Meulemans Jeroen, Bijnens Jacqueline, Delaere Pierre, Vander Poorten Vincent
Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium.
Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
Front Oncol. 2018 May 28;8:186. doi: 10.3389/fonc.2018.00186. eCollection 2018.
INTRODUCTION/AIM: Transoral laser microsurgery (TLM) is a minimally invasive surgical alternative for radiotherapy (RT) in the primary management of early glottic cancer. More recently, TLM emerged also as a possible salvage treatment for selected radiorecurrent cancers. We reviewed outcomes of primary and salvage TLM performed in a Belgian tertiary referral center.
A retrospective review of records from 142 consecutive patients who underwent TLM was performed. Oncologic outcomes were evaluated by means of descriptive statistics and Kaplan-Meier estimates. Variation of estimated outcomes between different subgroups was evaluated using Log-Rank analysis.
Of 142 patients, 109 (76.8%) underwent TLM as a primary treatment and 33 (23.2%) were treated in a salvage setting for recurrent or second primary glottic cancer. cT classification in the up-front TLM group was cT1a in 72 (66.1%), cT1b in 11 (10.1%), and cT2 in 26 (23.9%) patients. In the salvage group, patients were cT/rT classified as cT1a-rT1a in 17 (51.5%), cT1b-rT1b in 1 (3.0%), cT2-rT2 in 14 (42.4%), and cT3-rT3 in 1 (3.0%) patients. All patients were cN0. Second-look TLM was performed in 28 patients (19.7%), and RT was associated as adjuvant therapy in 5 patients (3.5%). Mean follow-up was 51.6 months (SD = 38.4 months). Three-year overall survival (OS) was 94.1% (SE = 2.2%), 3-year disease-specific survival (DSS) 100%, 3-year disease-free survival (DFS) 80.1% (SE = 3.8%), 3-year local recurrence-free survival (RFS) 81.0% (SE = 3.7%), and 3-year ultimate local control rate with laser alone 89.2% (SE = 3.0%). Upon subgroup analysis, no differences in OS, DSS, and DFS were observed between the up-front and salvage group (log rank; = 0.306, = 0.298, and = 0.061 respectively). However, local RFS and ultimate local control rate with laser alone were significantly higher in the primary treated TLM group (log rank, = 0.014 and = 0.012). Five-year laryngeal preservation rate was 89.7% (SE = 3.5%) in the total population, 100% in the upfront group, and 64.9% (SE = 9.8%) in the salvage group, a difference which proved statistically significant (Log-Rank, < 0.001).
This retrospective study confirms excellent oncologic outcomes of up-front TLM for early glottic cancer. In the salvage setting, TLM allows avoidance of total laryngectomy in the majority of cases.
引言/目的：经口激光显微手术（TLM）是早期声门癌初始治疗中放疗（RT）的一种微创替代手术。最近，TLM也成为部分放射性复发癌可能的挽救性治疗方法。我们回顾了在比利时一家三级转诊中心进行的初次及挽救性TLM的治疗结果。
对142例连续接受TLM手术患者的记录进行回顾性分析。通过描述性统计和Kaplan-Meier估计评估肿瘤学结局。使用Log-Rank分析评估不同亚组间估计结局的差异。
142例患者中，109例（76.8%）接受TLM作为初始治疗，33例（23.2%）因复发性或第二原发性声门癌接受挽救性治疗。初始TLM组的cT分类中，72例（66.1%）为cT1a，11例（10.1%）为cT1b，26例（23.9%）为cT2。在挽救性治疗组中，患者的cT/rT分类为：17例（51.5%）为cT1a-rT1a，1例（3.0%）为cT1b-rT1b，14例（42.4%）为cT2-rT2，1例（3.0%）为cT3-rT3。所有患者均为cN0。28例患者（19.7%）进行了二次TLM手术，5例患者（3.5%）接受RT作为辅助治疗。平均随访时间为51.6个月（标准差=38.4个月）。3年总生存率（OS）为94.1%（标准误=2.2%），3年疾病特异性生存率（DSS）为100%，3年无病生存率（DFS）为80.1%（标准误=3.8%），3年局部无复发生存率（RFS）为81.0%（标准误=3.7%），单纯激光治疗的3年最终局部控制率为89.2%（标准误=3.0%）。亚组分析显示，初始治疗组和挽救性治疗组在OS、DSS和DFS方面无差异（Log-Rank检验；分别为=0.306、=0.298和=0.061）。然而，初次接受TLM治疗组的局部RFS和单纯激光治疗的最终局部控制率显著更高（Log-Rank检验，=0.014和=0.012）。总体人群的5年喉保留率为89.7%（标准误=3.5%），初始治疗组为100%，挽救性治疗组为64.9%（标准误=9.8%），差异具有统计学意义（Log-Rank检验，<0.001）。
这项回顾性研究证实了初始TLM治疗早期声门癌具有出色的肿瘤学结局。在挽救性治疗中，TLM在大多数情况下可避免全喉切除术。
