nach oben

European Archives of Oto-Rhino-Laryngology

Erschienen in:

13.02.2018 | Laryngology

Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO₂ laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients

verfasst von: Filippo Carta, Fabrizio Bandino, Aurora Marta Olla, Natalia Chuchueva, Clara Gerosa, Roberto Puxeddu

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

CO₂ laser transoral microsurgery for glottic carcinoma, when indicated, has the well-established advantages of low morbidity and positive oncological outcomes. The present study aims to determine how patient age, and tumor site could negatively impact prognosis; other variables such as the status of the margins of resection, tobacco and alcohol intake, and the grade of differentiation of the tumors have been evaluated.

Methods

This was a retrospective analysis on 261 patients with a glottic carcinoma who underwent CO₂ laser transoral microsurgery. The impact of different variables was calculated using univariate and multivariate analyses.

Results

The study included 248 males and 13 females. The median follow-up period was 4.3 years. Five-year disease-specific survival, recurrence-free survival, local control with laser alone, overall laryngeal preservation, and overall survival rates were 99.4, 92.2, 93.8, 97.6, and 85.5%, respectively. Equivalent results were observed in young and elderly patients. Patients with positive margins after CO₂ laser transoral microsurgery showed a reduced local control with laser alone. T2 patients with true subglottic spreading and patients with anterior commissure involvement of grade 3 (Rucci’s classification) experienced worse local control rates, despite free surgical margins confirmed by histology.

Conclusions

CO₂ laser transoral microsurgery is an effective and reproducible single-stage modality therapy for young and elderly patients with glottic carcinoma. Superficial close margins can be managed by a careful wait-and-see policy, while positive margins should undergo surgical enlargement. In our experience, undifferentiated tumors, true subglottic extension, and anterior commissure involvement of grade 3 were associated with worse outcomes.

Nur mit Berechtigung zugänglich

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin D, Forman D, Bray F (2015) Int J Cancer 136:E359–E386. https://doi.org/10.1002/ijc.29210 CrossRefPubMed

Gioacchini FM, Tulli M, Kaleci S, Bondi S, Bussi M, Re M (2017) Therapeutic modalities and oncologic outcomes in the treatment of T1b glottic squamous cell carcinoma: a systematic review. Eur Arch Otorhinolaryngol 274:4091–4102. https://doi.org/10.1007/s00405-017-4736-z CrossRefPubMed

Strong MS, Jako GJ (1972) Laser surgery in the larynx. Early clinical experience with continuous CO₂ laser. Ann Otol Rhinol Laryngol 81:791–798. https://doi.org/10.1177/000348947208100606 CrossRefPubMed

Steiner W, Jaumann MP, Pesch HJ (1980) Endoscopic laser surgery of the larynx. Ther Umsch 37:1103–1109PubMed

Steiner W (1988) Experience in endoscopic laser surgery of malignant tumours of the upper aero-digestive tract. Adv Otorhinolaryngol 39:135–144. https://doi.org/10.1159/000415662 PubMed

Steiner W, Vogt P, Ambrosch P, Kron M (2004) Transoral carbon dioxide laser microsurgery for recurrent glottic carcinoma after radiotherapy. Head Neck 26:477–484. https://doi.org/10.1002/hed.20009 CrossRefPubMed

Peretti G, Piazza C, Cocco D, de Benedetto L, del Bon F, de Zinis RLO, Nicolai P (2010) Transoral CO₂ laser treatment for T_is-T₃ glottic cancer: the University of Brescia experience on 595 patients. Head Neck 32:977–983. https://doi.org/10.1002/hed.21278 CrossRefPubMed

Ledda GP, Puxeddu R (2006) Carbon dioxide laser microsurgery for early glottic carcinoma. Otolaryngol Head Neck Surg 134:911–915. https://doi.org/10.1016/j.otohns.2005.10.049 CrossRefPubMed

Rödel RM, Steiner W, Müller RM, Kron M, Matthias C (2009) Endoscopic laser surgery of early glottic cancer: involvement of the anterior commissure. Head Neck 31:583–592. https://doi.org/10.1002/hed.20993 CrossRefPubMed

10.

Ledda GP, Grover N, Pundir V, Masala E, Puxeddu R (2006) Functional outcomes after CO₂ laser treatment of early glottic carcinoma. Laryngoscope 116:1007–1011. https://doi.org/10.1097/01.mlg.0000217557.45491.bd CrossRefPubMed

11.

Puxeddu R, Sionis S, Gerosa C, Carta F (2015) Enhanced contact endoscopy for the detection of neoangiogenesis in tumors of the larynx and hypopharynx. Laryngoscope 125:1600–1606. https://doi.org/10.1002/lary.25124 CrossRefPubMed

12.

Remacle M, Eckel HE, Antonelli A, Brasnu D, Chevalier D, Friedrich G, Olofsson J, Rudert HH, Thumfart W, de Vincentiis M, Wustrow TP (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 257:227–231. https://doi.org/10.1007/s004050050228 CrossRefPubMed

13.

Remacle M, van Haverbeke C, Eckel H, Bradley P, Chevalier D, Djukic V, de Vicentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J (2007) Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 264:499–504. https://doi.org/10.1007/s00405-007-0279-z (Erratum in: Remacle M, van Haverbeke C, Eckel H, Bradley P, Chevalier D, Djukic V, de Vicentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J (2007) Eur Arch Otorhinolaryngol 264:709) CrossRefPubMed

14.

Rucci L, Gammarota L, Gallo O (1996) Carcinoma of the anterior commissure of the larynx: II. Proposal of a new staging system. Ann Otol Rhinol Laryngol 105:391–396. https://doi.org/10.1177/000348949610500512 CrossRefPubMed

15.

Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumours. Wiley, Oxford

16.

Roman BR, Goldenberg D, Givi B (2016) AHNS series-do you know your guidelines? Guideline recommended follow-up and surveillance of head and neck cancer survivors. Head Neck 38:168–174. https://doi.org/10.1002/hed.24100 CrossRefPubMed

17.

Goor KM, Peeters AJ, Mahieu HF, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM, van Agthoven M (2007) Cordectomy by CO₂ laser or radiotherapy for small T1a glottic carcinomas: costs, local control, survival, quality of life, and voice quality. Head Neck 29:128–136. https://doi.org/10.1002/hed.20500 CrossRefPubMed

18.

Fiorini FR, Deganello A, Larotonda G, Mannelli G, Gallo O (2014) Tobacco exposure and complications in conservative laryngeal surgery. Cancers 6:1727–1735. https://doi.org/10.3390/cancers6031727 CrossRefPubMedPubMedCentral

19.

Mo HL, Li J, Yang X, Zhang F, Xiong JW, Yang ZL, Tan J, Li B (2017) Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and meta-analysis. Lasers Med Sci 32:461–467. https://doi.org/10.1007/s10103-016-2103-8 CrossRefPubMed

20.

Piazza C, del Bon F, Paderno A, Grazioli P, Perotti P, Barbieri D, Majorana A, Bardellini E, Peretti G, Nicolai P (2016) The diagnostic value of narrow band imaging in different oral and oropharyngeal subsites. Eur Arch Otorhinolaryngol 273:3347–3353. https://doi.org/10.1007/s00405-016-3925-5 CrossRefPubMed

21.

Pittore B, Ismail-Koch H, Davis A, Parodo G, Ledda GP, Brennan PA, Puxeddu R (2009) Thyroarytenoid muscle invasion in T1 glottic carcinoma. Eur Arch Otorhinolaryngol 266:1787–1791. https://doi.org/10.1007/s00405-009-0929-4 CrossRefPubMed

22.

Piazza C, Paderno A, Grazioli P, Del Bon F, Montalto N, Perotti P, Morello R, Filauro M, Nicolai P, Peretti G (2017) Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery. Laryngoscope. https://doi.org/10.1002/lary.26861

23.

Piazza C, Mangili S, Bon FD, Paderno A, Grazioli P, Barbieri D, Perotti P, Garofolo S, Nicolai P, Peretti G (2014) Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the laryngoscore. Laryngoscope 124:2561–2567. https://doi.org/10.1002/lary.24803 CrossRefPubMed

24.

Hoffmann C, Cornu N, Hans S, Sadoughi B, Badoual C, Brasnu D (2016) Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy. Laryngoscope 126:1817–1822. https://doi.org/10.1002/lary.25757 CrossRefPubMed

25.

Ansarin M, Cattaneo A, de Benedetto L, Zorzi S, Lombardi F, Alterio D, Rocca MC, Scelsi D, Preda L, Chiesa F, Santoro L (2017) Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery. Head Neck 39:71–81. https://doi.org/10.1002/hed.24534 CrossRefPubMed

26.

Sjögren EV (2017) Transoral laser microsurgery in early glottic lesions. Curr Otorhinolaryngol Rep 5:56–68. https://doi.org/10.1007/s40136-017-0148-2 CrossRefPubMedPubMedCentral

27.

Shoffel-Havakuk H, Lahav Y, Davidi ES, Haimovich Y, Hain M, Halperin D (2016) The role of separate margins sampling in endoscopic laser surgery for early glottic cancer. Acta Otolaryngol 136:491–496. https://doi.org/10.3109/00016489.2015.1132843 CrossRefPubMed

28.

Fiz I, Mazzola F, Fiz F, Marchi F, Filauro M, Paderno A, Parrinello G, Piazza C, Peretti G (2017) Impact of close and positive margins in transoral laser microsurgery for Tis-T2 glottic cancer. Front Oncol 7:245. https://doi.org/10.3389/fonc.2017.00245 CrossRefPubMedPubMedCentral

29.

Aluffi Valletti P, Taranto F, Chiesa A, Pia F, Valente G (2017) Impact of resection margin status on oncological outcomes after CO2 laser cordectomy. Acta Otorhinolaryngol Ital. https://doi.org/10.14639/0392-100X-870 PubMed

30.

Bagatella F, Bignardi L (1981) Morphological study of the laryngeal anterior commissure with regard to the spread of cancer. Acta Otolaryngol 92:167–171. https://doi.org/10.3109/00016488109133252 CrossRefPubMed

31.

Tillmann B, Paulsen F, Werner JA (1994) Structures of the anterior commissure of the larynx. Biomechanical and clinical aspects. Laryngorhinootologie 73:423–427. https://doi.org/10.1055/s-2007-997165 CrossRefPubMed

32.

Eckel HE (2001) Local recurrences following transoral laser surgery for early glottic carcinoma: frequency, management, and outcome. Ann Otol Rhinol Laryngol 110:7–15. https://doi.org/10.1177/000348940111000102 CrossRefPubMed

33.

Zeitels SM, Burns JA, Dailey SH (2004) Suspension laryngoscopy revisited. Ann Otol Rhinol Laryngol 113:16–22. https://doi.org/10.1177/000348940411300104 CrossRefPubMed

34.

Peretti G, Piazza C, Mensi MC, Magnoni L, Bolzoni A (2005) Endoscopic treatment of cT2 glottic carcinoma: prognostic impact of different pT subcategories. Ann Otol Rhinol Laryngol 114:579–586. https://doi.org/10.1177/000348940511400801 CrossRefPubMed

35.

Peretti G, Piazza C, Mora F, Garofolo S, Guastini L (2016) Reasonable limits for transoral laser microsurgery in laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 24:135–139. https://doi.org/10.1097/moo.0000000000000240 CrossRefPubMed

36.

Peretti G, Piazza C, Del Bon F, Mora R, Grazioli P, Barbieri D, Mangili S, Nicolai P (2013) Function preservation using transoral laser surgery for T2–T3 glottic cancer: oncologic, vocal, and swallowing outcomes. Eur Arch Otorhinolaryngol 270:2275–2281. https://doi.org/10.1007/s00405-013-2461-9 CrossRefPubMed

37.

Blanch J-L, Vilaseca I, Caballero M, Moragas M, Berenguer J, Bernal-Sprekelsen M (2011) Outcome of transoral laser microsurgery for T2–T3 tumors growing in the laryngeal anterior commissure. Head Neck 33:1252–1259. https://doi.org/10.1002/hed.21605 CrossRefPubMed

38.

Canis M, Ihler F, Martin A, Wolff HA, Matthias C, Steiner W (2014) Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery. Head Neck 36:652–659. https://doi.org/10.1002/hed.23338 CrossRefPubMed

39.

Vilaseca I, Bernal-Sprekelsen M, Luis Blanch J (2010) Transoral laser microsurgery for T3 laryngeal tumors: prognostic factors. Head Neck 32:929–938. https://doi.org/10.1002/hed.21288 PubMed

40.

Page C, Mortuaire G, Mouawad F, Ganry O, Darras J, Pasquesoone X, Chevalier D (2013) Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) in the management of laryngeal carcinoma: oncologic results. A 35-year experience. Eur Arch Otorhinolaryngol 270:1927–1932. https://doi.org/10.1007/s00405-012-2300-4 CrossRefPubMed

41.

Sessions DG, Ogura JH, Fried MP (1975) Carcinoma of the subglottic area. Laryngoscope 85:1417–1423. https://doi.org/10.1288/00005537-197509000-00001 CrossRefPubMed

42.

Ansarin M, Cattaneo A, Santoro L, Massaro M, Zorzi S, Grosso E, Preda L, Alterio D (2010) Laser surgery of early glottic cancer in elderly. Acta Otorhinolaryngol Ital 30:169–174PubMedPubMedCentral

43.

Ravanelli M, Farina D, Rizzardi P, Botturi E, Prandolini P, Mangili S, Peretti G, Nicolai P, Maroldi R (2013) MR with surface coils in the follow-up after endoscopic laser resection for glottic squamous cell carcinoma: feasibility and diagnostic accuracy. Neuroradiology 55:225–232. https://doi.org/10.1007/s00234-012-1128-3 CrossRefPubMed

44.

Lucioni M, Bertolin A, Lionello M, Giacomelli L, Rizzotto G, Marioni G (2016) Open partial horizontal laryngectomy for salvage after failure of CO(2) laser-assisted surgery for glottic carcinoma. Eur Arch Otorhinolaryngol 273:169–175. https://doi.org/10.1007/s00405-015-3734-2 CrossRefPubMed

45.

Rennemo E, Zätterström U, Boysen M (2008) Impact of second primary tumors on survival in head and neck cancer: an analysis of 2063 cases. Laryngoscope 118:1350–1356. https://doi.org/10.1097/MLG.0b013e318172ef9a CrossRefPubMed

Titel: Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients
verfasst von: Filippo Carta
Fabrizio Bandino
Aurora Marta Olla
Natalia Chuchueva
Clara Gerosa
Roberto Puxeddu
Publikationsdatum: 13.02.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Archives of Oto-Rhino-Laryngology / Ausgabe 5/2018
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-018-4890-y

Neu im Fachgebiet HNO

16.04.2024 | HNO-Chirurgie | Nachrichten

Update HNO

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO₂ laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet HNO

HNO-Op. auch mit über 90?

Intrakapsuläre Tonsillektomie gewinnt an Boden

Bilateraler Hörsturz hat eine schlechte Prognose

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Update HNO

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2018

Pharyngeal fistulas after total laryngectomy with and without tracheostoma plasty according to Herrmann

Towards an in vitro fibrogenesis model of human vocal fold scarring

Sentinel lymph node biopsy in cutaneous head and neck melanoma

Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection

Authors’ response to Commentary on “European status on temporal bone training: a questionnaire study”

Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques

Neu im Fachgebiet HNO

HNO-Op. auch mit über 90?

Intrakapsuläre Tonsillektomie gewinnt an Boden

Bilateraler Hörsturz hat eine schlechte Prognose

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Update HNO