Transoral laser surgery for early glottic carcinoma

This prospective study evaluates the oncological results of transoral laser surgery (TLS) for glottic carcinoma categorized Tis, T1 and T2 in a large, unselected group of 285 consecutive patients from a university-based refer ral center that uses transoral laser surgery as the standard approach to th ese tumors. Patients were treated between 1 January 1987 and 31 December 19 96. Thirty three patients had Tis disease, 174 T1 tumors and 113 T2. Main o utcome measures were local control with initial therapy, ultimate local con trol, regional control, organ preservation, overall survival and cause-spec ific survival. The 5-year uncorrected actuarial survival for all 285 patien ts was 71.1%, and cause-specific actuarial survival was 98.7%. Local contro l with initial treatment was 85.9%, ultimate local control with salvage for local treatment failures 98.5%, and regional control 98.4%. In all, 94.3% had their larynges preserved after 5 years. Although favorable oncological results for early laryngeal carcinoma treated with laser surgery are suppor ted this study, no definitive recommendations can be given for the best sin gle treatment. Partial laryngectomies lead to the highest local control rat es reported so far, radiotherapy is believed to preserve voice best and las er surgery is associated with time- and cost-effectiveness, low morbidity, fair local control rates and excellent re-treatment options in case of loca l failure. All specialists dealing with the treatment of early glottic carc inoma should be able to offer these different treatment modalities to their patients and to deal specifically with each patient's individual needs and preferences.