Head and neck

Vol. 45: Issue 6 - December 2025

Optimising oncologic outcomes in pT3 glottic cancers treated by transoral laser microsurgery: the impact of adjuvant treatment

Authors

Aurora Pinacoli , Laura Ruiz-Sevilla , Claudio Sampieri , Paolo Bosio , Filippo Marchi , Gabriele Zigliani , Francesca Del Bon , Giorgio Peretti , Isabel Vilaseca , Cesare Piazza

Key words: larynx, cancer, T3, glottis, CO2 laser, transoral microsurgery, adjuvant treatment, radiotherapy
DOI: 10.14639/0392-100X-A1372
Publication Date: 2025-11-28

Abstract

Objective. The treatment strategy for cT3 glottic squamous cell carcinoma (SCC) is far from being standardised, and the role of adjuvant treatment(s) is not clearly defined. This study assessed the impact of adjuvant (chemo-)radiotherapy ([C]RT) for patients with pT3 glottic SCC treated by transoral carbon dioxide laser microsurgery (CO2 TOLMS) presenting adverse pathological features.
Methods. A multicentric retrospective study was conducted at 3 referral hospitals, including patients with pT3 glottic SCC treated from January 2010 to October 2023. Demographic, clinical, and histopathological data were collected, together with data on surgery, postoperative functional performance, adjuvant treatment(s) with (C)RT, and complications. Five- and 10-year overall (OS), disease-specific (DSS), disease-free (DFS), and total laryngectomy free survivals (TLFS) were estimated by Kaplan-Meier curves. Uni- and multivariate Cox proportional hazards regression models were used to determine independent risk factors for survivals.
Results. One hundred and forty-one patients treated with CO2 TOLMS for pT3 glottic SCC were included in the study. Twenty-six (18.4%) patients received adjuvant treatment(s): 19 (13.5%) received RT alone, and the remaining 7 (5%) received CRT. Five-year OS, DSS, DFS, and TLFS were 78.1%, 91.5%, 49.7%, and 64.8%, respectively. Age independently correlated with worse OS, DFS, and TLFS at both uni- and multivariate Cox analysis. Adjuvant therapy was an independent protective factor for recurrence or death (DFS) at univariate (hazard ratio [HR] 0.46, p = 0.03) and multivariate (HR 0.38, p = 0.01) Cox analysis.
Conclusions. This study suggests that adjuvant treatment with (C)RT has a positive impact on DFS for pT3 glottic SCC treated by CO2 TOLMS. The similar OS, DSS, and TLFS observed in pT3 SCC treated by CO2 TOLMS alone and a selected group of unfavourable lesions needing adjuvant (C)RT show that adding such a treatment on top of conservative surgery may ensure good oncologic outcomes even in a selected subgroup of more aggressive glottic pT3. Further prospective studies should be conducted to validate these findings and confirm the relevance of adjuvant treatment(s) in this setting.

Downloads

PDF
Authors

Aurora Pinacoli - Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health (DSMC), University of Brescia, School of Medicine, Brescia, Italy. AP and LR-S share the first authorship. Corresponding author - aurora.pinacoli@gmail.com

Laura Ruiz-Sevilla - Department of Otorhinolaryngology, Hospital Universitari Joan XXIII, Tarragona, Spain. AP and LR-S share the first authorship.

Claudio Sampieri - Functional Unit of Head and Neck Tumors, Hospital Clinic, Barcelona, Spain; Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain

Paolo Bosio - Unit of Otorhinolaryngology, ASST Bergamo Est, Seriate, Italy

Filippo Marchi - Unit of Otorhinolaryngology – Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

Gabriele Zigliani - Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy

Francesca Del Bon - Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy

Giorgio Peretti - Unit of Otorhinolaryngology – Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

Isabel Vilaseca - Functional Unit of Head and Neck Tumors, Hospital Clinic, Barcelona, Spain; Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain

Cesare Piazza - Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health (DSMC), University of Brescia, School of Medicine, Brescia, Italy

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright

Copyright (c) 2025 Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale

How to Cite
Pinacoli, A., Ruiz-Sevilla, L., Sampieri, C., Bosio, P., Marchi, F. ., Zigliani, G., Del Bon, F., Peretti, G., Vilaseca, I., & Piazza, C. (2025). Optimising oncologic outcomes in pT3 glottic cancers treated by transoral laser microsurgery: the impact of adjuvant treatment. ACTA Otorhinolaryngologica Italica, 45(6), 388–398. https://doi.org/10.14639/0392-100X-A1372
  • Abstract viewed - 11 times
  • PDF downloaded - 1 times