Functional outcomes and laryngectomy-free survival after transoral CO₂ laser microsurgery for stage 1 and 2 glottic carcinoma.

OBJECTIVE

To compare the functional and oncologic outcomes of transoral CO₂ laser microsurgery relative to radiotherapy for early-stage glottic carcinoma.

DESIGN

Functional analysis: population-based, prospective, nonrandomized consecutive series of stage 1 and 2 glottic carcinoma treated with laser surgery (n  =  54) or radiotherapy (n  =  25). Oncologic analysis: population-based, historical cohort comparing laser surgery (n  =  54) and radiotherapy (n  =  76).

SETTING

Academic cancer centre.

METHODS AND OUTCOME MEASURES

Functional results were prospectively collected prior to treatment and at 3, 6, 12, and 24 months following treatment using validated performance scales assessing general level of function, speech, and swallowing. Oncologic results were collected from a larger cohort from the cancer registry of CancerCare MB.

RESULTS

Laser surgery resulted in a voice that was less likely to be understood all the time (Performance Status Scale for Head and Neck Cancer Patients: understandability score < 100; OR  =  12.2; p  =  .03) and a higher likelihood of having a Voice Handicap Index (VHI-10) score of 10 or more (OR  =  16.2; p  =  .001). Five-year laryngectomy-free survival rates for laser versus radiation were 87 versus 76% (p  =  .16). Subset analysis revealed that stage 1 5-year laryngeal preservation rates for laser (n  =  51) versus radiation (n  =  46) were 100 versus 86% (p  =  .02).

CONCLUSIONS

There is a higher likelihood of hoarseness after laser surgery, but the severity of this handicap is mild in most patients. Laser microsurgery results in excellent laryngeal preservation rates, which may exceed those of radiation.