Physician First in U.S. to Use Blue Laser for Early Vocal Fold Cancer

A Sylvester Comprehensive Cancer Center surgeon was the first in the U.S. to use the 445-nm blue laser for early glottic cancer, the most common type of laryngeal cancer.

One-year follow-up of 49 patients diagnosed with this cancer of the vocal cords and treated with the blue laser by David Rosow, M.D., an associate professor of otolaryngology and director of the Division of Laryngology and Voice at the University of Miami Miller School of Medicine, shows the laser effectiely removes early glottic tumors, with excellent voice outcomes.  

Results comparing outcomes with the 532-nm potassium titanyl phosphate (KTP) laser are published in The Laryngoscope.

Advantages of the Blue Laser

Clinicians generally treat early glottic cancers with either surgery, including surgery with the carbon dioxide (CO2) laser, or radiation.

Depending on the tumor’s size and location, surgeons may need to remove some or all of the vocal cords, or folds, which can impact one’s ability to speak.

“That’s one of the advantages of this technique with the blue laser,” Dr. Rosow said. “It enables us to spare as much of the vocal fold as possible. The more of the vocal fold that you can spare, the better the potential voice outcome.”

The Miller School has helped to pave the way in establishing an important innovation for laryngeal cancer patients’ quality of life, according to Fred Telischi, M.E.E., M.D., the James R. Chandler Chairman of the Department of Otolaryngology and professor of otolaryngology, neurological surgery and biomedical engineering at the Miller School.

“We were early adopters of this technology, which enabled Dr. Rosow and colleagues to accrue the patients needed to establish the technique’s safety and efficacy in early glottic cancer,” Dr. Telischi said.

Filling the KTP Gap

Using lasers to remove laryngeal cancer dates back to the 1970s. 

“Around 2008, my mentor at Massachusetts General Hospital, Dr. Steven Zeitels, discussed using the KTP laser for removing cancer of the vocal folds,” Dr. Rosow said. “Doing that, he was able to preserve much more of the vocal fold than with traditional laser surgery at the time.”

Treatment with the KTP laser worked well. Dr. Rosow and colleagues at the Miller School used the approach for many years until the company that produced the KTP laser stopped making it. 

There was no replacement until 2020, when the FDA approved the blue laser. Dr. Rosow was the third surgeon in the U.S. to use the laser for any surgery and the first for cancer. 

“Because we have extensive experience here with dealing with early glottic cancer, my colleague, Dr. Mursalin Anis, and I went back through our cases in order to publish results comparing the KTP with the blue laser,” said Dr. Rosow, who wrote his thesis for The Triological Society and later submitted it for publication.  

Blue Laser Improves Voice Outcomes

Traditional surgery to treat early glottic tumors is with the CO2 laser. The technique generally requires removing more of the vocal fold. 

“With the blue laser and previously with the KTP, we’re able to remove just the tumor itself down to normal tissue. We found in our chart review that patients’ voices tend to improve after blue laser treatment. From the patient standpoint, it’s a very attractive treatment option,” Dr. Rosow said. “Other benefits include that it’s a one-and-done technique and doesn’t require postoperative radiation or chemotherapy.”

While radiation also remains an option, studies show an overwhelming number of patients prefer laser surgery to radiation, according to Dr. Rosow. 

Next Steps

Dr. Rosow will now work on a comparison of outcomes beyond the three-year window he analyzed.

“We need longer-term studies comparing five-year outcomes with radiation and blue laser surgery,” said Dr. Rosow. “We’re also planning a clinical trial looking into new therapies that might be injected into the vocal folds for treatment of cancer.”

Other Miller School researchers who contributed to the published study included:

• Mursalin Anis, M.D., Ph.D., assistant professor of otolaryngology

• Recent Miller School laryngology fellows Eytan Keidar, D.O., and Nicolas J. Casellas, M.D.

* Otolaryngology chief resident Luke Pasick, M.D.