Salvage transoral laser microsurgery for early recurrent glottic carcinoma after primary laser treatment

Conclusion: Salvage transoral laser microsurgery (TLM) may be a curative organ-preserving treatment for early recurrent glottic carcinoma after primary laser resection. However, failure after TLM seems to be associated with decrease of survival and larynx preservation rates. Objective: To evaluate the oncological results of salvage TLM for early recurrent glottic carcinoma after primary laser treatment. Methods: Records of 50 patients with local recurrences of glottic carcinoma treated by salvage TLM between January 1994 and December 2008 were retrospectively analyzed. Results: Thirty-six rT1 and 14 rT2 lesions were treated with salvage TLM. Mean follow-up was 68.3 months. Thirty-one patients were cured by first salvage TLM and four by further laser procedures. The other 15 patients were finally salvaged by laryngectomy or radiotherapy. Five-year overall survival, disease-specific survival, local control, and loco-regional control rates were 89.9%, 97.9%, 62.3%, and 60.1%, respectively. Larynx preservation rate after long-term follow-up was 86%. In univariate analysis, second local recurrence showed a statistically significant impact on disease-specific survival rate (p = 0.049) and larynx preservation rate (p = 0.006). In multivariate analysis, it was associated with a statistically significant decrease in larynx preservation rate (p = 0.016). There was no statistically significant difference in oncological results between patients with and without anterior commissure involvement.