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In-Office KTP or PDL Treatment of VF Leukoplakia Effective for Disease Control

by Literature Reviews •

Is serial in-office laser treatment for vocal fold (VF) leukoplakia effective for long-term disease control with minimal morbidity?

Bottom line
Serial outpatient potassium titanyl phosphate (KTP) or pulsed dye laser (PDL) treatment of VF leukoplakia is effective for disease control with minimal morbidity and preservation of voice quality.

Background: Leukoplakia is a clinical diagnosis indicating the presence of keratin on the VF epithelial surface. This diagnosis portends a risk of malignant transformation, with the severity of dysplasia associated with an increased rate of malignant degeneration. The management of leukoplakia poses a clinical dilemma because leukoplakia carries with it a risk of malignant transformation regardless of dysplasia grade, and it often recurs after treatment. There is no consensus on treatment, with surgeons offering varying degrees and frequency of surveillance, differing thresholds for repeat biopsy, and options of repetitive ablative or excisional management. Recently, treatment with in-office laser has become a common strategy. Although there are studies demonstrating the efficacy of in-office laser treatment of VF leukoplakia, these works are often based on a small series that may not be specific to leukoplakia, do not employ serial treatment, have short-term follow-up, and do not use objective methods to quantify disease regression (See Figure 2).

Figure 2. Determination of % lesion regression. (A) Average lesion area (three measurements) = 1,831 pixels. (B) Average full VF area (three measurements) = 6,924 pixels. Percent VF covered by the lesion was determined by (A/B) × 100% = (1,831/6,924) × 100% = 26.4% of the VF covered by lesion. This % was then compared with the postoperative picture % to determine regression. Credit: Copyright 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Figure 2. Determination of % lesion regression. (A) Average lesion area (three measurements) = 1,831 pixels. (B) Average full VF area (three measurements) = 6,924 pixels. Percent VF covered by the lesion was determined by (A/B) × 100% = (1,831/6,924) × 100% = 26.4% of the VF covered by lesion. This % was then compared with the postoperative picture % to determine regression.
Credit: Copyright 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Study design: Retrospective review (2008–2015).

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