ABSTRACT The aims of this study were to evaluate the results of CO2 laser surgery alone and CO2 laser surgery combined with radiotherapy in patients with T2N0M0 glottic carcinoma. A retrospective analysis was conducted of 35 cases of T2N0M0 glottic carcinoma. Fourteen patients with normal vocal cord mobility were treated with endoscopic CO2 laser surgery alone. The remaining 21 patients were treated with CO2 laser surgery followed by radiotherapy (44 - 70 Gy, including low-dose carboplatin chemoradiotherapy). Main outcome measures were local control, organ preservation, recurrence, 5-year survival, and successful salvage in cases of recurrence. We evaluated the patient’s voice with the psychoacoustics GRBAS scale, maximum phonation time (MPT), and airflow rate (AFR) obtained by aerodynamic tests. Mean follow-up period was 5 years. Among the 35 T2N0M0 patients, 5-year survival and 5-year voice preservation rates were 97% and 89%, respectively. Local recurrence occurred in 7 of these patients (20%); 4 of 7 local recurrences were successfully re-treated by laser surgery. Total laryngectomy was necessary for salvage treatment in the remaining 3 patients. The post-treatment voice qualities were judged to be the same or improved over pretreatment qualities. There was little change in MPT and AFR after treatment in non-recurrence patients. CO2 laser microsurgery is an excellent tool for treating selected cases of T2N0M0 glottic
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M. Sawatsubashi, T. Umezaki, T. Shin and S. Komune, "A Combination of Endoscopic CO2 Laser Microsurgery and Radiotherapy for Treatment of T2N0M0 Glottic Carcinoma," International Journal of Otolaryngology and Head & Neck Surgery, Vol. 1 No. 2, 2012, pp. 28-33. doi: 10.4236/ijohns.2012.12006.
 H. Miyahara, “Cigarette Smoking as a Carcinogenesis Risk Factor in Cancer of the Larynx and Pharynx,” Journal of the Japan Broncho-Esophagological Society, Vol. 56, No. 5, 2005, pp. 383-393. Hdoi:10.2468/jbes.56.383
 S. W. Barthel and R. M. Esclamado, “Primary Radiation Therapy for Early Glottic Cancer,” Otolaryngology—Head and Neck Surgery, Vol. 124, No. 1, 2001, pp. 35-39. H
 L. P. Bron, D. Soldati, A. Zouhair, M. Ozsahin, E. Brossard, P. Monnier and P. Pasche, “Treatment of Early Stage Squamous-Cell Carcinoma of the Glottic Larynx: Endoscopic Surgery or Cricohyoidoepiglottopexy versus Radiotherapy,” Head and Neck, Vol. 23, No. 10, 2001, pp. 823-829. Hdoi:10.1002/hed.1120
 E. de Campora, M. Radici and L. de Campora, “External versus Endoscopic Approach in the Surgical Treatment of Glottic Cancer,” European Archives of Oto-Rhino-Laryngology, Vol. 258, No. 10, 2001, pp. 533-536.
 H. E. Eckel, W. Thumfart, M. Jungehülsing, C. Sittel and E. Stennert, “Transoral Laser Surgery for Early Glottic Carcinoma,” European Archives of Oto-Rhino-Laryngology, Vol. 257, No. 4, 2000, pp. 221-226.
 Y. Kumamoto, M. Masuda, Y. Kuratomi, S. Toh, A. Shinokuma, K Chujo, T. Yamamoto and S. Komiyama, “FAR Chemoradiotherapy Improves Laryngeal Preservation Rates in Patients with T2N0 Glottic Carcinoma,” Head and Neck, Vol. 24, No. 7, 2002, pp. 637-642.
 O. Laccourreye, R. Gutierrez-Fonseca, D. Garcia, S. Hans, N. Hacquart, M. Ménard and D. Brasnu, “Local Recurrence after Vertical Partial Laryngectomy, a Conservative Modality of Treatment for Patients with Stage I-II Squamous Cell Carcinoma of Glottis,” Cancer, Vol. 85, No. 12, 1999, pp. 2549-2556.
 G. Motta, E. Esposito, B. Cassiano and S. Motta, “T1T2-T3 Glottic Tumors: Fifteen Years Experience with CO2 Laser,” Acta Oto-Laryngologica (Supplementum), Vol. 527, 1997, pp. 155-159.
 M. Sawatsubashi, K. Tsuda, K. Suzuki, S. Takagi, A. Inokuchi and T. Shin, “Endoscopic CO2 Laser Surgery for T1N0 Glottic Carcinoma,” Japanese Journal of Cancer Clinics, Vol. 47, No. 5, 2001, pp. 413-419.
 M. Remacle, H. E. Eckel, A. Antonelli, D. Brasnu, D. Chevalier, G. Friedrich, J. Olofsson, H. H. Rudert, W. Thumfart, M. de Vincentiis and T. P. Wustrow, “Endoscopic Cordectomy: A Proposal for a Classification by the Working Committee, European Laryngological Society,” European Archives of Oto-Rhino-Laryngology, Vol. 257, No. 4, 2000, pp. 227-231. Hdoi:10.1007/s004050050228
 L.-X. Yang, E. B. Douple, J. A. O’Hara and H.-J. Wang, “Carboplatin Enhances the Production and Persistence of Radiation-Induced DNA Single-Strand Breaks,” Radiation Research, Vol. 143, No. 3, 1995, pp. 302-308. H
 L. X. Yang, E. B. Douple and H.-J. Wang, “Irradiation Enhances Cellular Uptake of Carboplatin,” International Journal of Radiation Oncology Biology Physics, Vol. 33, No. 3, 1995, pp. 641-646.
 H. H. W. de Gier, P. P. M. Knegt, M. F. de Boer, C. A. Meeuwis, L.-A. van der Velden and J. D. F. Kerrebijn, “CO2-Laser Treatment of Recurrent Glottic Carcinoma,” Head and Neck, Vol. 23, No. 3, 2001, pp. 177-180.
 M. Hirano, S. Saito, M. Sawashima, S. Hiki and H. Hirose, “A Guideline for Vocal Function Tests,” Journal of the Japan Broncho-Esophagological Society, Vol. 23, No. 2, 1982, pp. 164-167. Hdoi:10.5112/jjlp.23.164
 J. T. Kenedy, P. M. Paddle, B. J. Cook, P. Chapman and T. A. Iseli, “Vice Outcomes Following Transoral Laser Microsurgery for Early Glottis Squamous Cell Carcinoma,” The Journal of Laryngology & Otology, Vol. 121, No. 12, 2007, pp. 1184-1188. H
 G. Kanonier, E. Fritsch, T. Rainer and W. F. Thumfart, “Radiotherapy in Early Glottic Carcinoma,” The Annals of Otology, Rhinology and Laryngology, Vol. 105, No. 10, 1996, pp. 759-763.
 E. Medini, I. Medini, K. K. Chung, M. Gapany and S. H. Levitt, “Curative Radiotherapy for Stage II-III Squamous Cell Carcinoma of the Glottic Larynx,” American Journal of Clinical Oncology, Vol. 21, No. 3, 1998, pp. 302-305.
 J. H. Brandenburg, “Laser Cordotomy versus Radiotherapy: An Objective Cost Analysis,” The Annals of Otology, Rhinology and Laryngology, Vol. 110, No. 4, 2001, pp. 312-318.
 E. N. Myers, R. L. Wagner and J. T. Johnson, “Microlaryngoscopic Surgery for T1 Glottic Lesions: A CostEffective Option,” The Annals of Otology, Rhinology and Laryngology, Vol. 103, No. 1, 1994, pp. 28-30.
 K. G. Delsupehe, I. Zink, M. Lejaegere and R. W. Bastian, “Voice Quality after Narrow-Margin Laser Cordectomy Compared with Laryngeal Irradiation,” Otolaryngology— Head and Neck Surgery, Vol. 121, No. 5, 1999, pp. 528533. Hdoi:10.1016/S0194-5998(99)70051-3
 D. M. Hartl, A. Ferlito, D. F. Brasnu, J. A. Langendijk, A. Rinaldo, C. E. Silver and G. T. Wolf, “Evidence-Based Review of Treatment Options for Patients with Glottic Cancer,” Head and Neck, Vol. 33, No. 11, 2011, pp. 1638-1648. Hdoi:10.1002/hed.21528
 M. Quer, X. Leon, C. Orus, P. Venegas, M. López and J. Burgués, “Endoscopic Laser Surgery in the Treatment of Radiation Failure of Early Laryngeal Carcinoma,” Head and Neck, Vol. 22, No. 5, 2000, pp. 520-523.