Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological...

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Oncology

Background:

• Anterior commissure (AC) involvement in early glottic cancer is a known risk factor for suboptimal outcomes after transoral laser microsurgery (TLM).
• Understanding the impact of AC-related factors on oncological results is crucial for treatment planning.

Purpose of the Study:

• To evaluate the influence of clinical and radiological anterior commissure (AC) factors on oncological outcomes in T1 stage early glottic carcinoma treated with TLM.
• To assess recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) in this patient cohort.

Main Methods:

• Retrospective analysis of clinical, radiological, and follow-up data from patients treated with TLM for T1 glottic squamous cell carcinoma involving the AC.
• Kaplan-Meier survival analysis was used to determine RFS, LCL, LP, and OS rates.

Main Results:

• Five-year survival rates: OS 75.1%, RFS 64.8%, LCL 73.8%, LP 83.4%.
• Higher OS and RFS were observed in patients with early-stage AC patterns compared to advanced stages (p=0.004, p=0.034).
• Vertical extension ratio significantly impacted OS and RFS (p=0.023, p=0.001), while thyroid cartilage interlaminar angle affected LCL (p=0.041).

Conclusions:

• Transoral laser microsurgery (TLM) remains a viable treatment for anterior commissure (AC) involvement in early glottic cancer.
• AC3 type involvement and increased vertical extension are associated with negative prognostic outcomes.
• Narrow thyroid cartilage angles may correlate with increased recurrence; alternative treatment modalities should be considered for such cases.