Transoral laser microsurgery for glottic cancer in the elderly: Efficacy and safety

Abstract

Background Data about the results of transoral laser microsurgery (TLM) in elderly patients are limited. Methods A retrospective study of 72 consecutive cases of glottic carcinoma (63 pT1 and 9 pT2 cases) in elderly patients (≥70 years old, mean 76 years) treated with TLM was made. A systematic review of the literature was performed. Results Six patients (8%) had postoperative complications, but no treatment‐related deaths were observed. Local recurrences occurred in 12 patients (16.5%): nine with pT1 (14%) and three with pT2 (33%) tumors. Five‐year disease‐specific survival (DSS), overall survival, and laryngectomy‐free survival were 95%, 68%, and 88%, respectively. The literature review indicated that TLM is safe and effective treatment for these patients, with few complications and good local control (>85%) and DSS (>90%) rates. Conclusions Our results and the information from the literature show that TLM for glottic cancer in elderly patients can lead to satisfactory treatment results.

TLM Outcomes in Elderly Patients with Glottic Pre-Malignancy and Early Malignancy; A 12-Year Retrospective Study

“…As the prevalence of head and neck cancer in elderly populations increases, the need for safe, effective and tolerable treatments in this medically complex patient group becomes increasingly important. 2 The high comorbidity rates associated with increasing age causes concern about the safety and acceptability of more aggressive treatment. 2 As such, older patients may be inappropriately excluded from receiving conventional treatments which would be offered to younger patients, 16,17 even if they have no significant comorbidities.…”

“…The combined effect of the increased risk of head and neck cancer with advancing age, 1,2 along with the ageing UK population is projected to result in a marked rise in the prevalence of glottic malignancy and pre-malignancy in the elderly. 2 In general, early cancers are managed either surgically or with radical external beam radiotherapy (EBRT). Surgical options include trans-oral laser microsurgery (TLM) or open partial laryngectomy.…”

“…In 2012, an analysis of TLM in patients over 65 years of age showed the technique to be effective 7 and a systematic review and case series of 72 cases of TLM in those over 70 years old showed satisfactory surgical treatment results. 2 Exploring oncological outcomes specifically in this subgroup is relevant, because of the increased social and medical challenges associated with older patients who are more likely to have medical comorbidities and a lower functional status. 11 When considering the treatment options for these elderly patients with early glottic cancer, the benefits, risks and practical logistics must be explained to aid decision making.…”

A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases

“…For example, optimal laryngeal exposure should be considered of paramount importance when dealing with an anterior T3 through a TLM approach [28,29,30,31]. By contrast, age and comorbidities do not preclude (or even strongly suggest) use of a mini-invasive surgical approach such as TLM, especially considering its rapid operating time and short in-hospital stay, with limited functional sequelae and complications [32,33,34]. Definitely, however, the amount of LC T3 amenable to such a straightforward treatment is relatively limited even in experienced centers [35].…”

“…In fact, if one considers the LEDFS of TLM vs. CRT, the superiority of the former is striking. Considering the wider indications of TLM when compared to those of CRT (since RT alone performed quite poorly in the present study), age and comorbidities contraindicating non-surgical protocols are, per se, strong indications for the management of selected anterior T3 LC through a transoral route [2,34].…”