Transoral carbon dioxide laser microsurgery for recurrent glottic carcinoma after radiotherapy.

BACKGROUND Transoral laser microsurgery is successfully performed in the treatment of primary laryngeal carcinomas. Few publications deal with the application in patients with recurrent glottic carcinomas after radiation failure. Our study aims to review our experience with transoral laser microsurgery in these patients. METHODS Thirty-four patients with early and advanced recurrent glottic carcinoma after full-course radiotherapy (rT1, n = 11; rT2, n = 10; rT3, n = 10; rT4, n = 3) had CO(2) laser treatment with curative intent between 1987 and 1998. RESULTS Twenty-four patients (71%) were cured with one or more laser procedures. In nine patients, recurrences could not be controlled by laser microsurgery: six patients underwent total laryngectomy and three palliative treatment. One patient received total laryngectomy because of chondronecrosis after laser treatment. With a median follow-up interval of 38.6 months, the 3-year and 5-year disease-specific survival was 86%. The overall 3-year survival rate was 74%; the corresponding 5-year survival rate was 53%. No major complications occurred. In three cases, temporary tracheostomy was needed. CONCLUSIONS In early-stage and advanced-stage recurrent glottic carcinomas after radiotherapy, CO(2) laser treatment can successfully be used as a curative organ-preserving procedure. Compared with salvage laryngectomy, results are superior with respect to preservation of laryngeal function. Great expertise is required, especially in resections of advanced-stage recurrent carcinomas.