Minimal invasive LASER-resection vs. radiotherapy as primary treatment of early glottic cancer. A population-based study with, up to 16 years follow up of survival, rate of laryngectomy and voice function

Abstract

Background

Early glottic cancer can be treated with laser resection or radiotherapy. In an earlier study, we found that voice function after laser resection was inferior to that after radiotherapy.

Objectives

This study was designed to determine if reduced margins at laser resection improved voice function without impairing oncologic results.

Method

A total of 268 patients with previously untreated T1–T2 glottic carcinoma were studied. They were primarily treated with either radiotherapy (n = 119) or laser resection (n = 149). Survival, need for additional treatment (radiotherapy and/or total layngectomi) and voice function was compared.

Result

Median follow up time was 7 years with range 0.5–16.6. There was no difference in the overall survival (p = .065) or disease-specific survival. (p = .126). After radiotherapy 32/119 patients and after laser resection 57/149 patients had recurrence. Total rate of laryngectomy was 24% in the radiotherapy group, and 8% in the laser resection group (p = .001). Voice analysis (T1A) showed more roughness in the radiotherapy group, otherwise no difference.

Conclusions

By reducing the surgical margins, we have achieved a better voice function (T1A) but more patients have needed repeated laser excisions and some have also needed supplementary radiotherapy. The risk of laryngectomy and survival were apparently not affected.

Chinese Abstract

背景

早期声门癌可以通过激光切除或放射疗法来治疗。 在以前的一项研究中, 我们发现激光切除后的发声功能比放射治疗后的要差。

目的

本研究旨在确定激光切除切缘的缩小是否可以改善声音功能而不损害肿瘤学结果。

方法

对 268 名既往未接受治疗的 T1-T2 声门癌患者进行了研究。 他们主要接受放射治疗 (n = 119) 或激光切除 (n = 149)。 比较了生存率, 即需要额外的治疗(放射治疗和/或全喉切除术)的需要和声音功能。

结果

中位随访时间为 7 年, 范围为 0.5-16.6。总体生存率 (p = .065) 或疾病特异性生存率(p = .126)没有什么区别。 放射治疗后119名患者中有 32名及激光切除后149例患者中有57名出现复发。 放疗组中喉切除总率为24%, 而激光切除组为 8% (p = .001)。 语音分析(T1A)显示放疗组更多的粗糙度, 其他方面无差异。

结论

通过减小手术切缘, 我们获得了更好的发声功能 (T1A), 但更多的患者需要重复激光切除, 有些还需要补充放射治疗。 喉切除术的风险和生存显然没有受到影响。

Keywords:

• Larynx
• laryngeal
• glottic
• cancer
• carcinoma
• tumor
• tumour
• radiotherapy
• radiation
• laser
• surgery
• excision
• follow up
• survival
• recurrence
• voice function
• voice quality
• GRB

Acknowledgements

The authors offer sincere thanks to Professor Johan Wennerberg for valuable help with the processing of the material.

Disclosure statement

We have no conflict of interest.