Flexible Endoscopic Laser Surgery for Glottic Carcinoma After Radiotherapy Failure: A First Experience

TL;DR

Flexible endoscopic laser surgery (FELS) is a minimally invasive option for treating glottic cancer that recurs after radiotherapy, offering larynx preservation and avoiding risks of general anesthesia.

Contribution

The study presents the first five-year evaluation of FELS as a salvage treatment for glottic carcinoma after radiotherapy failure.

Findings

FELS achieved 66.7% five-year overall survival and disease control in patients with recurrent/persistent glottic carcinoma.

Larynx preservation was achieved in 55.6% of patients, with three T1-stage patients cured without further treatment.

FELS provided local control in 55.6% of cases without the need for additional salvage treatments.

Abstract

Background: Surgery is the only salvage treatment for radiotherapy (RT) failures in glottic carcinoma management, and total laryngectomy is performed in the majority of cases, resulting in a substantial decline in the quality of life for patients. Transoral CO2 laser microsurgery (TOLMS), as a salvage treatment for RT failures, demonstrated its efficiency, albeit more inferior compared to treatment results obtained in primary glottic carcinoma, but has some limitations, predominantly associated with difficult anatomy and inadequate glottis exposure and also because of mandatory larynx suspension and general anesthesia with myorelaxation that present risks or contraindications for some categories of patients. Flexible endoscopic laser surgery (FELS) can overcome some of the limitations of TOLMS, being a minimally invasive therapeutic option for this category of patients. The study's purpose was to evaluate the long-term (five-year) effectiveness of FELS in treating recurrent/persistent glottic carcinoma after RT failure.

Methods: FELS was performed in nine patients with recurrent (four) and persistent (five) early-stage (T1a: two; T1b: one; T2: six) glottic carcinoma after RT failure (males: eight; females: one), aged 47-66 (mean: 55.4±7.8). FELS under local anesthesia with spontaneous ventilation was performed in five patients (55.6%), and the rest of the patients were operated on under general anesthesia with superimposed high-frequency jet ventilation (SHFJV). Tumor ablation by neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was performed in all the cases, and adjuvant RT (20-22 Gy) was performed in two cases of persistent T2 tumors.

Results: Five-year overall survival and ultimate disease control, including salvage treatment, were obtained in six patients (66.7%), cure with larynx preservation was obtained in five patients (55.6%), disease-free survival was obtained in five cases (55.6%), and ultimate local control with FELS alone was obtained in five cases (55.6%). All three patients with the T1 stage of disease were alive, free of disease, with the preserved larynx due to FELS alone.

Conclusion: FELS can be considered an efficient method of treating recurrent and persistent T1-T2 glottic carcinoma after RT failure, offering a minimally invasive surgical alternative for cure with larynx preservation, especially for patients with risks/contraindications to general anesthesia and transoral microsurgery.

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