CARBON-DIOXIDE LASER VAPORIZATION IN EARLY GLOTTIC CARCINOMA

Objective: Presently, widely employed treatment modalities for early g lottic carcinoma include radiation therapy, surgical excision, and car bon dioxide laser excision. All these treatments have good oncological results, but poor or questionable functional-results in terms of qual ity of voice and mucosal wave patterns as seen via a laryngostroboscop e. We assessed the oncological and functional results of carbon dioxid e laser vaporization of the diseased mucosa as a more conservative tre atment alternative. Design: Case series. Setting: Department of Otolar yngology-Head and Neck Surgery in a tertiary care center. Patients: Th irty-three patients with early glottic carcinoma (carcinoma in situ an d Tla squamous cell carcinoma) who were referred to our center in the period from 1986 through 1990 were selected for carbon dioxide laser v aporization treatment on the criterion of a still recognizable mucosal wave pattern of the affected vocal fold via a laryngostroboscope. Mai n Outcome Measures: Local tumor control, voice quality, and a good app earance via a laryngostroboscope. Results: Two patients were excluded from evaluation because a simultaneously diagnosed, incurable second p rimary tumor precluded frequent follow-up. Of the remaining 31 patient s seen during a median follow-up period of 58 months, seven patients d ied of unrelated causes. A local recurrence of disease developed in tw o patients and was treated by radiation therapy. A recurrence of disea se developed again in one of these patients but was successfully treat ed by total laryngectomy. Overall, local control of disease was achiev ed in all patients, with a 97% laryngeal preservation rate. Functional results in terms of voice quality were good in 97% of the patients, 7 5% of whom even retained a normal voice. Normal or near normal laryngo stroboscopic appearance was achieved in 68% of all patients. Conclusio n: Carbon dioxide laser vaporization is a good treatment alternative f or early glottic carcinoma in terms of oncological as well as function al results.