Transoral CO2 laser for surgical management of glottic carcinoma in situ

Objectives/Hypothesis: In carcinoma in situ (CIS) tumors malignant cells ha ve not penetrated the basement membrane and therefore have no metastatic po tential. Treatment strategies of CIS are topics of ongoing discussion. The aim of this study was to evaluate long-ter-m results of CO2 laser therapy i n laryngeal CIS, Methods: From 1986 to 1995, 29 patients with glottic CIS w ith a minimum follow-up of 2 years were treated initially with transoral CO 2 laser surgery and were included is this series. Results: A complete remov al of the tumor was possible with superficial laser cordectomy in 21 patien ts and with subligamental laser cordectomy in 8 cases. There was no tumor-r elated death in this series. Repeated laser resections were performed in fo ur patients for local recurrences. No patient required total laryngectomy o r radiotherapy during a follow-up ranging from 25 to 143 months. Conclusion s: Local control rates presented in this study are superior to those previo usly reported with conventional surgery and similar to those after radiothe rapy. The ultimate rate of larynx preservation was seven times higher than reported after radiotherapy. Our results add further support to the observa tion that laser surgery is the best treatment option for CIS of the larynx. Based on the material of this study, recommended treatment for CIS is CO2 laser resection in combination with a meticulous follow-up for early recogn ition of local recurrence.