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Flexible Endoscopic Laser Surgery for Glottic Carcinoma After Radiotherapy Failure: A First Experience
Petru Gurău1, Oleg Arnaut2,3, Eusebiu Sencu4
1Oncology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, MDA.
Cureus
|March 31, 2026
Summary
Flexible endoscopic laser surgery (FELS) offers an effective, minimally invasive treatment for recurrent glottic cancer after radiotherapy. This approach achieves larynx preservation and good survival rates, particularly for patients unsuitable for traditional surgery.
Area of Science:
- Otolaryngology
- Oncology
- Surgical Innovation
Background:
- Radiotherapy failure in glottic carcinoma often necessitates salvage surgery, frequently total laryngectomy, significantly impacting patient quality of life.
- Transoral CO2 laser microsurgery (TOLMS) is an alternative but has limitations due to anatomy and anesthesia requirements.
- Flexible endoscopic laser surgery (FELS) presents a minimally invasive option to overcome TOLMS limitations for specific patient groups.
Purpose of the Study:
- To evaluate the long-term (five-year) effectiveness of FELS for treating recurrent or persistent glottic carcinoma following radiotherapy failure.
Main Methods:
- FELS was performed on nine patients (four recurrent, five persistent) with early-stage glottic carcinoma (T1a-T2) post-radiotherapy.
- Procedures utilized neodymium-doped yttrium aluminum garnet (Nd:YAG) laser ablation.
- Five patients underwent FELS under local anesthesia with spontaneous ventilation; four had general anesthesia with high-frequency jet ventilation.
Main Results:
- Five-year overall survival and disease control (including salvage) were achieved in 66.7% of patients.
- Larynx preservation and disease-free survival were observed in 55.6% of cases.
- All three T1-stage patients treated with FELS alone were disease-free with preserved larynx.
Conclusions:
- FELS is an effective, minimally invasive treatment for T1-T2 glottic carcinoma recurring after radiotherapy.
- It provides a viable surgical alternative for larynx preservation, especially for patients with contraindications to general anesthesia or traditional transoral surgery.
