ORLANDO, FL-Laser involution of early stage glottic cancer-with complete treatment of the malignancy weeks after the first session-appears to offer long-term control of the disease while preserving excellent voice function, researchers reported at the 88th annual meeting of the American Broncho-Esophagological Association (ABEA).
Explore this issue:June 2008
In a preliminary report that described treatment of 23 patients, Steven M. Zeitels, MD, Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School in Boston, suggested that treatment with pulsed angiolytic lasers might offer a better solution for laryngeal cancer than ionizing radiation.
This is somewhat unconventional, Dr. Zeitels said during the ABEA session, which was conducted as part of the annual Combined Otolaryngology Spring Meeting. I’ll ask you to keep an open mind.
He said the use of pulsed angiolytic lasers has previously been demonstrated to be effective for managing vocal fold dysplasia.
Based on this experience, we evaluated treating early glottic cancers by selectively targeting the intralesional microcirculation, Dr. Zeitels said. Initially we used the yellow-light 585-nm pulsed-dye laser, but ultimately abandoned it. For the past three years, the 532-nm pulsed-KTP [potassium titanyl phosphate] laser was used exclusively because it provides substantially enhanced precision, as well as being less expensive. This approach was derived from the work of the late Judah Folkman’s concepts of neoplastic growth resulting from tumor angiogenesis.
Staged microlaryngeal treatment was adopted because it facilitated optimal functional results and was considered safe because early glottic cancer rarely metastasizes. Furthermore, intercurrent disease for around three months is typical when treating these tumors with radiotherapy, he said.
Dr. Zeitels also noted that the initial angiolytic laser endoscopic management of glottic cancer with lasers still preserves other treatment options including other forms of surgery and radiation.
Among the 23 patients, 13 had cancer in both vocal folds; 13 presented with T1 disease, nine had T2 disease, and one had T4 disease. Dr. Zeitels said that among these patients one recurrence was observed, but retreatment with the laser involuted the tumor and that patient has now been subsequently free of disease for more than two years.
All the patients have no evidence of disease, and 13 of them had treatment more than two years ago. The mean follow-up was 28 months. The longest a patient has cancer-free subsequent to the laser treatment has been 5.5 years, Dr. Zeitels said in his oral presentation.
Dr. Zeitels used the 585-nm pulsed-dye laser in the initial eight patients and the 532-nm pulsed-KTP laser in the last 15 patients to eradicate the vocal fold tumors. Both lasers are capable of involuting vocal fold cancer; however, we observed the pulsed-KTP laser to be more effective, he said. Incremental endolarygneal treatment of early glottic cancer is safe and allows for substantially better functional outcome.