But although the tumor was widespread within the larynx, it was not growing deep into the paraglottic space. By using the 532-nm pulsed-KTP laser, the cancer has been controlled, and his voice is now better than it had been in a decade.
Explore this issue:May 2009
When prognosticating voice outcome subsequent to early glottic cancer treatment, patients’ particular anatomy and how much lamina propria they may have underlying the tumor can be as important as the shape and location of the cancer, Dr. Zeitels said.
He also discussed the exciting prospects of the use of biomaterials to help restore voice, pointing out how researchers have shown how a piece of biomaterial can restore pliability even to a vocal cord made stiff by inserting a plastic angiocatheter submucosally through the vocal fold of a cadaver.
The catheter-stiffened vocal fold simulates the vibratory characteristics of a successfully treated cancer. It’s stiff as a board, so that we have to get something underneath the membrane to restore pliability, Dr. Zeitels said.
Is this perfect? No, he said. Can you re-establish vocal-fold vibration? Yes-even with a piece of plastic still there.
This is kind of exciting, because you can imagine this is the future of cancer management, he said. This, ultimately, for many patients will turn into an office-based injection procedure.
Studies Indicate Procedure’s Efficacy
A study on laser treatment presented by Wolfgang Steiner, MD, in 2005 showed that of 333 patients with T1a tumors, 89.3% had their lesions controlled after five years, and 97.6% of those had their larynx preserved.
Out of 212 patients with T2 tumors, 84% with the T2a type had their lesions controlled after five years, as did 74% of the T2b patients. The larynx had been preserved in 95% of the T2a patients and in 85% of the T2b patients.
In 2006, a study by Giorgio Peretti, MD, et al. showed that endoscopic resection for early glottic cancer patients yielded good results. The 13 patients with tumors in situ had a local control rate of 92% after five years, and 75 patients with T1 lesions had a rate of 90%. The larynx had been preserved in 94.4% of patients. The 67 patients with T2 type glottic cancer had a local control rate of 82% after five years, and the larynx was preserved in 94% of the patients.
Dr. Shapshay said that with his own patients, from 1982 to 2006, he achieved good results with endoscopic treatment.