Salvage transoral laser microsurgery for early recurrent glottic carcinoma after primary laser treatment
Salvage transoral laser microsurgery for early recurrent glottic carcinoma after primary laser treatment
复制标题
经口激光显微手术治疗初次激光治疗后早期复发性声门癌
DOI：
10.3109/00016489.2012.734929
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发表时间：
2013-05-01
影响因子：
1.4
通讯作者：
Huang, Zhigang
中科院分区：
文献类型：
--
作者：
Huang, Junwei;Yu, Zhenkun;Huang, Zhigang
摘要结论：经口激光显微手术（TLM）可能是一种有效的器官保留治疗早期复发性声门癌后的主要激光切除术。然而，TLM后的失败似乎与生存率和喉保存率的下降有关。目的：探讨声门型喉癌初次激光治疗后早期复发的补救性TLM的疗效。研究方法：回顾性分析1994年1月至2008年12月间50例声门型喉癌局部复发患者行TLM挽救性切除术的临床资料。结果：36例rT1和14例rT2病变接受了挽救性TLM治疗。平均随访时间为68.3个月。31例患者通过第一次挽救性TLM治愈，4例通过进一步激光手术治愈。其余15例经喉切除或放射治疗后治愈。5年总生存率、疾病特异性生存率、局部控制率和局部区域控制率分别为89.9%、97.9%、62.3%和60.1%。长期随访喉保存率为86%。在单变量分析中，第二次局部复发对疾病特异性生存率（p = 0.049）和喉保留率（p = 0.006）有统计学显著影响。在多变量分析中，它与喉保留率的统计学显著降低相关（p = 0.016）。有和没有前连合受累的患者之间的肿瘤结果没有统计学显著差异。
Abstract Conclusion: Salvage transoral laser microsurgery (TLM) may be a curative organ-preserving treatment for early recurrent glottic carcinoma after primary laser resection. However, failure after TLM seems to be associated with decrease of survival and larynx preservation rates. Objective: To evaluate the oncological results of salvage TLM for early recurrent glottic carcinoma after primary laser treatment. Methods: Records of 50 patients with local recurrences of glottic carcinoma treated by salvage TLM between January 1994 and December 2008 were retrospectively analyzed. Results: Thirty-six rT1 and 14 rT2 lesions were treated with salvage TLM. Mean follow-up was 68.3 months. Thirty-one patients were cured by first salvage TLM and four by further laser procedures. The other 15 patients were finally salvaged by laryngectomy or radiotherapy. Five-year overall survival, disease-specific survival, local control, and loco-regional control rates were 89.9%, 97.9%, 62.3%, and 60.1%, respectively. Larynx preservation rate after long-term follow-up was 86%. In univariate analysis, second local recurrence showed a statistically significant impact on disease-specific survival rate ( p = 0.049) and larynx preservation rate ( p = 0.006). In multivariate analysis, it was associated with a statistically significant decrease in larynx preservation rate ( p = 0.016). There was no statistically significant difference in oncological results between patients with and without anterior commissure involvement.