This approach is conceptually attractive since it is repeatable, preserves all conventional cancer treatment options, and results in outstanding vocal function by improving phonatory mucosal pliability, he said.
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June 2008Dr. Zeitels explained that although the KTP can be used in a continuous mode to imprecisely cut and ablate tissue, this is not what we did. By precisely calibrating settings including the pulse width of the KTP laser, we ablated the tumor without substantially heating and scarring the underlying residual normal vocal tissue.
Further Testing Necessary
Preliminary observations suggest that this new and novel cancer treatment strategy is effective; however, larger patient cohorts and longer follow-up will be necessary to establish incontrovertible oncological efficacy, Dr. Zeitels said.
Amy Chen, MD, MPH, Associate Professor of Otolaryngology at Emory University in Atlanta, concurred. There is no study that includes just 23 patients that would make a procedure ready for prime time, said Dr. Chen, who also serves as Director of Health Services Research for the Atlanta-based American Cancer Society.
Dr. Chen noted that radiation therapy, although highly effective and widely used, is expensive and time-consuming. A course of radiotherapy can cost tens of thousands of dollars, she said. It usually involves 35 treatments with patients coming to the radiation suite daily for at least six weeks. (The laser treatment required only two or three sessions.)
She noted that such a regimen can be grueling for the patient, especially a patient who lives a distance from the tertiary hospital where the treatment is offered. Many patients have to take time off from work, and that can compromise their employment.
Dr. Chen said that ionizing radiation therapy raises the threat of future malignancies and can cause long-term and permanent hypothyroidism, requiring lifelong medication.
It would be helpful to find some treatment that does not cause the adverse effects. That is why this study is fascinating and may be promising, she said.
Criteria for Success
Because glottic cancer is relatively rare and treatments that are now employed are generally acceptable, Dr. Chen said that a head-to-head comparison would probably require a comparison of subjective and objective voice outcomes.
According to the American Cancer Society, an estimated 10,000 new cases of laryngeal carcinoma are diagnosed each year in the United States. About 3900 deaths occur yearly as a result of this disease. Laryngeal cancer affects men four times more frequently than women. Laryngeal cancer makes up 1% to 2% of all malignancies worldwide.