Abstract
Background: The impact of the anterior commissure (AC) involvement on prognosis in laryngeal cancer remains a topic of discussion with inconsistent results in the literature. This review examines AC involvement as a prognostic factor in patients with early glottic cancer (Tis–T2) treated with radiotherapy or transoral laser microsurgery (TLM). Methods: A systematic literature search was performed. Due to the heterogeneity of the data, no meta-analysis was implemented. Weighted averages were calculated if the appropriate data were extractable. Results: Thirty-four studies on radiotherapy and 23 on TLM fit the inclusion criteria. The majority of studies for both radiotherapy (67.7%) and TLM (75.0%) did not report a significant impact on oncological outcomes. Weighted averages were slightly lower in patients with AC involvement. The two studies that applied a more detailed classification showed a significant impact on the amount of AC involvement. Conclusions: Binary variables (yes/no) for AC involvement lead to inconsistent results. Studies that use more detailed classifications of the AC show that there is a significant impact on the outcome. To further elucidate the role of the AC, detailed stratification of tumors involving the AC need to be investigated in further studies for both treatment modalities.
Highlights
It is widely acknowledged that the involvement of the anterior commissure (AC) in early glottic cancer (Tis–T2) can have negative impacts on outcomes, the extent of the impact remains a topic of discussion with inconsistent results reported in the literature
This review shows that the use of a binary variable for the involvement of the AC leads to conflicting results due to variability in definition, work-up, and treatment parameters of the AC area
Weighted averages indicate that local control (LC) may be lower in tumors with involvement than tumors without involvement in the AC
Summary
It is widely acknowledged that the involvement of the anterior commissure (AC) in early glottic cancer (Tis–T2) can have negative impacts on outcomes, the extent of the impact remains a topic of discussion with inconsistent results reported in the literature. Rucci et al defined the AC—on the basis of embryonic development—as the area of the glottis situated anteriorly between the vocal folds that extends in a vertical direction, both upwards and downwards [1] It is rarely the site of origin of glottic cancer [1], but it is often involved in anterior lesions spreading from left to right, and from inferior to superior. The impact of the anterior commissure (AC) involvement on prognosis in laryngeal cancer remains a topic of discussion with inconsistent results in the literature. To further elucidate the role of the AC, detailed stratification of tumors involving the AC need to be investigated in further studies for both treatment modalities
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