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Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes.
Laryngoscope. 2017 07; 127(7):1644-1651.L

Abstract

OBJECTIVE

Although vocal fold (VF) leukoplakia is commonly treated with in-office laser, there is no data on its long-term effectiveness. This study hypothesizes that VF leukoplakia treated by serial in-office laser results in long-term disease control with maintenance of voice and minimal morbidity.

STUDY DESIGN

Retrospective review (2008-2015).

METHODS

Forty-six patients with VF leukoplakia treated by in-office KTP (potassium titanyl phosphate) or PDL (pulsed dye laser) were included. Median follow-up from final laser treatment was 19.6 months. Main outcomes included: 1) rate of disease control, 2) percentage of disease regression using ImageJ analysis. Secondary outcomes included vocal assessment using the Voice Handicap Index-10 (VHI-10).

RESULTS

Patients underwent a median of 2 (range: 1-6) in-office laser treatments. Time between treatments was median 7.6 months. After final treatment, 19 patients (41.3%) had no disease; two patients (4.3%) progressed to invasive cancer; overall disease regression was median 77.1% (P < 0.001); and VHI-10 score decreased by median 5 (P = 0.037). Thirty-one patients (67.4%) were responders (controlled with in-office treatment only); failures were 13 patients (28.3%) who required operative intervention and two patients (4%) who underwent radiation. Compared to responders, failures demonstrated significantly shorter duration between treatments (median 2.3 vs. 8.9 months, P = 0.038) and significantly less regression (median 49.3% vs. 100%, P = 0.006).

CONCLUSION

Serial outpatient KTP or PDL treatment of VF leukoplakia is effective for disease control with minimal morbidity and preservation of voice quality. We suggest that patients requiring repeated in-office treatment every 6 months may benefit from earlier operative intervention; other factors associated with in-office success remain unclear.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:1644-1651, 2017.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai.Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center.Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center.Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center.Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center, New York, New York, U.S.A.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28083976

Citation

Koss, Shira L., et al. "Serial In-office Laser Treatment of Vocal Fold Leukoplakia: Disease Control and Voice Outcomes." The Laryngoscope, vol. 127, no. 7, 2017, pp. 1644-1651.
Koss SL, Baxter P, Panossian H, et al. Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes. Laryngoscope. 2017;127(7):1644-1651.
Koss, S. L., Baxter, P., Panossian, H., Woo, P., & Pitman, M. J. (2017). Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes. The Laryngoscope, 127(7), 1644-1651. https://doi.org/10.1002/lary.26445
Koss SL, et al. Serial In-office Laser Treatment of Vocal Fold Leukoplakia: Disease Control and Voice Outcomes. Laryngoscope. 2017;127(7):1644-1651. PubMed PMID: 28083976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes. AU - Koss,Shira L, AU - Baxter,Peter, AU - Panossian,Haig, AU - Woo,Peak, AU - Pitman,Michael J, Y1 - 2017/01/13/ PY - 2016/04/30/received PY - 2016/10/18/revised PY - 2016/11/08/accepted PY - 2017/1/14/pubmed PY - 2017/8/19/medline PY - 2017/1/14/entrez KW - KTP KW - in-office laser KW - vocal fold leukoplakia SP - 1644 EP - 1651 JF - The Laryngoscope JO - Laryngoscope VL - 127 IS - 7 N2 - OBJECTIVE: Although vocal fold (VF) leukoplakia is commonly treated with in-office laser, there is no data on its long-term effectiveness. This study hypothesizes that VF leukoplakia treated by serial in-office laser results in long-term disease control with maintenance of voice and minimal morbidity. STUDY DESIGN: Retrospective review (2008-2015). METHODS: Forty-six patients with VF leukoplakia treated by in-office KTP (potassium titanyl phosphate) or PDL (pulsed dye laser) were included. Median follow-up from final laser treatment was 19.6 months. Main outcomes included: 1) rate of disease control, 2) percentage of disease regression using ImageJ analysis. Secondary outcomes included vocal assessment using the Voice Handicap Index-10 (VHI-10). RESULTS: Patients underwent a median of 2 (range: 1-6) in-office laser treatments. Time between treatments was median 7.6 months. After final treatment, 19 patients (41.3%) had no disease; two patients (4.3%) progressed to invasive cancer; overall disease regression was median 77.1% (P < 0.001); and VHI-10 score decreased by median 5 (P = 0.037). Thirty-one patients (67.4%) were responders (controlled with in-office treatment only); failures were 13 patients (28.3%) who required operative intervention and two patients (4%) who underwent radiation. Compared to responders, failures demonstrated significantly shorter duration between treatments (median 2.3 vs. 8.9 months, P = 0.038) and significantly less regression (median 49.3% vs. 100%, P = 0.006). CONCLUSION: Serial outpatient KTP or PDL treatment of VF leukoplakia is effective for disease control with minimal morbidity and preservation of voice quality. We suggest that patients requiring repeated in-office treatment every 6 months may benefit from earlier operative intervention; other factors associated with in-office success remain unclear. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1644-1651, 2017. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/28083976/Serial_in_office_laser_treatment_of_vocal_fold_leukoplakia:_Disease_control_and_voice_outcomes_ L2 - https://doi.org/10.1002/lary.26445 DB - PRIME DP - Unbound Medicine ER -