Bocciolini C, Presutti L, Laudadio P
Department of Otolaryngology, Head and Neck Surgery, Ospedale Maggiore, Bologna, Italy.
Acta Otorhinolaryngol Ital. 2005 Apr;25(2):86-93.
This study aims to define indications for micro-endoscopic laser surgery in early glottic carcinoma (Tis, T1a and T1b), to examine patterns of local recurrences and related retreatment methods. A cohort of 79 patients with previously untreated early glottic carcinoma, subjected to endoscopic CO2 laser excision between January 1993 and October 2000, was retrospectively examined. Patients included in data analysis had a mean follow-up of 39 months. Depth and extension of excisions were graded according to European Laryngological Society Classification, and included 5 types of cordectomy. Actuarial overall survival, determinate survival, disease-free survival, ultimate local control, and laryngeal preservation rates, at 3 years, were 97.5%, 98.7%, 89.9%, 92.4%, and 97.4%, respectively. Survival curves for overall and disease-free survival were calculated from the date of diagnosis using the KaplanMeier method. Of the 8 patients with local recurrences, 5 were managed with larynx-sparing treatment: a second endoscopic CO, laser cordectomy was performed in 2 patients, a supracricoid laryngectomy in 2 patients, and one patient was treated with radiotherapy. The remaining 3 patients were submitted to total laryngectomy, one of whom died due to neck metastases. One patient died from other causes. All other patients were alive and disease-free at the last follow-up. Understanding the diffusion pathways and timing of laryngeal glottic cancer is important both for treatment and prognosis. Correct knowledge of the subsites of the larynx and the routine use of pre-operative and intra-operative diagnostic assessment is useful in the selection of the appropriate type of resection. Microendoscopic laser surgery is efficacious for early glottic carcinoma, with oncological results comparable to those observed following radiotherapy or conventional partial laryngectomy, however, in this case, local recurrences have a greater range of re-treatment options.
本研究旨在明确早期声门癌（Tis、T1a和T1b）的显微内镜激光手术适应证，研究局部复发模式及相关再治疗方法。回顾性分析了1993年1月至2000年10月间接受内镜二氧化碳激光切除的79例未经治疗的早期声门癌患者队列。纳入数据分析的患者平均随访39个月。切除深度和范围根据欧洲喉科学会分类进行分级，包括5种类型的声带切除术。3年时的精算总生存率、确定生存率、无病生存率、最终局部控制率和喉保留率分别为97.5%、98.7%、89.9%、92.4%和97.4%。总生存和无病生存曲线采用Kaplan-Meier法从诊断日期开始计算。在8例局部复发患者中，5例接受了保留喉的治疗：2例患者进行了第二次内镜二氧化碳激光声带切除术，2例患者进行了环状软骨上喉切除术，1例患者接受了放疗。其余3例患者接受了全喉切除术，其中1例因颈部转移死亡。1例患者死于其他原因。所有其他患者在最后一次随访时均存活且无疾病。了解喉声门癌的扩散途径和时间对于治疗和预后都很重要。正确了解喉的亚部位并常规使用术前和术中诊断评估有助于选择合适的切除类型。显微内镜激光手术对早期声门癌有效，肿瘤学结果与放疗或传统部分喉切除术后观察到的结果相当，然而，在这种情况下，局部复发有更多的再治疗选择。
