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Transoral laser resection of glottic carcinoma: what is the significance of anterior commissure involvement?

  • K A Stephenson (a1) and J J Fagan (a2)

Abstract

Background:

The optimal management of glottic carcinoma involving the anterior commissure is controversial.

Method:

A retrospective analysis was conducted of 76 patients with glottic squamous cell carcinoma treated by transoral carbon dioxide laser resection by a single surgeon.

Results:

Sixty-three patients (with tumour stage Tis–T3) were eligible for inclusion. Thirty patients had involvement of the anterior commissure; these patients were significantly more likely to have either uncertain or positive margins (63.3 vs 30.3 per cent, p = 0.012), and were also more likely to receive adjuvant radiotherapy (40 vs 3.2 per cent, p = 0.0005). The overall laryngeal preservation rate was 96.8 per cent; there was no statistically significant difference between those with and without anterior commissure involvement (96.7 and 96.9 per cent respectively).

Conclusion:

Transoral laser resection with the use of adjuvant radiotherapy in a minority of patients with adverse pathological findings can be recommended for the primary treatment of anterior commissure glottic cancer from an oncological perspective; excellent local control and laryngeal preservation rates can be achieved.

Copyright

Corresponding author

Address for correspondence: Prof J J Fagan, Division of Otolaryngology, University of Cape Town, Cape Town, South Africa E-mail: Johannes.Fagan@uct.ac.za

Footnotes

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Presented at the 50th Congress of the South African Society of Otorhinolaryngology, Head and Neck Surgery, 18–21 October 2014, Cape Town, South Africa.

Footnotes

References

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1 Krespi, YP, Meltzer, CJ. Laser surgery for vocal cord carcinoma involving the anterior commissure. Ann Otol Rhinol Laryngol 1989;98:105–9
2 Rucci, L, Gammarota, L, Borghi Cirri, MB. Carcinoma of the anterior commissure of the larynx: I. Embryological and anatomic considerations. Ann Otol Rhinol Laryngol 1996;105:303–8
3 Rucci, L, Gammarota, L, Gallo, O. Carcinoma of the anterior commissure of the larynx: II. Proposal of a new staging system. Ann Otol Rhinol Laryngol 1996;105:391–6
4 Kirchner, JA, Carter, D. Intralaryngeal barriers to the spread of cancer. Acta Otolaryngol 1987;103:503–13
5 Bradley, PJ, Mackenzie, K, Wight, R, Pracy, P, Paleri, V; ENT-UK Head & Neck Group. Consensus statement on management in the UK: transoral laser assisted microsurgical resection of early glottic cancer. Clin Otolaryngol 2009;34:367–73
6 Mizrachi, A, Rabinovics, N, Hilly, O, Shvero, J. Analysis of failure following transoral laser surgery for early glottic cancer. Eur Arch Otorhinolaryngol 2014;271:2247–51
7 Pham, TA, De Freitas, R, Sigston, E, Vallance, N. Factors leading to the use of alternate treatment modalities following transoral laser excision of T1 and T2 glottic squamous cell carcinoma. ANZ J Surg 2012;82:720–3
8 Chone, CT, Yonehara, E, Martins, JE, Altemani, A, Crespo, AN. Importance of anterior commissure in recurrence of early glottic cancer after laser endoscopic resection. Arch Otolaryngol Head Neck Surg 2007;133:882–7
9 Steiner, W, Ambrosch, P, Rödel, RM, Kron, M. Impact of anterior commissure involvement on local control of early glottic carcinoma treated by laser microresection. Laryngoscope 2004;114:1485–91
10 Rödel, RM, Steiner, W, Müller, RM, Kron, M, Matthias, C. Endoscopic laser surgery of early glottic cancer: involvement of the anterior commissure. Head Neck 2009;31:583–92
11 Crespo, AN, Chone, CT, Gripp, FM, Spina, AL, Altemani, A. Role of margin status in recurrence after CO2 laser endoscopic resection of early glottic cancer. Acta Otolaryngol 2006;126:306–10
12 Ansarin, M, Santoro, L, Cattaneo, A, Massaro, MA, Calabrese, L, Giugliano, G et al. Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Arch Otolaryngol Head Neck Surg 2009;135:385–90
13 Grant, DG, Bradley, PT, Parmar, A, Toll, EC, Baldwin, DL, Porter, GC et al. Implications of positive margins or incomplete excision in laryngeal cancer treated by transoral laser microsurgery: how we do it. Clin Otolaryngol 2009;34:479–92
14 Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti, A eds. AJCC Cancer Staging Manual, 7th edn. New York: Springer, 2010;5762
15 Desloge, RB, Zeitels, SM. Endolaryngeal microsurgery at the anterior glottal commissure: controversies and observations. Ann Otol Rhinol Laryngol 2000;109:385–92
16 Maheshwar, AA, Gaffney, CC. Radiotherapy for T1 glottic carcinoma: impact of anterior commissure involvement. J Laryngol Otol 2001;115:298301
17 Tong, CC, Au, KH, Ngan, RK, Chow, SM, Cheung, FY, Fu, YT et al. Impact and relationship of anterior commissure and time-dose factor on the local control of T1N0 glottic cancer treated by 6 MV photons. Radiat Oncol 2011;6:53
18 Reddy, SP, Hong, RL, Nagda, S, Emami, B. Effect of tumor bulk on local control and survival of patients with T1 glottic cancer: a 30-year experience. Int J Radiat Oncol Biol Phys 2007;69:1389–94
19 Hoffmann, C, Hans, S, Sadoughi, B, Brasnu, D. Identifying outcome predictors of transoral laser cordectomy for early glottic cancer. Head Neck 2016;38(suppl 1):E406–11
20 Lee, HS, Chun, BG, Kim, SW, Kim, ST, Oh, JH, Hong, JC et al. Transoral laser microsurgery for early glottic cancer as one-stage single modality therapy. Laryngoscope 2013;123:2670–4
21 Hakeem, AH, Tubachi, J, Pradhan, SA. Significance of anterior commissure involvement in early glottic squamous cell carcinoma treated with trans-oral CO2 laser microsurgery. Laryngoscope 2013;123:1912–17
22 Peretti, G, Piazza, C, Cocco, D, De Benedetto, L, Del Bon, F, Redaelli De Zinis, LO et al. Transoral CO(2) laser treatment for T(is)-T(3) glottic cancer: the University of Brescia experience on 595 patients. Head Neck 2010;32:977–83
23 Sachse, F, Stoll, W, Rudack, C. Evaluation of treatment results with regard to initial anterior commissure involvement in early glottic carcinoma treated by external partial surgery or transoral laser microresection. Head Neck 2009;31:531–7
24 Kelly, MD, Hahn, SS, Spaulding, CA, Kersh, CR, Constable, WC, Cantrell, RW. Definitive radiotherapy in the management of stage I and II carcinomas of the glottis. Ann Otol Rhinol Laryngol 1989;98:235–9
25 Marshak, G, Brenner, B, Shvero, J, Shapira, J, Ophir, D, Hochman, I et al. Prognostic factors for local control of early glottic cancer: the Rabin Medical Center retrospective study on 207 patients. Int J Radiat Oncol Biol Phys 1999;43:1009–13
26 Blanch, JL, Vilaseca, I, Caballero, M, Moragas, M, Berenguer, J, Bernal-Sprekelsen, M. Outcome of transoral laser microsurgery for T2-T3 tumors growing in the laryngeal anterior commissure. Head Neck 2011;33:1252–9

Keywords

Transoral laser resection of glottic carcinoma: what is the significance of anterior commissure involvement?

  • K A Stephenson (a1) and J J Fagan (a2)

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