FLEX October 2023

15314995, 2023, 8, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/lary.30547 by Wake Forest Univesity, Wiley Online Library on [18/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

retrospective study by Nouraei et al. showed no signi fi cant difference between KTP and CO 2 in terms of one year VHI. Moreover, they highlighted an increased risk of failure to achieve a normal voice in recurrent patients treated with KTP (OR = 1.61, 95% CI: 1.2 – 2.19). 31 Our study did not support an increased risk of failure with the KTP laser technique. AswithCO 2 , the use of KTP depends on the surgeon ’ s judgment, experience, and skill to minimize tissue removal and maximize functional outcomes. 38 This judgment is driven by the belief by some surgeons that the KTP laser ’ s deeper tissue penetration enables the sterilization of microscopic disease that may require a more invasive resection with a CO 2 laser. The radiation regimens used to treat early glottic cancer vary, although radiotherapy is generally a standardized treatment with repeatable out comes. 39 The KTP laser therapy may reduce the amount of damage caused by surgery, but one potential disadvantage is that it does not provide a resection specimen for histologic analysis of the resection margins. 40 This might lead to treatment variability if the surgeon performing the proce dure cannot accurately assess the surgery ’ s success. We acknowledge that our study has some limitations including the low quality of evidence generated by these studies and the lack of well-designed RCTs. Another major limitation is the relatively small sample sizes with the included studied, increasing the probability of type II error. In addition, the observed high heterogeneity in the pooled analysis is another limitation that could hinder the general izability of our fi ndings; however, we tried to solve this het erogeneity by performing sensitivity analysis and subgroup analysis. We could not perform a publication bias analysis due to the small number of included studies. In conclusion, the current evidence suggests that KTP is a safe and effective method for treating patients with early glottic neoplasms. Overall survival, disease free survival, and recurrence rates are similar to CO 2 and radiotherapy. The voice bene fi ts of KTP are evident in the form of improved VHI and GRBAS scores. Additionally, KTP uniquely allows for of fi ce retreatment intervention for any suspicious lesion thereby preventing progression to a recurrence and obviating a trip to the operating room. BIBLIOGRAPHY 1. Overgaard J, Jovanovic A, Godballe C, Grau EJ. The Danish head and neck cancer database. Clin Epidemiol . 2016;8:491-496. 2. Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope United States. 2006;116(9 Pt 2 Suppl 111):1-13. 3. Marur S, Forastiere AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. Mayo Clin Proc . United States. 2016;91(3):386-396. 4. Henley SJ, Thomas CC, Sharapova SR, et al. Vital signs: disparities in tobacco-related cancer incidence and mortality - United States, 2004 – 2013. MMWR Morb Mortal Wkly Rep United States. 2016;65(44):1212 1218. 5. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975 – 2013 . Bethesda, MD: National Cancer Institute; 2016. 6. Barbu AM, Burns JA, Lopez-Guerra G, Landau-Zemer T, Friedman AD, Zeitels SM. Salvage endoscopic angiolytic KTP laser treatment of early glottic cancer after failed radiotherapy. Ann Otol Rhinol Laryngol . 2013; 122(4):235-239. 7. Higgins KM, Shah MD, Ogaick MJ, Enepekides D. Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radio therapy. J Otolaryngol Head Neck Surg . 2009;38(6):603-612.

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Laryngoscope 133: August 2023

Suppah et al.: KTP in Glottic Neoplasms 1813