- Email: [email protected]
Laser surgery for T1 laryngeal cancer
International Congress Series 1240 (2003) 773 – 776
Laser surgery for T1 laryngeal cancer Satoshi Kitahara *, Tetsuya Tanabe, Yoko Kitagawa, Yuko Matsumura, Etsuyo Tamura Department of Otolaryngology, National Defense Medical College, 3-2 Namiki Tokorozawa, Saitama 359-8513, Japan
Abstract We reported the result of laser surgery for T1 laryngeal cancer and discussed its effectiveness. Subjects were 84 cases who had been treated for T1 laryngeal cancer by laser surgery at Otolaryngology of National Defense Medical College Hospital. There were 2 supraglottic cases, 73 glottic, and 9 recurrent glottic after irradiation. Out of 47 cases with T1a glottic cancer, 38 cases were treated by laser alone and 9 were by laser and irradiation. One of 38 cases by laser alone resulted in local recurrence. Out of 26 with T1b, 14 were treated by laser alone and 12 were by laser and irradiation. One of 14 cases of laser resulted in local recurrence, and as for 12 cases of laser and irradiation, one resulted in local recurrence and two resulted in failure. We succeeded in treating two cases with supraglottic cancer by laser alone. All recurrent glottic cancer cases were treated by laser alone. We failed in one of five rT1a cases. Two of four rT1b resulted in failure and one resulted in local recurrence. In case of failure and recurrence, total laryngectomy was administered. None died of cancer. Laser surgery for T1 laryngeal cancer was considered to be highly effective. D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. Keywords: Endoscopic surgery; Laser surgery; T1 laryngeal cancer; Treatment; Irradiation
1. Introduction In 1972, the first report of laser surgery for laryngeal cancer was done by Strong and Jako [1] and this kind of surgery has been administered at many institutions. While the possibility of treatment of early laryngeal cancer by endoscopic surgery may include a lot
* Corresponding author. Tel.: +81-42-995-1686; fax: +81-42-996-5212. E-mail address: [email protected] (S. Kitahara). 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)00760-X
774
S. Kitahara et al. / International Congress Series 1240 (2003) 773–776
of merit, its indication must be discussed considerably. Therefore, we evaluated the results of treatment prior to discussion.
2. Material and methods/patients 2.1. Patients Subjects were 84 cases who had been treated by laser surgery at Otolaryngology of National Defense Medical College Hospital since April of 1982 till December of 1999. There were 2 supraglottic cancer, 73 glottic, 9 recurrent glottic after irradiation. In 26 cases with T1b cancer, 22 cases showed expansion of tumor including anterior commissure (85%) and as for 9 recurrent glottic cases there were 5 cases with rT1a and 4 cases with rT1b. After admission, all operations were administered under general anesthesia with technique of Laryngomicrosurgery. 2.2. Methods Appliances were CO2 laser or KTP 532 laser. For laser irradiation we used micromanipulator or hand piece to dissect or vaporize the tumor. Our indication was laryngeal T1 cancer of which tumor was localized and had the clear border line against normal tissue. Observation period was set at within 2 years and we evaluated the preservation rate of larynx, the survival rate, and the phonatory function after operation.
3. Result 3.1. Result of treatment As shown on Table 1, 38 out of 47 cases with glottic cancer were treated by laser surgery alone, 9 were by laser surgery and irradiation, and only 1 of patients treated by laser alone resulted in local recurrence. Table 2 showed that 14 cases were treated by laser alone, 12 were treated by laser and irradiation, and one of each method resulted in local recurrence. Two patients who had been treated by laser and irradiation resulted in failure. As shown on Table 3, two supraglottic cases were treated by laser surgery alone. None showed recurrence. Recurrent glottic cases were treated by laser alone. Four of five rT1a Table 1 Result of T1a cancer Method of treatment Laser Laser + radiation Total
38 9 47
CR: complete response, PR: partial response.
CR
PR
Recurrence
38 9 47
0 0 0
1/38 0/9 1/47
S. Kitahara et al. / International Congress Series 1240 (2003) 773–776
775
Table 2 Result of T1b cancer Method of treatment Laser Laser + radiation Total
14 12 26
CR
PR
Recurrence
14 10 24
0 2 2
1/14 1/10 2/24
CR
PR
Recurrence
2 2
0 0
0 0/2
CR: complete response, PR: partial response.
Table 3 Result of Supraglottic cancer Method of treatment Laser Total
2 2
CR: complete response, PR: partial response.
cases and one of five rT1b were successfully treated, three cases failed in treatment, and one rT1b case resulted in local recurrence (Table 4). Total laryngectomy was administered in all cases of failure and recurrence. 3.2. Preservation rate of larynx Preservation rate of larynx was shown on Table 5: T1a 98% (46/47); T1b 85% (22/26); rT1a 80% (4/5); rT1b 25% (1/4). 3.3. Survival rate Those were: T1a 96% (45/47); T1b 96% (24/26); rT1a and rT1b 100% (5/5, 4/4).(Table 6) None died of cancer. Table 4 Result of Recurrent cancer
rT1a Laser rT1b Laser Total
5 4 9
CR
PR
Recurrence
4 2 6
1 2 3
0/4 1/2 1/6
CR: complete response, PR: partial response.
Table 5 Preservation rate of larynx Type of tumor
Preservation rate of larynx
T1a T1b rT1a rT1b
98% 85% 80% 25%
(46/47) (22/26) (4/5) (1/4)
776
S. Kitahara et al. / International Congress Series 1240 (2003) 773–776
Table 6 Survival rate Type of tumor
Survival rate
T1a T1b rT1a rT1b
96% 96% 100% 100%
(45/47) (25/26) (5/5) (4/4)
Death from disease 0.
3.4. Phonatory function after treatment We could evaluate post-operative phonatory function of a total of 37 men and compare with normal value of male voice which was described in the textbook of ‘‘Assessment of Voice’’ edited by Japanese Association of Logopedics and Phoniatrics. The result of evaluation tended to be characterized by short maximum phonation time, increase of mean airflow rate, narrowing of vocal range, and high-pitched speaking range. Acoustically, rough and breathy voice was observed in some cases vaporized at anterior commissure. However, none suffered difficulty in daily conversation.
4. Discussion Laser surgery has its advantages and disadvantages. As for the advantages, we may say that irradiation is unnecessary, surgery can be minor, and reduction of treatment period leads to reduction of suffering period and economic merit [2]. On the other hand, disadvantages are the need for admission and general anesthesia, and also post-operative hoarseness in some cases [3]. Although there have been few reports of complications, we considered that immediate radiation therapy after deep vaporization of thyroid cartilage of anterior commissure might have caused abscess of frontal neck as a complication. 5. Conclusion We concluded that T1 laryngeal cancer could be completely treated by laser alone if we considered observance of indication. Even in unsuccessful cases of radiation therapy, we could salvage them by laser alone if the case was rT1a. References [1] M.S. Strong, G.J. Jako, Laser surgery in the larynx: early clinical experience with continuous CO2 laser, Ann. Otol. Rhinol. Laryngol. 81 (1972) 791 – 798. [2] A. Gallo, M. Vincentiis, V. Manciocco, M. Simonelli, M.L. Fiorella, P. Shah, CO2 laser cordectomy for earlystage glottic cancer: A long-term follow-up of 156 cases, Laryngoscope 112 (2002) 370 – 374. [3] C. Sittel, H.E. Eckel, C. Eschenburg, Phonatory results after laser surgery for glottic cancer, Otolaryngol. Head Neck Surg. 119 (1998) 418 – 424.
Laser surgery for T1 laryngeal cancer Satoshi Kitahara *, Tetsuya Tanabe, Yoko Kitagawa, Yuko Matsumura, Etsuyo Tamura Department of Otolaryngology, National Defense Medical College, 3-2 Namiki Tokorozawa, Saitama 359-8513, Japan
Abstract We reported the result of laser surgery for T1 laryngeal cancer and discussed its effectiveness. Subjects were 84 cases who had been treated for T1 laryngeal cancer by laser surgery at Otolaryngology of National Defense Medical College Hospital. There were 2 supraglottic cases, 73 glottic, and 9 recurrent glottic after irradiation. Out of 47 cases with T1a glottic cancer, 38 cases were treated by laser alone and 9 were by laser and irradiation. One of 38 cases by laser alone resulted in local recurrence. Out of 26 with T1b, 14 were treated by laser alone and 12 were by laser and irradiation. One of 14 cases of laser resulted in local recurrence, and as for 12 cases of laser and irradiation, one resulted in local recurrence and two resulted in failure. We succeeded in treating two cases with supraglottic cancer by laser alone. All recurrent glottic cancer cases were treated by laser alone. We failed in one of five rT1a cases. Two of four rT1b resulted in failure and one resulted in local recurrence. In case of failure and recurrence, total laryngectomy was administered. None died of cancer. Laser surgery for T1 laryngeal cancer was considered to be highly effective. D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. Keywords: Endoscopic surgery; Laser surgery; T1 laryngeal cancer; Treatment; Irradiation
1. Introduction In 1972, the first report of laser surgery for laryngeal cancer was done by Strong and Jako [1] and this kind of surgery has been administered at many institutions. While the possibility of treatment of early laryngeal cancer by endoscopic surgery may include a lot
* Corresponding author. Tel.: +81-42-995-1686; fax: +81-42-996-5212. E-mail address: [email protected] (S. Kitahara). 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)00760-X
774
S. Kitahara et al. / International Congress Series 1240 (2003) 773–776
of merit, its indication must be discussed considerably. Therefore, we evaluated the results of treatment prior to discussion.
2. Material and methods/patients 2.1. Patients Subjects were 84 cases who had been treated by laser surgery at Otolaryngology of National Defense Medical College Hospital since April of 1982 till December of 1999. There were 2 supraglottic cancer, 73 glottic, 9 recurrent glottic after irradiation. In 26 cases with T1b cancer, 22 cases showed expansion of tumor including anterior commissure (85%) and as for 9 recurrent glottic cases there were 5 cases with rT1a and 4 cases with rT1b. After admission, all operations were administered under general anesthesia with technique of Laryngomicrosurgery. 2.2. Methods Appliances were CO2 laser or KTP 532 laser. For laser irradiation we used micromanipulator or hand piece to dissect or vaporize the tumor. Our indication was laryngeal T1 cancer of which tumor was localized and had the clear border line against normal tissue. Observation period was set at within 2 years and we evaluated the preservation rate of larynx, the survival rate, and the phonatory function after operation.
3. Result 3.1. Result of treatment As shown on Table 1, 38 out of 47 cases with glottic cancer were treated by laser surgery alone, 9 were by laser surgery and irradiation, and only 1 of patients treated by laser alone resulted in local recurrence. Table 2 showed that 14 cases were treated by laser alone, 12 were treated by laser and irradiation, and one of each method resulted in local recurrence. Two patients who had been treated by laser and irradiation resulted in failure. As shown on Table 3, two supraglottic cases were treated by laser surgery alone. None showed recurrence. Recurrent glottic cases were treated by laser alone. Four of five rT1a Table 1 Result of T1a cancer Method of treatment Laser Laser + radiation Total
38 9 47
CR: complete response, PR: partial response.
CR
PR
Recurrence
38 9 47
0 0 0
1/38 0/9 1/47
S. Kitahara et al. / International Congress Series 1240 (2003) 773–776
775
Table 2 Result of T1b cancer Method of treatment Laser Laser + radiation Total
14 12 26
CR
PR
Recurrence
14 10 24
0 2 2
1/14 1/10 2/24
CR
PR
Recurrence
2 2
0 0
0 0/2
CR: complete response, PR: partial response.
Table 3 Result of Supraglottic cancer Method of treatment Laser Total
2 2
CR: complete response, PR: partial response.
cases and one of five rT1b were successfully treated, three cases failed in treatment, and one rT1b case resulted in local recurrence (Table 4). Total laryngectomy was administered in all cases of failure and recurrence. 3.2. Preservation rate of larynx Preservation rate of larynx was shown on Table 5: T1a 98% (46/47); T1b 85% (22/26); rT1a 80% (4/5); rT1b 25% (1/4). 3.3. Survival rate Those were: T1a 96% (45/47); T1b 96% (24/26); rT1a and rT1b 100% (5/5, 4/4).(Table 6) None died of cancer. Table 4 Result of Recurrent cancer
rT1a Laser rT1b Laser Total
5 4 9
CR
PR
Recurrence
4 2 6
1 2 3
0/4 1/2 1/6
CR: complete response, PR: partial response.
Table 5 Preservation rate of larynx Type of tumor
Preservation rate of larynx
T1a T1b rT1a rT1b
98% 85% 80% 25%
(46/47) (22/26) (4/5) (1/4)
776
S. Kitahara et al. / International Congress Series 1240 (2003) 773–776
Table 6 Survival rate Type of tumor
Survival rate
T1a T1b rT1a rT1b
96% 96% 100% 100%
(45/47) (25/26) (5/5) (4/4)
Death from disease 0.
3.4. Phonatory function after treatment We could evaluate post-operative phonatory function of a total of 37 men and compare with normal value of male voice which was described in the textbook of ‘‘Assessment of Voice’’ edited by Japanese Association of Logopedics and Phoniatrics. The result of evaluation tended to be characterized by short maximum phonation time, increase of mean airflow rate, narrowing of vocal range, and high-pitched speaking range. Acoustically, rough and breathy voice was observed in some cases vaporized at anterior commissure. However, none suffered difficulty in daily conversation.
4. Discussion Laser surgery has its advantages and disadvantages. As for the advantages, we may say that irradiation is unnecessary, surgery can be minor, and reduction of treatment period leads to reduction of suffering period and economic merit [2]. On the other hand, disadvantages are the need for admission and general anesthesia, and also post-operative hoarseness in some cases [3]. Although there have been few reports of complications, we considered that immediate radiation therapy after deep vaporization of thyroid cartilage of anterior commissure might have caused abscess of frontal neck as a complication. 5. Conclusion We concluded that T1 laryngeal cancer could be completely treated by laser alone if we considered observance of indication. Even in unsuccessful cases of radiation therapy, we could salvage them by laser alone if the case was rT1a. References [1] M.S. Strong, G.J. Jako, Laser surgery in the larynx: early clinical experience with continuous CO2 laser, Ann. Otol. Rhinol. Laryngol. 81 (1972) 791 – 798. [2] A. Gallo, M. Vincentiis, V. Manciocco, M. Simonelli, M.L. Fiorella, P. Shah, CO2 laser cordectomy for earlystage glottic cancer: A long-term follow-up of 156 cases, Laryngoscope 112 (2002) 370 – 374. [3] C. Sittel, H.E. Eckel, C. Eschenburg, Phonatory results after laser surgery for glottic cancer, Otolaryngol. Head Neck Surg. 119 (1998) 418 – 424.