Voice Outcomes following Laser Surgery or Radiotherapy for T1 Glottic Cancer: Systemic Review and Meta‐Analysis

Abstract

Objectives: Systematic review of literature on patient-reported voice handicap following T1 glottic squamous cell carcinoma treatment using endoscopic surgery or radiation therapy. Methods: PubMed, Web of Science, and Scopus (1988-2013) were searched for papers reporting Voice Handicap Index (VHI) after treatment of early glottic carcinoma. Review and reference cross-checking were performed using a priori selection criteria. Study data were abstracted and publication quality categorized independently by 2 authors. Corresponding authors were contacted to maximize data for analysis. Meta-analysis was performed using a random-effects model. Results: Twenty-three studies with VHI data following surgery (n = 7), radiation (n = 4), or both (n = 12) were reviewed. Meta-analysis was then pursued with studies that included both modalities. Excluding studies reporting multiple T-stages or systematic treatment selection bias, 5 retrospective cohort studies describing 238 patients in total were suitable for meta-analysis. Depth of excision and follow-up time (mean, 47 months; range, 1-298 months) varied across studies. Three studies showed no VHI difference between treatment arms, 2 favored radiotherapy over surgery (one of which reported transmuscular cordectomy for all surgical patients), and none favored surgery. Meta-analysis slightly favored radiotherapy over endoscopic surgery (mean difference 7.73, 95% confidence interval 0.29-15.16, P = .03, I2 = 63%). Conclusions: Best available evidence was Level 4 with significant heterogeneity. Current literature may suggest lesser patient-reported voice handicap after radiation than endoscopic cordectomy, but the difference is of minimal clinical significance. Prospective randomized studies are needed for greater clarity when counseling patients.