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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
Photoangiolytic Treatment of Early Glottic Cancer

Aaron Friedman, MD, Steven M. Zeitels, MD, FACS, James A. Burns, MD, FACS, Gerrardo Lopez-Guerra, MD, Matthew J. Lutch, MD;
Massachusetts General Hospital; Boston, MA


PURPOSE OF STUDY
The 532nm pulsed-KTP (potassium titanyl phosphate) and 585nm pulsed-dye lasers (PDL) are photoangiolytic lasers that have been demonstrated to be effective for managing vocal-fold dysplasia. The putative mechanism of action is selective photoangiolysis of the sublesional microcirculation. Based on this experience, we sought to assess the efficacy of this approach in treating early glottic cancer by selectively targeting the intralesional/sublesional microvasculature. This strategy was derived from Folkmanís concepts of neoplastic growth resulting from tumor angiogenesis.

METHODS USED:
Prospective, non-randomized.

SUMMARY OF RESULTS:
A pilot group of 32 (T1-18, T2-14) patients with early glottic cancer were treated with a fiber-based angiolytic laser. The initial 8/32 were treated with the PDL and the latter 24/32 were done with the pulsed-KTP laser. No patient currently has cancer although 1/32 needed post-surgical radiotherapy and another required open vertical partial laryngectomy. The mean follow-up is 32 months; 17/32 are >2 years. The earliest patients were treated over 5 years ago.

CONCLUSIONS:
Angiolytic lasers effectively involuted early glottic cancer with microsurgically-directed non-ionizing radiation of dense neoplastic blood supply resulting in complete tumor regression. This approach is repeatable, preserves all conventional cancer-treatment options, and results in excellent vocal function by improving phonatory mucosal-wave vibration. Staged microlaryngeal treatment facilitated optimal functional results and was considered safe because early glottic-cancer rarely metastasizes. Furthermore, intercurrent disease during conventional incremental radiotherapy is typical when treating early glottic cancer. Observations herein suggest that this new and novel cancer-treatment strategy is effective; however, larger patient cohorts, longer follow-up, and multi-institutional confirmation are needed to establish incontrovertible oncologic efficacy.

 

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