Transoral laser microsurgery (TLM) is a relatively new treatment in the United States and is a viable option for several types of head and neck cancer, allowing physicians to target tumors without needing to surgically disassemble the patient, according to the experts interviewed for this article.
Explore this issue:
July 2008Gaining Acceptance in US
Surgeons in the United States began using TLM to treat tumors outside the larynx more than 10 years ago and have been increasingly using the technology to resect larger, more advanced stage head and neck tumors, said Michael Hinni, MD, Associate Professor at Mayo Medical School and a consultant in the Department of Otorhinolaryngology at Mayo Clinic in Scottsdale, AZ.
Most tertiary centers have a head and neck surgeon who is familiar with the technology, he said. But there still aren’t very many people with any significant experience. We’re working to change that.
Transoral laser microsurgery has taken a while to gain acceptance in the United States because of concerns about what happens when you split a tumor into pieces as it is being removed, said Salvatore Caruana, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery at Columbia University Medical Center in New York. To split a tumor and segmentally remove it meets with intuitive opposition, he explained.
Despite any trepidation, the procedure is becoming more popular largely because of its low morbidity and excellent cure rates compared to those of chemoradiation, which has been a mainstay for head and neck cancer for the past 10 to 15 years, said John Salassa, MD, Associate Professor at Mayo Medical School and a physician in the Department of Otolaryngology-Head and Neck Surgery at Mayo Clinic in Jacksonville, FL.
Indications
The procedure is generally indicated for patients with early-stage or medium-stage head and neck tumors, including squamous cell cancers of the oral cavity, oropharynx, hypopharnyx, and larynx, said Dr. Caruana.
Physicians at Mayo Clinic will consider TLM for most head and neck cancers. We can treat just about any T1 or T2, most T3, and some T4 tumors, explained Dr. Salassa.
The clinic has a database of approximately 800 patients who have undergone TLM since 1996.
Evaluation of this database has led researchers there to conclude that TLM is safe and effective in patients with previously untreated squamous cell cancer of the supraglottic larynx (Otolaryngol Head Neck Surg 2007;136:900-6) and in select patients with glottic larynx carcinoma (Otolaryngol Head Neck Surg 2007;137:482-6).
Selected patients with early and advanced previously untreated squamous cell tongue base cancer are also candidates for the procedure (Laryngoscope 2006;116:2150-5) as are those with persistent, recurrent, or secondary primary disease (Laryngoscope 2006;116:2156-61).