Barbu Anca M, Burns James A, Lopez-Guerra Gerardo, Landau-Zemer Tali, Friedman Aaron D, Zeitels Steven M
Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Ann Otol Rhinol Laryngol. 2013 Apr;122(4):235-9. doi: 10.1177/000348941312200404.
Management of early glottic cancer subsequent to failed radiotherapy is challenging, especially in balancing oncological control and function preservation. Patients frequently have been incentivized against surgical management and thus have undergone radiotherapy as initial treatment. This history compounds the difficulty of discussions about surgical management after recurrence. Typically, endoscopic salvage has less morbidity than transcervical partial laryngectomy and is clearly desirable over total laryngectomy. However, there are appropriate concerns about the efficacy of endoscopic salvage and the overarching impact on larynx preservation and survival. Given our success with endoscopic angiolytic KTP laser treatment of previously nonirradiated T1 and T2 glottic cancers, we examined our results from treating similar-sized lesions after failed radiotherapy.
We performed a retrospective chart review of 20 patients from our cancer database who had undergone failed radiation therapy elsewhere for early glottic cancer and then underwent endoscopic angiolytic KTP laser treatment.
Analysis of the geographic tumor recurrence of the 20 patients revealed T1a N0 M0 cancer in 4 patients, T1b N0 M0 cancer in 1 patient, T2a N0 M0 cancer in 1 patient, and T2b N0 M0 cancer in 14 patients. After KTP laser salvage treatment, 4 patients (20%) had local recurrence (all T2b) and required subsequent total laryngectomy, and 3 of these patients (15%) ultimately died of disease. The remaining 16 patients (80%) were free of disease at least 2 years after endoscopic salvage (average follow-up, 39 months).
Our investigation provides preliminary evidence that angiolytic KTP laser salvage treatment of early glottic cancer is an effective treatment after failed irradiation. Studies with larger cohorts and longer follow-up will be necessary to establish incontrovertible evidence of its efficacy.
放射治疗失败后的早期声门癌管理具有挑战性，尤其是在平衡肿瘤控制和功能保留方面。患者经常被劝阻不进行手术治疗，因此接受了放射治疗作为初始治疗。这段病史增加了复发后手术治疗讨论的难度。通常，内镜挽救手术的发病率低于经颈部分喉切除术，显然优于全喉切除术。然而，对于内镜挽救手术的疗效以及对喉保留和生存的总体影响存在合理的担忧。鉴于我们在内镜血管消融KTP激光治疗先前未接受过照射的T1和T2声门癌方面取得的成功，我们研究了在放射治疗失败后治疗类似大小病变的结果。
我们对癌症数据库中的20例患者进行了回顾性病历审查，这些患者在其他地方接受早期声门癌放射治疗失败后，接受了内镜血管消融KTP激光治疗。
对20例患者的肿瘤复发部位分析显示，4例为T1a N0 M0癌，1例为T1b N0 M0癌，1例为T2a N0 M0癌，14例为T2b N0 M0癌。KTP激光挽救治疗后，4例患者（20%）出现局部复发（均为T2b），需要随后进行全喉切除术，其中3例患者（15%）最终死于疾病。其余16例患者（80%）在内镜挽救后至少2年无疾病（平均随访39个月）。
我们的研究提供了初步证据，表明血管消融KTP激光挽救治疗早期声门癌在放射治疗失败后是一种有效的治疗方法。需要进行更大样本量和更长随访时间的研究，以确立其疗效的确凿证据。
