Outcomes of Treating Early Glottic Neoplasms With a Potassium Titanyl Phosphate Laser

Abstract

The aim of this study was to assess the outcome of treating glottic dysplasia and early squamous cell carcinoma (SCC) with potassium titanyl phosphate (KTP) photoangiolytic laser ablation. Methods: Patient demographics, comorbidities, and tumor characteristics were recorded. Perceptual, patient-reported, and objective voice outcomes were assessed. Use of treatment modalities in addition to the KTP laser, development of locoregional or metastatic SCC, and overall survival were recorded. Results: There were 23 patients with glottic dysplasia and 18 patients with glottic SCC. Mean age at treatment was 69 years. Most patients (95%) were male. Posttreatment fundamental frequency fell from 132 ± 35 to 116 ± 24 Hz (P = .03). Overall, 61% of patients achieved a normal voice. There was a learning-curve, and most treatment failures occurred in the first half of the series. Five-year KTP-only disease-control rates were 87.1% and 53.5% for dysplasia and malignancy, respectively. Five-year overall survival was 56%, with no laryngectomies or deaths due to SCC. Conclusions: Ablating dysplasia and early glottic cancer using a KTP laser is a viable treatment option. It has a learning curve and a failure rate but, in this series, no ultimate loss of oncologic control. Its introduction into clinical practice should be managed carefully in the context of multidisciplinary cancer care. Level of Evidence: 4.

KTP Laser Treatment of Early Glottic Cancer: A Multi-Institutional Retrospective Study

“…Laryngeal preservation remained 100% in the non-KTP salvage subgroup. Our KTP re-treatment rate (27%) compares favorably to Nouraei et al 25 While a majority of this subpopulation only required one re-treatment to achieve local control, this concept of the potential need for re-treatment is important to disclose during preoperative counseling. Furthermore, the need for close postoperative observation is paramount to early identification of new glottic pathology and subsequent re-treatment, so patients who have difficulty traveling or may be poor follow-up candidates are perhaps not well-suited for TLM-KTP.…”

“…To our knowledge, only one study to date 25 has in-depth reporting of re-treatments with the KTP in the OR or office after initial primary TLM-KTP. In that study by Nourei et al, 15 patients with previously untreated T1 or T2 EGC were treated initially by one or two-stage TLM-KTP.…”

“…23 Several reports of TLM-KTP from other groups exist, but are relatively small, retrospective, and single-institutional. 24-26 Additional studies would help evaluate clinical effectiveness as more surgeons adopt and employ this technique, while also contributing to the body of literature from which future prospective studies might be constructed. We present oncologic and voice outcomes from a large population of patients who underwent TLM-KTP ablation for EGC across multiple institutions and practice settings.…”

Outcomes of KTP Laser Ablation in Glottic Neoplasms: A Systematic Review and Meta‐Analysis

“…The only independent risk factor for KTP treatment failure was a difficult direct laryngoscopy. They further highlighted that the laryngeal preservation in patients who received KTP was 100%, 31 which is in line with the 97.5% laryngeal preservation rate for early-stage glottic malignancy and carcinoma in situ with RT. Similarly, Zeitels et al reported a 99% and 89% larynx preservation and survival in patients treated with KTP for T1 and T2 disease, respectively.…”

“…The final meta-analysis included eight studies (Figure 1). 6,[27][28][29][30][31][32][33] A total of 342 patients underwent KTP laser ablation within the included studies. All the included studies were performed between 2013 and 2022.…”