# Oncologic and Functional Outcomes of T3 Glottic Squamous Cell Carcinoma Following Transoral Laser Microsurgery: A Retrospective Chart Review

## TL;DR

This study shows that transoral laser microsurgery can be an effective treatment for advanced glottic cancer, with good survival and voice outcomes.

## Contribution

The study provides new evidence on the effectiveness of TLM for T3 glottic SCC, including the impact of anterior commissure involvement.

## Key findings

- TLM achieved 79.2% 2-year and 52.6% 5-year local control for T3 glottic SCC.
- Voice outcomes improved significantly at 6 and 12 months post-surgery.
- Anterior commissure involvement did not negatively affect survival or laryngectomy-free rates.

## Abstract

Few centers globally use transoral laser microsurgery (TLM) for primary treatment of T3 glottic squamous cell carcinoma (SCC); consequently, data on its use in this setting are sparse.

The aim of this study was to evaluate the oncologic and functional outcomes in T3 glottic SCC following TLM, including the impact of anterior commissure (AC) involvement.

Retrospective chart review.

Single Canadian tertiary care hospital in Halifax, Nova Scotia, from January 2006 to December 2021.

Adult (>18 years old) patients with T3 glottic SCC treated with TLM. Patients were excluded if they were previously treated for laryngeal cancer.

This study used prospectively collected data for patients treated with TLM for T3 glottic SCC.

Oncologic outcomes were assessed using disease-specific survival (DSS), local control (LC), and laryngectomy-free survival (LFS). Functional outcomes were measured using the Voice Handicap Index-10 (VHI-10).

In total, 28 patients (mean age = 68.4 years) underwent curative TLM for T3 glottic SCC. Sixteen of the cases involved the AC and 22 had paraglottic space involvement. Two and 5-year DSS were 79.2% (CI = 62.3%-100%). Two and 5-year LC were 80.2% (CI = 65.9%-97.4%) and 52.6% (CI = 27.4%-100%), respectively, and 2- and 5-year LFS rates were 86.1% (CI = 72.6%-100%) and 64.6% (CI = 35.8%-100%). AC involvement had no significant impact on DSS, LC, or LFS. There was no significant difference in preoperative and 3-month VHI-10 scores (P = .6632); however, there was significant improvement noted at the 6 (P = .042) and 12-month (P = .037) periods.

TLM is a viable surgical option for appropriately selected patients with T3 glottic SCC, with or without AC involvement, achieving favorable oncologic and functional outcomes.

These findings further contribute to the limited evidence supporting the use of TLM in the management of advanced-stage glottic cancer.

Graphical abstract