Endoscopic CO2 laser therapy of selected cases of supraglottic marginal tumors

Endoscopic CO2 laser intervention can be used as conservation surgery for s upraglottic laryngeal carcinomas in carefully selected patients. We analyze d retrospectively our experience in managing patients with early supraglott ic carcinomas operated on at the Clinic of Otorhinolaryngology, Szeged, Hun gary, during the 10-year period between 1987 and 1997. Conservation surgery was the treatment of choice in 187 patients, but only 23 (12%) were select ed for endoscopic CO2 laser surgery. Laser surgery was indicated predominan tly for T1 cancer of the epiglottis (n = 15, but was also performed for T2 cancers (n = 8). Of the 23 supraglottic tumors treated, 16 had no signs of recurrence to date (1.5 to 9 years after surgery) a local control rate of 7 0%. Six patients with recurrences underwent salvage therapies that included repeated laser excisions (n = 3), radiotherapy (to 60 Gy), horizontal supr aglottic laryngectomy and total laryngectomy. One patient was not resectabl e because of multiple metastases. Our experience with endolaryngeal CO2 las er excision indicates that it is a reasonable method in selected cases of s upraglottic tumors, but one-third of the patients required salvage treatmen t.