Transoral laser surgery to remove cancer at the base of the tongue is as effective as open surgery and may improve quality of life, according to a new study by researchers from Rush University Medical Center (Otolaryngology -- Head and Neck Surgery, July 2009, Vol. 141:1, pp. 66-69).
The study involved a retrospective chart review of 71 patients who underwent transoral laser microsurgery for squamous cell carcinoma of the base of the tongue. At 24 months, overall survival was 90% and disease-specific survival was 94%, the research team found. Quality-of-life data, obtained for 46 patients, revealed the majority had mild or no pain, minimally impaired to normal swallowing, and normal speech.
Advances in transoral laser microsurgery have transformed the surgeon's ability to treat cancer that was not otherwise amenable to surgical therapy, according to the university. The surgical technique developed at Rush University is performed through the opening of the mouth using an endoscope with a lighted camera and microscopic lens to view the area. Using a CO2 laser and microstaging, surgeons remove the tumor in small pieces, minimizing disruption to nearby tissues and reducing complications and the likelihood of infections, according to the study authors.
"Due to the precision of this surgery, most patients require less adjuvant chemotherapy, and in some cases patients will not need chemotherapy," said study author Guy Petruzzelli, M.D., Ph.D., chief of the section of head, neck, and skull base surgery and the Charles Arthur Weaver Professor of Cancer Research at Rush. "And the functional outcomes are superior. Patients are able to speak and swallow much sooner and better than with an open technique."
In the study, 91% of patients responding experienced "mild" or "no pain," and 97% had "minimal impairment" or "normal" swallowing function. In fact, no patients interviewed were using a gastrostomy tube after 18 months, with average gastrostomy use of just over three months overall, according to the researchers. Finally, 69.6% of patients reported "normal" speech.
"Transoral laser surgery is an acceptable and in many cases preferred option for managing appropriately sized tumors of the back of the tongue. Its overall safety and functional outcomes are in many cases superior to traditional open surgeries and potentially high-dose chemotherapy and radiation," Dr. Petruzzelli said.
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