Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Benjamin Judson

Subject Area(s)

Medicine, Surgery, Oncology

Abstract

The objective of this project is to report oncologic and functional outcomes for a cohort of patients with supraglottic squamous cell carcinoma (SSCC) treated in a multidisciplinary setting including the use of transoral laser microsurgery (TLM).

A retrospective observational study at Yale New Haven Hospital, academic teaching hospital was performed. A total of 56 patients without evidence of distant metastasis at presentation treated for SSCC between January 1, 2003 and December 31, 2007 were identified. The main outcome measures include overall survival (OS), locoregional and distant recurrence, and the incidence of tracheostomy and gastrostomy tube requirement.

Of the 56 patients, 22 (39%) were treated with TLM, 23 (41%) with definitive radiation (XRT) based therapy, and 11 (20%) with total laryngectomy (TL). Chronic tracheostomy requirement for the TLM, XRT, and TL groups was 0% (0/21), 35% (7/20) and 100% (11/11). Long term gastrostomy tube (PEG) use for the TLM, XRT, and TL groups was 15% (3/20), 36% (4/11) and 50% (5/10) respectively. Two year OS for TLM, TL, and XRT were 86% (18/21), 80% (8/10), and 52% (12/23) respectively. Controlling for age, stage, and treatment on multivariate analysis, younger age and treatment with either TL or TLM were significantly associated with improved survival.

In conclusion, transoral laser microsurgery, especially when employed in a multimodal approach including adjuvant chemoradiotherapy, offers acceptable oncologic results and good functional outcomes.

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