2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Annals of Otology, Rhinology & Laryngology 123(12)

Figure 3.  (A) Office examination demonstrating a T2b anterior glottic cancer extending below the anterior commissure tendon to the upper subglottis. This patient had undergone 2 endoscopic procedures prior to presentation. (B) Similar to the experience at the other institution, the patient developed limited local failure after angiolytic KTP laser treatment. The patient subsequently underwent successful radiotherapy, and the office laryngoscopy demonstrates a remarkably well-contoured anterior commissure region. Note the radiation-induced microvascular angiogenesis primarily on the right vocal fold.

Figure 4.  (A) Office laryngoscopy demonstrating an extensive transglottic T2b neoplasm with the epicenter in the right vocal fold. The patient subsequently underwent initial angiolytic potassium-titanyl-phosphate (KTP) laser treatment and, after disease recurrence, underwent full-course radiotherapy. (B) Office laryngoscopy demonstrating extensive glottic and subglottic recurrence after radiotherapy, which required total laryngectomy.

Bilateral disease was treated in a staged fashion to opti- mally preserve the architecture of the anterior commissure. The control of T2 disease with KTP laser treatment and ultra-narrow margins in this cohort was 80% (28/35). Local failure was more likely if there was greater involvement of the supraglottis and/or substantial invasion in the caudal subglottis. Unsuccessful attempts with endoscopic resec- tion were done on a majority of these failures. However, ultimately all 7 recurrences received salvage radiotherapy and 43% (3/7) are free of disease. It is not surprising that all 4 radiotherapy failures died from laryngeal cancer. Therefore, for T2 glottic cancer, larynx preservation and

survival were achieved in 89% (31/35) of patients and only 20% (7/35) underwent radiotherapy. In our view, it should be relatively easy for most sur- geons who routinely treat head and neck cancer to adopt KTP laser photoablation with ultra-narrow margins for T1 disease and advance to larger lesions over time. This is sim- ilar to Lynch’s 2 suggestion with suspension laryngoscopy and electrocautery in 1920, Kleinsasser’s 38 suggestion with microlaryngoscopy and cold instruments in the 1960s, and microlaryngoscopy with CO 2 laser proposed by Vaughan, Strong, and Jako 9,35 in the 1970s. It should be emphasized that KTP photoangiolytic tumor removal does not impart an

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