Oncologic outcomes of KTP laser surgery versus radiation for T1 glottic carcinoma

Outcomes of KTP Laser Ablation in Glottic Neoplasms: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the safety and clinical effectiveness of transoral laser microsurgery (TLM) with potassium-titanyl-phosphate (KTP) laser ablation for glottic neoplasms.

DATA SOURCE

MEDLINE via PubMed, SCOPUS, Web of Science, and Cochrane Library.

REVIEW METHODS

A systematic review and meta-analysis of studies assessing the safety and efficacy of KTP laser therapy in patients with early-stage glottic neoplasms.

RESULTS

Eight studies were included. After an average follow-up of 3.3 years, the overall survival and disease-free survival for patients who underwent KTP were 90.7% (95% CI 85%-96.5%) and 98.5% (95% CI 97.3%-99.8%), respectively. In the single-arm meta-analysis, the pooled estimate of recurrence was 7.7% (95% CI 3.4%-12%). The overall voice handicap index (VHI) estimate attributed to KTP in the single-arm meta-analysis was 6.76 (95% CI [3.05, 10.48]) and 5.21 (95% CI [2.86, 7.56]) within 6 months and after a one-year follow-up, respectively.

CONCLUSION

KTP laser ablation is a safe and effective method for treating patients with early glottic neoplasms. Laryngoscope, 2023.

Comparison of Oncologic Outcomes Between Radiation Therapy and Transoral Laser Microsurgery for Early Glottic and Supraglottic Squamous Cell Carcinoma; a Retrospective Cohort Study with Literature Review

Background: Laryngeal cancer is known as the second most common airway cancer. These tumors are usually diagnosed early; thus, it is important to choose the optimal treatment modality. Several studies are comparing transoral laser microsurgery (TLM) and radiotherapy in early-stage laryngeal cancer. Due to a paucity of high-quality research and the lack of conclusive randomized prospective studies, standard care for early glottic cancer is still a matter of controversy. Methods: In this retrospective cohort study, T1-T2N0M0 laryngeal cancer patients who underwent TLM or radiotherapy were compared with statistical methods in terms of Recurrence Rate, Organ (Larynx) Preservation Rate, Mortality Rate, and Overall Survival. Results: A total of 123 patients were evaluated in this study, 65 of whom underwent TLM and 58 underwent radiotherapy. There was no significant difference in demographic and medical characteristics of patients. The rate of recurrence was 27.3% in the TLM group and 43.6% in the radiotherapy group. There was no significant difference between the two groups (P = 0.114). Overall mortality rate (5.4% vs 39.6%, P = 0.001), Disease-specific mortality rate (5.5% vs 39.9%, P = 0.001), and aorgan preservation rate (98.5%vs 89.7%, P = 0.035) were all in favor of TLM. Conclusions: TLM appears to be the treatment of choice in patients with early laryngeal cancer due to a better overall survival rate, lower disease-specific mortality rate, and better organ preservation rate than definitive radiotherapy.

Phonosurgery: A review of current methodologies

Cold-steel has served as the gold standard modality of phonosurgery for most of its history. Surgical laser technology has revolutionized this field with its wide use of applications. Additional modalities have also been introduced such as coagulative lasers, photodynamic therapy, and cryotherapy. This review will compare the surgical modalities of cold steel, surgical lasers, phototherapy and cryotherapy. The mechanism of action, tissue effects and typical uses will be addressed for each modality.

T1 glottic laryngeal cancer: the role of routine follow-up visits in detecting local recurrence

Purpose

We assessed the treatment outcome and the benefits of routine follow-up visits in T1 glottic laryngeal squamous cell carcinoma (LSCC).

Methods

Medical records of patients diagnosed with stage T1 glottic LSCC (N = 303) in five Finnish university hospitals between 2003 and 2015 were reviewed. Moreover, data from the Finnish Cancer Registry and the Population Register Center were collected.

Results

Of all 38 recurrences, 26 (68%) were detected during a routine follow-up visit, and over half (21 of 38, 55%) presented without new symptoms. Primary treatment method (surgery vs. radiotherapy) was not connected with 5-year disease-specific survival (DSS) or laryngeal preservation rate.

Conclusion

The majority of recurrences were detected on a routine follow-up visit, and local recurrences often presented without new symptoms. Routine post-treatment follow-up of T1 glottic LSCC seems beneficial.

Trial registration

Trial registration number and date of registration HUS/356/2017 11.12.2017.

Surgery versus radiotherapy: Long term outcomes of T1 glottic cancer

Aim

The aim of this study was to compare the outcomes, patterns of failure and laryngeal preservation rates in patients with T1N0 glottic cancer treated with surgery or radiotherapy.

Materials/methods

Retrospective study of T1N0 glottic cancer patients treated in our institution between January 2007 and December 2017. Histologically proven squamous cell carcinoma patients, treated with upfront cordectomy/partial laryngectomy (S group) or radiotherapy (RT group) were included. Elective treatment of the neck was not permitted. Local failure (LF), disease-free survival (DFS), ultimate disease-free survival (UDFS), laryngectomy-free survival (LFS), disease-specific mortality (DSM) and overall survival (OS) were evaluated.

Results

Two hundred and one patients were eligible (172 S group, 29 RT group), with a median follow-up of 38.8 months. Overall, 33 (16%) patients had a recurrence, 30 (17%) in the S group and 3 (10%) in the RT group. Local failure was the predominant site of failure (28 S, 2 RT). Overall, of all those that were salvaged, 17 (8%) underwent total laryngectomy (15 S, 2 RT). There was no significant difference in the 5-year cumulative incidence of LF (20.8% S, 8.1% RT, p = 0.138), 5-y LFS (85.0% vs. 91.7%, p = 0.809), 5-y DFS (67.5% vs. 82.1%, p = 0.343), 5-y UDFS (82.5% vs. 90.3%, p = 0.647) and 5-y OS (84.5% vs. 90.3%, p = 0.892). Multivariate analysis showed no correlation between initial treatment and the analyzed outcomes.

Conclusion

Primary surgery or radiotherapy were similar first line options, since they do not differ in all outcomes. Patients' and physician's preferences must be considered when choosing first treatment.

KTP Laser Treatment of Early Glottic Cancer: A Multi-Institutional Retrospective Study

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.

Transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma

OBJECTIVES

To investigate the effective and safety of transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma by compared with CO2 laser surgery.

MATERIALS AND METHODS

From September 2015 to July 2018, 44 patients with early glottic carcinoma underwent transoral microsurgery were divided into 980-nm/1470-nm dual-wavelength fiber laser surgery (Dual-wavelength fiber laser group) and CO2 laser surgery (CO2 laser group). The operative time, number of other hemostatic devices used, postoperative blood loss, surgical complications and postoperative length of hospital stay The time of mucosal epithelialization and Voice Handicap Index-10(VHI-10) in pre-operation, 1-month postoperation and 6-month postoperation in both two groupswere retrospectively analyzed.

RESULTS

All the patients underwent successful operation and all the tumors received en-bloc resection with negative margins. The median operative time in Dual-wavelength laser group was faster than CO₂ laser group (32.00 min vs 37.50 min, p = 0.014). There was no statistically significant difference between the two groups in the median postoperative hospital stay and the median time of mucosal epithelialization. No patient need feeding tubes place temporarily or permanently in both two groups. Tongue numbness, tear of the palatal arch, postoperative vocal cord adhesion, VHI-10 score in Pre-operation, 1-month postoperation and 6-month postoperation were similar in both two group. No recurrence was reported in both groups during follow-up.

CONCLUSION

Compared to the CO₂ laser surgery, transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery is a safe and feasible procedure for early-stage glottic carcinoma. It can provide clearer surgical field without hemorrhage and make the operation simpler, smoother and faster.

Randomized controlled single-blinded clinical trial of functional voice outcome after vascular targeting KTP laser microsurgery of early laryngeal cancer

Background

Local control rate (LCR) of early glottic cancer is high after radiation therapy or transoral laser microsurgery (TLM). The aim of this study was to investigate functional voice outcome after TLM using a microvessel‐ablative potassium‐titanyl‐phosphate (KTP) laser in comparison with a gold standard cutting CO₂ laser.

Methods

The primary end point of this prospective, randomized, single‐blinded, clinical phase II study with control group was voice outcome during a follow‐up of 6 months assayed by Voice Handicap Index (VHI‐30)‐questionnaires in patients with unilateral high‐grade dysplasia, carcinoma in situ or early glottic cancer undergoing TLM‐KTP (n = 8) or TLM‐CO₂ (n = 12). The secondary end point was LCR.

Results

Starting from the 9‐week‐follow‐up visit, TLM‐KTP yielded significantly reduced VHI scores compared to TLM‐CO₂. No relapse occurred after TLM‐KTP in contrast to one recurrence after TLM‐CO₂ within 6 months.

Conclusion

Multicenter phase II or III studies on voice outcome or local control rate after TLM‐KTP in early glottic cancer are warranted enrolling larger patient cohorts.

Radiotherapy vs surgery for T1-2N0M0 laryngeal squamous cell carcinoma: A population-based and propensity score matching study

There are conflicting reports about whether radiotherapy or surgery is optimal for early‐stage laryngeal squamous cell carcinoma (LSCC), although both have recently been recommended. Patients with T1‐2N0M0 LSCC in the population‐based SEER database who underwent radiotherapy or surgery were reviewed. Propensity score matching was used to eliminate the baseline variations. After matching, 1913 pairs of patients were included. Overall, patients who received radiotherapy had worse cancer‐specific survival than patients with surgery. After stratification, the survival in patients who received radiotherapy was worse with respect to the following characteristics: ≤60 years of age; T1a glottis cancer; well‐differentiated tumors; and with married status. In other patients, survival outcomes were similar in patients who received radiotherapy and underwent surgery. Our results indicate that radiotherapy is not preferable in early‐stage LSCC patients who are ≤60 years of age, have T1a glottis cancer or well‐differentiated tumors, or are married. In other patients, both radiotherapy and surgery are comparable. However, our results cannot be a reference before controlled, prospective trials are performed.