Elsevier

American Journal of Otolaryngology

Volume 29, Issue 2, March–April 2008, Pages 101-105
American Journal of Otolaryngology

Original contribution
Diode laser microsurgery for treatment of Tis and T1 glottic carcinomas

https://doi.org/10.1016/j.amjoto.2007.03.004Get rights and content

Abstract

Purpose

The aim of the study was to demonstrate the oncologic safety of diode laser surgery in the treatment of early glottic carcinoma.

Materials and methods

The study included 45 patients affected by Tis and T1 glottic squamous cell carcinomas and treated endoscopically by diode laser (60 W, 810 nm). The endoscopic resections were graded according to the European Laryngological Society Classification including 5 types of cordectomy. These cases were classified according to the 2002 American Joint Committee on Cancer-International Union Against Cancer (AJCC-UICC) TNM system and included 9 Tis (20%), 31 T1a (68.9%), and 5 T1b (11.1%) glottic carcinomas. The length of follow-up ranged from 24 to 86 months, with an average follow-up period of 36 months. The case study included 39 males (86.7%) and 6 females (13.3%), aged 35 to 81 years, with a mean age of 51 years.

Results

There were 5 recurrences (11.1%): 4 local (8.9%), in which 3 were salvaged, and 1 (2.2%) regional. Three patients (6.7%) developed second primary cancers on the controlateral cord after a mean of 18 months. All local recurrences occurred in patients with T1b lesions. Forty patients (88.9%) were alive and disease-free at a median follow-up of 36 months. The overall larynx preservation was 97.6%. The actuarial recurrence-free survival analysis by the Kaplan-Meier method showed a survival of 92.3% at 2 years, 89.2 at 5 years, and 85.6 at 7 years.

Conclusions

Diode laser microsurgery is an oncologically safe, function-preserving modality for the treatment of Tis and T1 glottic carcinomas. This surgical technique provides excellent local control of disease and laryngeal preservation.

Introduction

In 1915, Lynch [1] described 9 cases of endoscopic excision of early laryngeal cancer. In 1972, Strong and Jako [2] described 3 cases of laryngeal tumors treated with endoscopic approach with combined use of the carbon dioxide laser and the operating microscope. From 1980, the transoral approach with laser surgery was brought into prominence by the works of several authors. This technique allows early-stage tumors to be removed with minimal sacrifice of healthy tissue and with retention of good voice quality [3], [4], [5], [6], [7], [8]. Radiotherapy (RT) and open partial laryngectomy (OPL) achieve these objectives with more or less comparable results. Surgery is slightly superior in cure rate, but RT achieves better voice quality. Open partial laryngectomy also involves a temporary tracheotomy and a longer hospitalization.

The safety and value of the carbon dioxide and Nd:Yag lasers in endoscopic laryngeal microsurgery have been well documented for the treatment of glottic cancer. Recently, the technical evolution allowed the project of a new laser: the diode laser. Compared with the ND:Yag and carbon dioxide lasers, the diode laser is small, portable, versatile, and very simple to use. It has a stable power output, a rapid setup time, an expected long life, no installation costs, and it is virtually maintenance-free. To our knowledge, this report is the first in the literature about the laser diode surgery for the treatment of glottic cancer.

The aim of this study was to review the oncologic results in a series of 45 patients with Tis and T1 glottic cancer treated with endoscopic microsurgery by diode laser and to demonstrate the oncologic safety of diode laser surgery.

Section snippets

Materials and methods

Between January 1999 and July 2005, 61 patients affected by Tis and T1 glottic squamous cell carcinomas were endoscopically treated by diode laser at the ENT Department of the Hospital of Dolo (Venice, Italy). Data from 45 patients with a minimum follow-up of 24 months were analyzed. These cases were classified according to the 2002 AJCC-UICC TNM system and included 9 Tis (20%), 31 T1a (68.9%), and 5 T1b (11.1%) glottic carcinomas. Three patients with Tis carcinoma had distinct synchronous

Results

All patients were routinely admitted the day before surgery. The length of hospitalization ranged from 2 to 5 days with a mean of 2.2 days. No major complications were observed. The development of small granulomas was uncommon and they usually resorbed within a few weeks without any further surgery. In our series of 45 patients, we found a very low rate of glottic iatrogenic granulomas (6.6%). There were only 3 cases, all located in the posterior third of the vocal cord and resorbed within a

Discussion

Laser has been successfully used in endoscopic laryngeal surgery since 1980. The most used lasers in ENT practice are carbon dioxide, diode, and ND:Yag lasers. Diode lasers were introduced in the early 1980s with power outputs of around 100 mW, but they now have capabilities of several tens of watts of power and are widely used in industries. They are semiconductor devices that produce laser light from electrical currents passed through them and have a high electrical-to-optical efficiency:

Conclusions

Diode laser microsurgery is a safe and cost-effective procedure that offers good oncologic results and acceptable functional results in the treatment of Tis, T1a, and T1b vocal cord cancer. Local control rates and overall survival obtained in our series are comparable to those reported after RT. Diode laser is very attractive as it is small, compact, portable, efficient, relatively quiet, and very simple to use. It has a stable power output, an expected long life, no installation costs, and is

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