Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement

Cesare Piazza; Alberto Paderno; Elisabeth V Sjogren; Patrick J Bradley; Hans E Eckel; Antti Mäkitie; Nayla Matar; Vinidh Paleri; Giorgio Peretti; Roberto Puxeddu; Miquel Quer; Marc Remacle; Vincent Vander Poorten; Isabel Vilaseca; Ricard Simo

doi:10.1007/s00405-021-06957-5

Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement

Eur Arch Otorhinolaryngol. 2021 Nov;278(11):4373-4381. doi: 10.1007/s00405-021-06957-5. Epub 2021 Jul 5.

Authors

Cesare Piazza^{1

2}, Alberto Paderno^{3

4}, Elisabeth V Sjogren⁵, Patrick J Bradley⁶, Hans E Eckel⁷, Antti Mäkitie⁸, Nayla Matar⁹, Vinidh Paleri¹⁰, Giorgio Peretti¹¹, Roberto Puxeddu¹², Miquel Quer¹³, Marc Remacle¹⁴, Vincent Vander Poorten^{15

16}, Isabel Vilaseca¹⁷, Ricard Simo¹⁸

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, ASST-Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy.
² Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
³ Department of Otorhinolaryngology-Head and Neck Surgery, ASST-Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy. albpaderno@gmail.com.
⁴ Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. albpaderno@gmail.com.
⁵ Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
⁶ Department of ORL-HNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham, UK.
⁷ Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Klagenfurt General Hospital, Klagenfurt, Austria.
⁸ Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.
⁹ Department of Otolaryngology-Head and Neck Surgery, Saint Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon.
¹⁰ Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
¹² Unit of Otorhinolaryngology-Head and Neck Surgery, Azenda Ospedaliero Universitaria, Presidio Ospedaliero Duilio Casula, Cagliari, Italy.
¹³ Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona, Barcelona, Spain.
¹⁴ Department of Otolaryngology, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg.
¹⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
¹⁶ Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
¹⁷ Otorhinolaryngology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
¹⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Head, Neck and Thyroid Cancer Unit, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK.

Abstract

Purpose: To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO₂ TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT].

Methods: Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO₂ TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process.

Results: The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO₂ TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up.

Conclusion: Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO₂ TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO₂ TOLMS for LSCC in the salvage setting is presented.

Keywords: Carbon dioxide laser; Chemoradiation; Laryngeal cancer; Radiotherapy; Salvage surgery; Transoral laser microsurgery.

MeSH terms

Carbon Dioxide
Consensus
Glottis
Head and Neck Neoplasms*
Humans
Laryngeal Neoplasms* / surgery
Laser Therapy*
Lasers
Microsurgery
Salvage Therapy
Treatment Outcome

Substances

Carbon Dioxide