Transoral laser microsurgery for advanced laryngeal cancer
Transoral laser microsurgery for advanced laryngeal cancer
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DOI：
10.1001/archotol.133.12.1198
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发表时间：
2007-12-01
影响因子：
--
通讯作者：
Steiner, Wolfgang
中科院分区：
文献类型：
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作者：
Hinni, Michael L.;Salassa, John R.;Steiner, Wolfgang
目的：报告经口激光显微手术（TLM）治疗晚期喉癌的肿瘤学和功能结局。设计：前瞻性病例系列研究。设置：多机构（学术、三级转诊中心）。共有117例经病理证实的T2至T4病变、III期或IV期患者，摘要1997年至2004年，我院共收治声门型或声门上型喉癌12例，均行TLM治疗。所有患者的最低随访期为2 years.Interventions：经口激光显微手术117例，颈淋巴结清扫术91例，辅助放疗45 patients.Main Outcome Measures：终点分析包括喉保存，总生存率，无病生存率，局部控制，局部控制，和远处转移。术后并发症，气管切开率，和喂养管dependency.Results：存活患者的中位随访期为5年。2年时，治疗后喉完整的患者百分比为92%。2年局部控制率和局部区域控制率分别为82%和77%。2年无瘤生存率和总生存率分别为68%和75%。5年Kaplan-Meier估计值为局部控制，74%;局部区域控制，68%;无病生存率，58%;总生存率，55%;远处转移，14%。4例患者（3%）发生治疗相关死亡。7例患者（6%）发生术后出血。这些患者的器官保存和无疾病复发，2例（3%）气管切开依赖，4例（7%）feedingtube dependent.Conclusions：在晚期喉癌患者中，TLM与或不放疗是一个有效的治疗策略，为器官保存。此外，低发病率和死亡率以及良好的肿瘤学和功能结局使TLM成为一种有吸引力的治疗选择。
Objective: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer.Design: Prospective case series study.Setting: Multi-institution (academic, tertiary referral centers).Patients: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years.Interventions: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients.Main Outcome Measures: End points analyzed included laryngeal preservation, overall survival, diseasefree survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined.Results: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feedingtube dependent.Conclusions: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.