Roedel Ralph M W, Matthias Christoph, Wolff Hendrik A, Schindler Phillip, Aydin Tomas, Christiansen Hans
Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Göttingen, Germany.
Auris Nasus Larynx. 2010 Aug;37(4):474-81. doi: 10.1016/j.anl.2009.11.004. Epub 2009 Dec 23.
To analyze oncological results of transoral laser microsurgery (TLM) on recurrent early glottic cancer after primary radiotherapy.
The records of 53 patients treated by TLM for early (rTis-rT2) and advanced (rT3, rT4) recurrence after curative radiotherapy were retrospectively analyzed. Data on loco-regional control, overall survival, and disease specific survival were calculated by the Kaplan-Meier method. The larynx preservation rates were given absolutely.
Mean post-therapeutic follow-up time after TLM for patients alive was 87.9 months. Twenty-two patients (42%) were cured by the first TLM procedure, but one of them underwent total laryngectomy after TLM due to chondronecrosis without evidence of residual tumor. Thirty-one patients (58%) developed another recurrence after TLM. Ten of them were cured by further laser procedures alone. Therefore, in 31 patients (58%), local recurrences were successfully treated by TLM alone. In 20 patients, recurrences could not be controlled by TLM: 14 patients underwent salvage laryngectomy and six palliative treatment. Three- and five-year loco-regional control rates for all patients were 46.1 and 38.8%. Three- and five-year overall survival rates were 67.5 and 53.3%. The corresponding 3- and 5-year disease specific survival rates were 68.6%, each. There was no statistically significant difference in loco-regional control or survival between patients presenting initially with early and advanced recurrence. Further recurrence after the first TLM procedure was associated with a statistically significant decrease in 3- and 5-year overall (56.6% vs. 81.8% and 40.2% vs. 70.5%; p=0.03) and disease specific (48.9% vs. 100%, each; p=0.001) survival. Ultimate local control rate including repeated TLM and salvage laryngectomy was 77.4%.
Many patients with recurrent glottic carcinoma after primary radiotherapy can be cured by single or repeated TLM as an organ-preserving procedure. However, in case of failure after TLM for the first recurrence, salvage laryngectomy should be considered early as local control by further laser surgery is unfavorable.
分析经口激光显微手术（TLM）治疗原发性放疗后复发的早期声门癌的肿瘤学结果。
回顾性分析53例接受TLM治疗的根治性放疗后早期（rTis - rT2）和晚期（rT3、rT4）复发患者的记录。采用Kaplan - Meier法计算局部区域控制、总生存率和疾病特异性生存率。绝对给出喉保留率。
存活患者TLM治疗后的平均随访时间为87.9个月。22例患者（42%）首次TLM手术治愈，但其中1例术后因软骨坏死行全喉切除术，无残留肿瘤证据。31例患者（58%）TLM术后再次复发。其中10例仅通过进一步激光手术治愈。因此，31例患者（58%）的局部复发仅通过TLM成功治疗。20例患者的复发无法通过TLM控制：14例行挽救性喉切除术，6例行姑息治疗。所有患者的3年和5年局部区域控制率分别为46.1%和38.8%。3年和5年总生存率分别为67.5%和53.3%。相应的3年和5年疾病特异性生存率均为68.6%。初发时为早期和晚期复发的患者在局部区域控制或生存率方面无统计学显著差异。首次TLM手术后的进一步复发与3年和5年总生存率（56.6%对81.8%和40.2%对70.5%；p = 0.03）和疾病特异性生存率（均为48.9%对100%；p = 0.001）的统计学显著降低相关。包括重复TLM和挽救性喉切除术在内的最终局部控制率为77.4%。
许多原发性放疗后复发的声门癌患者可通过单次或重复TLM作为保留器官的手术治愈。然而，如果首次复发TLM治疗失败，应尽早考虑挽救性喉切除术，因为进一步激光手术控制局部情况不利。
