Transoral Laser Microsurgery Favored Over Radiotherapy in T1 Glottic Carcinoma Survival

How do the outcomes of CO₂ transoral laser microsurgery (TLM) and radiotherapy (RT) compare in the treatment of T1 glottic carcinoma?

Bottom line: TLM is associated with better outcomes than RT in overall survival, confidence interval, disease-specific survival, and laryngeal preservation in patients with T1 glottic carcinoma.

BACKGROUND: Approximately two-thirds of laryngeal cancers arise in the glottic area, and most are diagnosed early. Although TLM and RT are considered effective treatments, debate remains about which results in better functional and oncologic outcomes. There is a paucity of high-quality prospective evidence in academic literature directly comparing the modalities.

STUDY DESIGN: Systematic review.

SETTING: Dalhousie Division of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.

SYNOPSIS: Researchers conducted a literature search for studies directly comparing TLM and RT in T1 glottic carcinoma. They performed a meta-analysis of critical oncological outcomes, including overall survival, disease-specific survival, laryngeal preservation, and local control, on 16 identified studies. Ten studies reported overall survival numbers, 12 reported numbers for disease-specific survival, and 15 reported numbers for laryngeal preservation. In each of these studies, numbers were provided for both TLM and RT, and they significantly favored TLM. Authors note that the ability to salvage patients who recur after their initial TLM procedure with repeat TLM or radiation may explain these associated improvements. Fourteen studies reported local control numbers for both TLM and RT, and analysis demonstrated no difference as primary therapies. Overall, findings demonstrated greater favorability for TLM over RT in every study area but local control. Study limitations included a lack of available randomized controlled trials that met inclusion criteria and the inclusion of observational non-randomized cohort studies that may produce selection bias.

CITATION: Vaculik MF, MacKay CA, Taylor SM, et al. Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO₂ transoral laser microsurgery and radiotherapy. J Otolaryngol Head Neck Surg. 2019;48:44.