This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on Web of Science (6)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Laryngology/ Speech/ Language Pathology  • Neoplasms of Head & Neck  • Surgery  • Laser Surgery  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

Michael L. Hinni, MD; John R. Salassa, MD; David G. Grant, MD; Bruce W. Pearson, MD; Richard E. Hayden, MD; Alexios Martin, MD; Hans Christiansen, MD; Bruce H. Haughey, MD; Brian Nussenbaum, MD; Wolfgang Steiner, MD

Arch Otolaryngol Head Neck Surg. 2007;133(12):1198-1204.

Objective  To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer.

Design  Prospective case series study.

Setting  Multi-institution (academic, tertiary referral centers).

Patients  A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years.

Interventions  Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients.

Main Outcome Measures  End points analyzed included laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined.

Results  The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent.

Conclusions  In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Scottsdale (Drs Hinni and Hayden); Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Jacksonville, Jacksonville, Florida (Drs Salassa, Grant, and Pearson); Departments of Otolaryngology–Head and Neck Surgery (Drs Martin and Steiner) and Radiotherapy (Dr Christiansen), University of Göttingen, Göttingen, Germany; and Department of Otolaryngology–Head and Neck Surgery, Washington University, St Louis, Missouri (Drs Haughey and Nussenbaum).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?