Usefulness of Carbon-dioxide Laser Surgery for Organ-preserving Hypopharyngeal Cancer Treatment

Abstract

To determine the effectiveness of organ-preserving CO₂ laser laryngomicrosurgery for treatment of hypopharyngeal carcinomas we undertook a retrospective review of 57 previously untreated patients who underwent CO₂ laser laryngomicrosurgery for treatment of hypopharyngeal carcinomas between 1979 and 2005. Tumor distribution was 15 cases with T1, 39 cases with T2, and 3 cases with T3. Node status was positive in 49.1% of the patients. Regarding stage classification, 8 were stage I, 22 stage II, 9 stage III, and 18 stage IV. Surgical procedure by CO₂ laser surgery fell into 4 groups : 7 cases with CO₂ laser resection, 2 with CO₂ laser vaporization, 21 with CO₂ laser resection + radiation, and 27 with CO₂ laser vaporization + radiation. Five-year overall and disease-specific survival rates were 38.2% and 82.0% respectively. The five-year local control rate and laryngeal preservation rate were 76.4% and 81.2%. The five-year disease-specific survival rates were 100% for stage I, 90.9% for stage II, 77.8% for stage III, and 68.0% for stage IV. The five-year local control rate and laryngeal preservation rate were 80.0% and 86.7% with T1, and 79.0% and 82.0% with T2. The five-year local control rate was 90.5% with CO₂ laser resection + radiation and 73.1% with CO₂ laser vaporization + radiation. Causes of death in 32 (56.1%) cases consisted of 1 case (1.8%) of local recurrence, 4 (7.0%) of neck lymph-node recurrence, 3 (5.3%) of distant metastasis, 1 (1.8%) of unknown cause, and 24 (42.1%) by other cause of death. Organ-preserving CO₂ laser resection + radiation for treatment of selected hypopharyngeal carcinomas was considered to be quite effective therapy.