Upfront Transoral Laser Microsurgery May Offer Survival Benefit Over Radiotherapy in Patients With Early-Stage Supraglottic Squamous Cell Carcinoma

by Linda Kossoff •

How does transoral laser microsurgery (TLM) with neck dissection compare with definitive radiotherapy (RT) in terms of survival outcome when treating patients with T2N0 supraglottic squamous cell carcinoma (SSCC)?

BOTTOM LINE

An upfront, TLM-based surgical approach to T2N0 SSCC may offer an overall survival benefit compared with definitive RT.

BACKGROUND: National Comprehensive Cancer Network guidelines for management of early-stage (I–II) SSCC stipulate definitive RT or surgery resection with neck treatment. Since the advent of TLM techniques, literature has detailed favorable recurrence-free survival with surgical management of early SSCC, but studies specifically detailing outcomes following TLM are rare.

STUDY DESIGN: Database study.

SETTING: Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, Calif.

SYNOPSIS: Researchers mined the National Cancer Database to identify adult patients with clinical stage II (cT2N0M0) SSCC treated from 2010–2016 who received TLM resection of the primary tumor with elective neck dissection, with a minimum lymph node yield of 10 or definitive RT administered within a dose range per guidelines. Of the 1,067 patients who met inclusion criteria, 991 underwent primary RT, 45 underwent TLM with neck dissection without adjuvant treatment, and 31 underwent TLM with neck dissection with adjuvant RT +/- chemotherapy. The five-year overall survival rate was higher in the TLM without adjuvant treatment group (67.80%) compared with either the RT (51.30%) or the TLM with adjuvant treatment (47.50%) cohorts. Patients undergoing TLM with neck dissection who required adjuvant therapy demonstrated comparable overall survival to patients receiving definitive RT. Authors conclude that given the current relative infrequency of a primary TLM approach, surgeons might more often consider a TLM-based upfront surgical approach. Study limitations included the lack of information granularity inherent in any retrospective cohort study.

CITATION: Panuganti BA, Voora R, Coffey C, et al. Transoral laser microsurgery with neck dissection versus radiotherapy for T2N0 supraglottic cancer. Laryngoscope. 2023;133:601-606.