Sjögren Elisabeth V, Langeveld Ton P M, Baatenburg de Jong Robert J
Department of ENT, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Head Neck. 2008 Sep;30(9):1167-74. doi: 10.1002/hed.20852.
Since the introduction of endoscopic laser surgery at our institution in 1996, 189 patients have been treated for T1 glottic carcinoma.
Treatment allocation (radiotherapy vs laser surgery) and outcome were evaluated.
Fifty-one percent of T1a lesions were considered suitable for laser surgery. Sixteen percent of T1a patients treated with laser surgery needed additional treatment because of positive resection margins. Overall local control and larynx preservation were 89% and 96%. Both were poorer in T1a patients with larger lesions treated with radiotherapy (local control 75% versus 89%, p = .05, larynx preservation 83% vs 100%, p = .001).
Outcome for T1a patients selected for laser surgery is excellent. In patients with larger lesions treated with radiotherapy, outcome is inferior to patients selected for laser surgery, but also to that reported for (unselected) T1a carcinomas treated with radiotherapy in literature. Strategies to improve treatment results in patients deemed unsuitable for laser surgery should be designed.
自1996年我院引入内镜激光手术以来，已有189例T1期声门癌患者接受了治疗。
对治疗分配（放疗与激光手术）及结果进行评估。
51%的T1a期病变被认为适合激光手术。接受激光手术治疗的T1a期患者中有16%因手术切缘阳性而需要额外治疗。总体局部控制率和喉保留率分别为89%和96%。在接受放疗的较大病变T1a期患者中，这两个指标均较差（局部控制率75%对89%，p = 0.05；喉保留率83%对100%，p = 0.001）。
选择激光手术治疗的T1a期患者预后良好。接受放疗的较大病变患者的预后不仅不如选择激光手术治疗的患者，而且也低于文献报道的（未选择的）接受放疗的T1a期癌患者。应制定策略以改善被认为不适合激光手术的患者的治疗效果。
