Pathological Grading Determines the Clinical Efficacy of Outpatient KTP Laser Treatment for Vocal Fold Leukoplakia.

Abstract

Vocal fold leukoplakia is commonly managed with outpatient potassium titanyl phosphate (KTP) laser therapy; however, limited data exist on the impact of different pathological grades on long-term efficacy. This study retrospectively analyzed the treatment outcomes, identified prognostic factors, and provided insights to improve disease characterization and clinical management. Retrospective study (2017-2024). Ninety two patients with vocal fold leukoplakia treated in Fudan Eye and ENT hospital (FD-EENT) were included. The mean follow-up period after the last treatment was 20.53 ± 17.32 months. Disease control was assessed by lesion regression using ImageJ analysis. Acoustic outcomes were evaluated using the Voice Handicap Index-30 (VHI-30), GRBAS scale, and other acoustic parameters. Patients underwent a mean of 1.6 treatment sessions. Following the last treatment, the lesion regression rates were 90.1% for no dysplasia, 81.75% for mild dysplasia, and 86.83% for moderate dysplasia, compared to 51.0% for severe dysplasia and 32.9% for carcinoma in situ (CIS). Patients with pathological grades of severe dysplasia and CIS showed significantly poorer treatment outcomes than those with milder dysplasia (***p = 0.0001). Outpatient KTP laser effectively controls disease progression in vocal fold leukoplakia, with efficacy linked to the degree of dysplasia. KTP laser is an effective treatment for milder pathological dysplasia, but its efficacy diminishes in more severe stages. The treatment should be carefully considered for patients with severe dysplasia and CIS, with close follow-up, and biopsy should be performed to monitor malignant transformation and prevent delayed treatment.