 3-20 days). There was no postoperative aspiration pneumonia and nasogastric tube was not performed in any of the cases.
CONCLUSION
Transoral laser microsurgery may be a feasible salvage method for recurrent glottic cancer to gain oncologic and functional results, and could be used as an organpreserving procedure with curative intent in selected cases.