Transoral laser microsurgery for recurrence after primary radiotherapy of early glottic cancer

Objective: Recurrent glottic cancer after radiotherapy could be managed by open neck or endoscopic surgery. The aim of this study is to position the value of transoral CO2 laser surgery (TLM) in recurrence of early glottic cancer, which have been treated primarily by radiotherapy. Methods: The records of 53 patients who were treated in the clinic for otorhinolaryngology of the University of Göttingen by TLM for early (rTis–rT2) and advanced (rT3, rT4) recurrence after curative radiotherapy were retrospectively analyzed for the period between November 1987 and July 2005. There were 45 men (85%) and 8 women (15%) with a median age of 67 [36-92] years. Patients were treated or re-examined till December 2008 within a mean post-therapeutic follow-up time of 87.9 [8-224] months. 31 patients (58%) had a recurrence in the early stage (1 x rpTis, 16 x rpT1, 14 x rpT2, all N0), whereas 22 patients (42%) had an advanced local or loco-regional recurrence (17 x rpT3 , 5 x rp T4a, 20 x N0, 2 x N +). Endpoints of this study are loco-regional control, overall survival and disease specific survival. The data were calculated by the Kaplan-Meier method. The larynx preservation rates were given absolutely. Results: In 22 cases (42%), the local recurrence was successfully treated with the first treatment by TLM, while 31 patients (58%) developed a second recurrence after an average of 13.6 [3-58] months. For all patients, the 3 and 5-year rates for the loco-regional control by TLM were 46.1% and 38.8%, for the overall survival 67.5% and 53.3% and for the disease specific survival 68,6%. In the further course, a total of 14 patients (28%) received a laryngectomy, of which 5 (36%) died. During the mean follow-up period, a total of 11 (21%) patients died tumor caused. In a total of 31 patients (58%), the local recurrence was controlled by one-time or repeated TLM. The 3- and 5-year overall survival rate were 67.5% and 53.3%. The 3 and 5-year rate for disease specific survival was 68.6%. For both parameters there were no statistically significant differences between patients with recurrences in the early stage or advanced stage. Ultimate local control rate including repeated TLM and salvage laryngectomy was 77.4% The development of a second recurrence after the first TLM was associated with a statistically significant decrease in the 3- and 5- year rates of overall survival (56.6% vs 81.8% and 40.2% vs. 70.5%) and the disease specific survival (48.9% vs. 100%). Conclusions: The results of the study show that the treatment of recurrent early glottic cancer after primary radiotherapy by TLM is a reasonable, minimally invasive and low-complication treatment option. However in case of failure after TLM for the first recurrence, a total "salvage laryngectomy" should be considered early as local control by further TLM treatment seems to be unfavorable.2017-05-2