Role of Endolaryngeal Surgery (with or without Laser) Compared with Radiotherapy in the Management of Early (T1) Glottic Cancer: A Clinical Practice Guideline

J Yoo,R.W Gilbert,J.A Hammond,C Lacchetti

doi:10.3747/co.20.1237

J Yoo, R.W Gilbert + Show 2 more

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https://doi.org/10.3747/co.20.1237

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Abstract

To provide evidence-based practice guideline recommendations concerning the role of endolaryngeal surgery (with or without laser) compared with radiation therapy for patients with early (T1) glottic cancer, assessing survival, locoregional control, laryngeal preservation rates, and voice outcomes. The medline, embase, and Cochrane Library databases were searched to identify relevant studies from 1996 to 2011. Recommendations were formulated based on that evidence and on the expert opinion of Cancer Care Ontario's Head and Neck Cancer disease site group. The systematic review and practice guideline were externally reviewed by practitioners in Ontario, Canada. The available evidence was of a level insufficient to demonstrate a clear difference between treatment options when considering the likelihood of local control or overall survival. Although the evidence was mainly retrospective, there was a suggestion that, compared with surgery, radiotherapy might be associated with less measureable perturbation of voice without a significant difference in patient perception. The likelihood of laryngeal preservation may be higher when surgery can be offered as initial treatment. For patients with early (T1) glottic cancer, the evidence is insufficient to demonstrate a difference between endolaryngeal surgery (with or without laser) and external-beam radiation therapy. The choice between treatment modalities has been based on patient and clinician preferences and general medical condition.

Highlights

There is continuing debate about whether radiation therapy or surgery, with or without laser, is the superior treatment for early glottic cancer
The available evidence was of a level insufficient to demonstrate a clear difference between treatment options when considering the likelihood of local control or overall survival
The evidence was mainly retrospective, there was a suggestion that, compared with surgery, radiotherapy might be associated with less measureable perturbation of voice without a significant difference in patient perception

Summary

Introduction

There is continuing debate about whether radiation therapy or surgery, with or without laser, is the superior treatment for early glottic cancer. The evidence to date has been insufficient to resolve the controversies, because of the paucity of prospective randomized trials. Opinions about optimal therapy have been demonstrated to vary across disciplines[1] and between countries[2]. The aim of the Head and Neck Cancer Disease Site Group (dsg) of Cancer Care Ontario’s Program in Evidence-Based Care (pebc) was to systematically review reported studies in the literature, to compare outcomes from those studies, and to provide guidance on the effectiveness of the two most common treatment options for early glottic cancer: endolaryngeal surgery and radiotherapy

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