Abstract
A therapeutic decision in the treatment of Tis/T1a glottic carcinoma with radiotherapy (RT) or transoral laser surgery (TOS) is still an open issue. Oncologic outcome and voice quality may support the choice for the latter To conduct a systematic review and meta-analysis to compare oncologic and functional outcomes of TOS and RT as treatment options for Tis/T1a glottic cancer. Literature research on online databases was carried out. Potentially eligible articles were reviewed. Relevant articles were selected and evaluated. There was statistical significance favoring patients initially treated with TOS when it comes to overall survival, disease-specific survival and larynx preservation. No difference in local control was found. TMF, Jitter and Shimmmer measurements presented statistically significant results in favor of RT. Self-assessment of voice quality (VHI) and f0 showed no statistically significant differences. Maximum Phonation Time (MPT) had a better response to RT. There is a trend in favor of RT. Tis/T1a glottic cancer patients submitted to TOS had significant overall and disease specific survival and had fewer risks of having a total laryngectomy, when compared to the radiotherapy group. The self-assessment of voice quality and f0 did not show any difference; however, Jitter, Shimmer and MPT measurements favored radiotherapy.
Highlights
The aim of the treatment of early glottic carcinoma (T1-T2) is to achieve local control of the disease, preserving the organ as well as its functions
For T1a glottic carcinoma there are advantages in the use of laser microsurgery as the treatment is provided in one single procedure, allows for the histopathological study of margins, preserves the contralateral vocal fold, and local recurrence can be prematurely diagnosed, permitting a punctual surgical reapproach
The disadvantages of the surgery are: removal of extra tissue with oncologic margins, favoring irregular glottic coaptation; the need to evaluate surgical anesthetic risk; the need for specialized surgery material, and inadequate exposure of the endolarynx
Summary
The aim of the treatment of early glottic carcinoma (T1-T2) is to achieve local control of the disease, preserving the organ as well as its functions (breathing, protection of the airways and phonation) It can be treated by transoral laser microsurgery (TOS) of the larynx or by cold instrument, open partial laryngectomy or radiotherapy (RT). The disadvantages of radiotherapy, are extensive including local temporary or persistent edema, glottis stenosis, xerostomia, and hypothyroidism Throughout the literature both methods have presented good oncologic and functional results; the choice taken depends on the experience and preference of the group in charge of the patient, as there are no clear-cut advantages of one over the other[1,3]. The objective is to perform a systematic review and meta-analysis in order to compare oncologic and functional outcomes of TOS and RT as treatment options for Tis/T1a glottic cancer
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