Up-front and salvage transoral laser microsurgery for early glottic squamous cell carcinoma: A single centre retrospective case series

Abstract

Introduction/aim: Transoral laser microsurgery (TLM) is a minimally invasive surgical alternative for radiotherapy (RT) in the primary management of early glottic cancer. More recently, TLM emerged also as a possible salvage treatment for selected radiorecurrent cancers. We reviewed outcomes of primary and salvage TLM performed in a Belgian tertiary referral center. Patients and methods: A retrospective review of records from 142 consecutive patients who underwent TLM was performed. Oncologic outcomes were evaluated by means of descriptive statistics and Kaplan-Meier estimates. Variation of estimated outcomes between different subgroups was evaluated using Log-Rank analysis. Results: Of 142 patients, 109 (76.8%) underwent TLM as a primary treatment and 33 (23.2%) were treated in a salvage setting for recurrent or second primary glottic cancer. cT classification in the up-front TLM group was cT1a in 72 (66.1%), cT1b in 11 (10.1%), and cT2 in 26 (23.9%) patients. In the salvage group, patients were cT/rT classified as cT1a-rT1a in 17 (51.5%), cT1b-rT1b in 1 (3.0%), cT2-rT2 in 14 (42.4%), and cT3-rT3 in 1 (3.0%) patients. All patients were cN0. Second-look TLM was performed in 28 patients (19.7%), and RT was associated as adjuvant therapy in 5 patients (3.5%). Mean follow-up was 51.6 months (SD = 38.4 months). Three-year overall survival (OS) was 94.1% (SE = 2.2%), 3-year disease-specific survival (DSS) 100%, 3-year disease-free survival (DFS) 80.1% (SE = 3.8%), 3-year local recurrence-free survival (RFS) 81.0% (SE = 3.7%), and 3-year ultimate local control rate with laser alone 89.2% (SE = 3.0%). Upon subgroup analysis, no differences in OS, DSS, and DFS were observed between the up-front and salvage group (log rank; p = 0.306, p = 0.298, and p = 0.061 respectively). However, local RFS and ultimate local control rate with laser alone were significantly higher in the primary treated TLM group (log rank, p = 0.014 and p = 0.012). Five-year laryngeal preservation rate was 89.7% (SE = 3.5%) in the total population, 100% in the upfront group, and 64.9% (SE = 9.8%) in the salvage group, a difference which proved statistically significant (Log-Rank, p < 0.001). Conclusion: This retrospective study confirms excellent oncologic outcomes of up-front TLM for early glottic cancer. In the salvage setting, TLM allows avoidance of total laryngectomy in the majority of cases.