Treatment Of Early Glottic Carcinoma Research Articles

Factors Impacting Provider Treatment Decision-Making in Early Glottic Cancer.

Transoral laser microsurgery (TLMS) and radiotherapy (XRT) are mainstays of treatment for early glottic carcinoma (EGC). Here, we investigated case-dependent provider treatment preferences and identify factors which impact decision-making in EGC. This cross-sectional survey of laryngologists, head-and-neck surgeons, and radiation oncologists presented five diagrammatic cases of progressively advanced EGC (T1/2, N0). Respondents indicated preference for TLMS or XRT and ranked factors which influenced their recommendation for each case. Analysis utilized descriptive statistics, Fischer's exact tests, and Kruskal-Wallis tests for nonparametric data. A total of 141 complete responses (69.5% laryngologists) were received. Most respondents practiced in academic settings (93.5%) and within multidisciplinary teams (94.0%). Anterior commissure involvement was the most important a priori tumor factor for case-independent treatment recommendation (Likert Scale: 4.22/5), followed by Laterality (Likert Scale: 4.02/5). Across all specialties, TLMS was recommended for unilateral T1a lesions. Laryngologists continued recommending TLMS in T2 lesions (41.0%) more than head-and-neck surgeons (5.0%) and radiation oncologists (0.0%). Across all cases, survival and voice outcomes were the most important clinical factors impacting treatment decisions. Radiation oncologists weighed voice more heavily than laryngologists in more complex presentations of EGC (rank: 1.6 vs. 2.7, Kruskall-Wallis: p < 0.05). In more complex clinical presentations of EGC, preference for TLMS compared to XRT differed across specialists, despite similar rankings of factors driving these treatment recommendations. This may be driven by differing experiences and viewpoints on case-dependent voice outcomes following TLMS versus XRT, suggesting a need for increased understanding of how tumor location and depth impact voice outcomes. V Laryngoscope, 2024.

Awake endoscopic laser surgery for early glottic carcinoma.

The objective of this study was to demonstrate the oncologic efficacy of awake endoscopic laryngeal surgery in the treatment of T1-T2 glottic carcinoma. This is a retrospective study. Seventy-one patients with early glottic carcinoma (T1a- 26, T1b- 18, T2- 27) who underwent awake flexible endoscopic laryngeal surgery under local anesthesia and mild intravenous sedation were included in the study. In 64 cases (90.1%) only endoscopic tumor ablation by Nd:YAG laser (in 32.4% of cases being preceded by diathermy snare excision) was performed, and in 7 T2 cases postoperative radiotherapy was also offered. There were no complications during or after the endoscopic surgery. Ultimate control of disease, including salvage treatment, was obtained in 67 patients (94.4%). Cure without recurrence was achieved in 60 cases (84.5%). Local control without salvage radiotherapy or/and open surgery was achieved in 64 (90.1%) patients. Larynx preservation was obtained in 66 (93.0%) cases. At 5 years from the beginning of endoscopic treatment, 74.6% of the patients were alive and free of disease. The best results were obtained in the T1a group of treated patients, all the patients being free of disease with the preserved larynx. Awake endoscopic laryngeal surgery is a safe and oncologically efficient method of treatment of early glottic carcinoma that can be considered as an alternative to the traditional approach, primarily, for patients with risks/contraindications for radiotherapy, general anesthesia, and transoral microsurgery, and also for the patients who prefer to avoid general anesthesia with its related risks and would rather choose office-based laryngeal surgery.

Impact of Anterior Commissure Involvement and Frozen Guided Resections on Oncological Outcomes after Laser Cordectomy in Early Glottic Cancers – A 10-year Retrospective Analysis from a Tertiary Care Cancer Center in India

Background: Early glottic cancers can be treated using different options such as transoral laser microsurgery (TLM), open partial laryngectomy (OPL), and radiation therapy (RT). TLM provides similar oncological benefits to OPL in a few subsets of patients, and the quality of voice is comparable to RT, while hospitalization time is reduced. Resection by laser microsurgery of early glottic cancer with anterior commissure involvement (ACI) is more challenging mainly due to difficulty in adequate exposure. The frozen section is reliable in TLM for determining the extent of resection and the real depth which may be masked on videoscopy. Materials and Methods: This study is a retrospective analysis of patients with early glottic cancer (Tis, T1) who underwent TLM in a tertiary cancer center in South India from January 1, 2012, to December 31, 2019. All patients were identified from the hospital registry. Results: The study included 89 patients, and the median follow-up was 54 months. Out of 89 patients, 14 patients had local recurrence which was managed with salvage TLM/salvage RT/salvage laryngectomy. There were three patients with nondisease-specific deaths. Among the study population, the laryngeal preservation rate was 96.6%, the cause-specific survival rate was 100%, and the overall survival rate was 97.7%. The 3-year disease-free survival rate was 84.4%. ACI and frozen margin positivity were statistically significant poor prognostic factors. Conclusion: TLM is a safe and effective treatment of early glottic carcinoma. Apart from tumor (T) staging, ACI and frozen positivity were negative predictive factors. The results suggest the need to consider ACI in the T staging of glottic tumors. Frozen positivity helps us in re-excision but signifies that the disease is deeply infiltrative or aggressive and a vigilant follow-up is required for these patients.

CO2 transoral laser microsurgery for early glottic carcinoma with anterior commissure involvement

ObjectiveAnterior commissure (AC) involvement is an unfavorable factor for transoral laser microsurgery (TLM) treatment of early glottic carcinoma (EGC). This study aimed to evaluate the therapeutic efficacy of TLM treatment for EGC with AC involvement. MethodsFrom 2008 to 2017, 177 patients with T1-T2 EGC with AC involvement were retrospectively included and divided into the TLM group (n=115) receiving CO2 laser TLM and the control group undergoing open surgery (n=62). The survival outcomes, postoperative complications, laryngeal preservation rate, recurrence and the phonological results were compared between groups. ResultThe TLM group had significantly reduced hospital stay, hospitalization costs, and intraoperative blood loss as compared with the control group. The tracheotomy rate was significantly higher in the control group (96.8% vs. 0%). The 5-year overall survival (OS) was 89.6% and 85.5% in the TLM group and control group, respectively. Log-rank test showed no difference in survival rate between the two groups. There was no significant difference in laryngeal preservation rate and overall recurrence rate between groups. In postoperative vocal function evaluation, there were significant differences in the overall grade (G), the roughness (R), the breathiness (B), Voice Handicap Index-10 (VHI-10), Jitter, Shimmer, noise/harmonic ratio (NHR), maximum phonation time (MPT), phonation threshold pressure (PTP) between the two groups. ConclusionFor EGC with AC involvement, TLM has similar survival outcomes with the open surgery, but has better postoperative voice outcomes. Meanwhile, TLM can effectively reduce intraoperative blood loss, hospitalization time, hospitalization costs and postoperative complications.

Comparison of Partial Laryngectomy Versus Radiotherapy for the Treatment of Early Glottic Carcinoma: Complications and Oncological Results: A Nonrandomized Clinical Trial

The aim of this non-randomized clinical trial was to evaluate tumor outcomes and subjective quality of voice following radiotherapy and partial laryngectomy in early-stage glottic laryngeal cancers. Non-Randomized Clinical Trial. Otolaryngology and radiation oncology clinics of Imam Khomeini (an affiliated hospital of Tehran University of Medical Sciences) and Amir Aalam Hospitals. Fifteen patients with early-stage glottic laryngeal carcinoma were admitted to the otolaryngology clinic, divided into two treatment groups: radiotherapy and partial laryngectomy. Of the total 50 patients, 25 had a partial laryngectomy and 25 radiotherapies. The comparison of the average of the Voice Handicap Index (VHI) showed significant improvement of vocal quality after treatment for both partial laryngectomy and radiotherapy (P&lt;0.0001 for both). But there was no significant difference in VHI mean scores between the two treatment groups (patients treated by partial laryngectomy and radiotherapy). Short- and long-term complication was higher in patients undergoing surgery than radiotherapy group (P&lt;0.0001). With regard to oncological outcome after one and eight-year after treatment, no differences were observed in the two treatment groups; there was a significant relationship between smoking cessation and recurrence of disease in the partial laryngectomy treatment group (P=0.012). There was no significant difference in voice quality and life expectancy of patients operated on using open surgery and patients treated with radiotherapy in this series. Open surgery may have more noticeable complications than radiotherapy.

TREATMENT OF EARLY GLOTTIC CARCINOMA WITH TRANSORAL ENDOSCOPIC LASER SURGERY.

Laryngeal carcinoma is one of the most common tumors of the head and neck, just after skin cancer. Alongside open surgery, transoral endoscopic laser surgery (TOLS) has become widespread as a treatment method. Our aim was to assess the efficacy of transoral laser cordectomy in a group of patients with early glottic carcinoma. We retrospectively analyzed data on 131 patients who underwent TOLS in the 2017-2021 period. We divided patients into groups according to tumor stage and type of cordectomy performed, and compared outcomes between the groups. Our results revealed a higher number of patients in the group with Tis and T1a than in those with T1b and T2 who underwent type III cordectomy, and also a higher number of those for whom outpatient follow-ups were sufficient after surgery in the same group. We did not observe significant difference in outcomes according to cordectomy type except for type V (a-d), where a higher number of patients had to undergo radiotherapy. This study underlines the importance of careful patient selection for TOLS, as well as the need for close cooperation with pathology and radiology specialists to ensure optimal approach and extent of surgery for each individual patient. It also displayed TOLS as a sound therapeutic option for early stages of glottic carcinoma but also indicated the need for similar studies in a larger number of patients to elucidate the effectiveness in certain glottis areas.

Clinical Effect of Transoral Laser Surgery in the Treatment of Early Glottic Carcinoma

To investigate the therapeutic effect of transoral laser surgery in patients with early-stage glottic laryngeal cancer. 72 patients were randomly divided into an observation group (n=36) and a control group (n=36), who were diagnosed with early stage portal laryngeal carcinoma by pathological biopsy in our hospital from May 2017 to November 2019. The control group underwent conventional laryngectomy, while the observation group underwent carbon dioxide laser treatment under microscopic supported laryngoscopy. The patients’ treatment status and complications during the 6 mo postoperative follow-up period were also recorded. The results showed that 30 patients in the observation group and 6 patients in the control group had vocal cord neovascularization 6 mo after surgery and 20 patients in the control group had vocal cord neovascularization and 16 patients in the control group had vocal cord neovascularization. There were no statistically significant differences in the preoperative levels of vascular endothelial growth factor, Nitric oxide and tumor necrosis factor-alpha between the two groups (p>0.05), while the postoperative levels of vascular endothelial growth factor, Nitric oxide and tumor necrosis factor-alpha were statistically significant (p<0.05). The effective rate of treatment in the observation group was significantly higher than that in the control group, and the complication rate was lower than that in the control group (p<0.05). The application of micro-supported laryngoscopic carbon dioxide laser for the treatment of early glottic laryngeal carcinoma can improve the clinical treatment effect and reduce postoperative complications, which is worthy of application.

Does advanced age affect treatment of early glottic carcinoma?

AimsEarly glottic carcinoma is currently managed by radiation therapy or endoscopic surgery. Both are effective in elderly patients, but their respective indications are poorly determined. The present study assessed our management of very elderly patients with early glottic carcinoma. Material and methodsA retrospective single-center study included all patients aged 75 years and older at diagnosis, treated by radiation therapy or endoscopic surgery with curative intent for T1 or T2 glottic carcinoma between 2004 and 2018. ResultsRecords of 33 patients (27 men and 6 women; mean age, 82.2 years (range, 76.1-93.1 years)) were reviewed. 24 patients received radiation therapy and 9 endoscopic resection. The only factor for choice of treatment was anterior commissure involvement. Overall survival was 87% at 2 years and 62% at 5 years. 19% of patients relapsed within 5 years and had to undergo further treatment. There were no treatment-related deaths. Radiation therapy was associated with more acute local complications, with two temporary treatment interruptions and one uncompleted treatment. Surgical treatment was more likely to result in dysphonia, found in 80% of cases. ConclusionTreatment of early glottic cancer in elderly subjects can consist in either radiotherapy or endoscopic surgery. Age should not affect management. Surgical treatment is shorter and better tolerated, although with poorer vocal outcome, and may be preferred in the most comorbid patients.

CO2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review

Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis–T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique.

Laser versus radiotherapy in treatment of early glottic carcinoma

Laser versus radiotherapy in treatment of early glottic carcinoma

Voice outcomes for early laryngeal cancer.

Treatment options for early laryngeal cancer are well established with good local control and 5-year survival. The commonest treatments are radiotherapy or transoral laser microsurgery (TLM). There are advantages and disadvantages of the different modalities, but debate continues regarding the voice outcomes posttreatment. This review will focus on early glottic carcinoma and voice outcomes following the different treatments. TLM and radiotherapy are both likely to affect voice quality, but the extent of voice change depends on different factors. These factors can be divided into patient, tumour and treatment factors. Recent meta-analyses data show similar voice outcomes for either modality in the treatment of early glottic carcinoma. However, larger tumours and those involving the anterior commissure are associated with worse voice outcomes. There are various considerations for the patient and clinician before deciding on the preferred treatment for early glottic carcinoma. Although both TLM and radiotherapy will affect voice outcomes, the recent meta-analyses show similar voice outcomes for either modality in the treatment of early glottic carcinoma. There are numerous variables in the published studies hindering direct comparisons. These include heterogeneous patient groups, different treatment standardization and methods of voice analysis.

Optimal Treatment for Early Glottic Carcinoma

Abstract The management of early glottic cancer has evolved significantly over the past two decades, with transoral laser microsurgery and radiotherapy emerging as the two favored modalities of treatment. Although the role of Open partial conservative surgery has reduced but there are still some specific indications. The preference of one modality over another has generated lot of debate and continues to be controversial. As the survival outcomes are similar in all the modalities, we need to consider factors like professional needs, quality of life, vocal function and cost-effectiveness as regards the modality to be preferred. This manuscript aims at comprehensive overview of the contemporary literature comparing all the treatment modalities. Optimal Treatment for Early Glottic Carcinoma Open conservative laryngeal surgery (CLS), transoral laser microsurgery (TOLMS) and radiation therapy are valid and effective options for treating Tis, T1, and T2 glottic lesions. Although the evidence favoring any of the single modality to another is globally low level, but there is considerable shift towards trans-oral laser microsurgery. Subjective selection bias and opinion affect the decision making. The opportunity for CLS and TOLMS depend on the experience and expertise of the surgical oncology specialists. Three important tumor factors have significant influence on decision making in early glottic cancer: T-stage, true vocal cord mobility and involvement of anterior commissure (AC). Main treatment goal in early laryngeal cancer is to optimize local control, while optimizing preservation of function and hence quality of life. For achieving this goal, a careful initial clinical evaluation is very important. The clinical examination is most often performed using fiberoptic or rigid endoscopy to assess the extent of lesion and laryngeal mobility, which is the main issue in treatment of early glottic cancer. Laryngeal mobility was the only predictor of minor thyroid cartilage invasion treated with conservation laryngeal surgery and for early-stage to mid stage tumors involving the AC [1,2]. AC must be thoroughly evaluated clinically, as the approach and outcomes differ with the disease extension to this critical site. Subglottic extension and proximity of the tumor to the cricoid cartilage must be ascertained in view of organ-preservation surgery, in which a stable cricoid is essentially preserved. Evaluation under general anesthesia with 30 degree angled rigid endoscope helps in assessing AC and subglottic extension. Initial workup should include CT and/or MRI of the larynx especially if there is AC or subglottic extension on laryngoscopy. Guidelines are not generally useful and do not provide detail for selection of optimal treatment modality for particular patient. To optimize patient outcome, current evidence must be combined with experience of the multidisciplinary team managing these patients. Emphasis should be on an honest and open discussion regarding all of the aspects of different treatment options.

Laryngeal Compensation for Voice Production After CO2 Laser Cordectomy.

ObjectivesCarbon dioxide (CO2) laser cordectomy is considered one of the modalities of choice for treatment of early glottic carcinoma. In addition to its comparable oncological results with radiotherapy and open surgical procedures, it preserves of laryngeal functions including voice production. The aim of this study was to detect how the larynx compensates for voice production after different types of CO2 laser cordectomy for early glottic carcinoma together with assessment of the vocal outcome in each compensation mechanism.MethodsOne hundred twelve patients treated with CO2 laser cordectomy were classified according to their main postoperative phonatory site. Perceptual analysis of voice samples using GRBAS (grade, roughness, breathiness, asthenia, and strain) scale was done for 88 patients after exclusion of the voice samples of all female patients to make the study population homogenous and the samples of 18 male patients due to bad quality (4 patients) or unavailability (14 patients) of their voice samples and the results were compared with those obtained from control group that included 25 age-matched euphonic male subjects.ResultsFive types of laryngeal compensation were defined including: vocal fold to vocal fold, vocal fold to vocal neofold, vocal fold to vestibular fold, vestibular fold, to vestibular fold, and arytenoids hyper adduction. Characters changes of voice produced by each compensation type were found to be statistically significant except for breathiness, asthenia and strain changes in vocal fold to vocal fold compensation type.ConclusionThe larynx can compensate for voice production after CO2 laser cordectomy by five different compensation mechanisms with none of them producing voice quality comparable with that of controls.

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

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.

Oncological and functional outcome after surgical treatment of early glottic carcinoma without anterior commissure involvement.

Introduction. Glottic carcinoma can be successfully diagnosed in its early stages and treated with high percentage of success. Organ preservation and optimal functional outcomes could be achieved with wide array of surgical techniques for early glottic cancer, including endoscopic approaches or open laryngeal preserving procedures, making surgery the preferred method of treatment of early glottic carcinoma in the last few years. Material and Methods. Prospective study was done on 59 patients treated for Tis and T1a glottic carcinoma over a one-year time period in a tertiary medical center. Patients were treated with endoscopic laser cordectomy (types II–IV cordectomies according to European Laryngological Society classification of endoscopic cordectomies) and open cordectomy through laryngofissure. Follow-up period was 60 months. Clinical and oncological results were followed postoperatively. Voice quality after the treatment was assessed using multidimensional voice analysis 12 months after the treatment. Results. There were no significant differences between oncological and functional results among two groups of patients, though complications were more frequent in patients treated with open cordectomy. Conclusion. Endoscopic laser surgery should be the first treatment of choice in treatment of early glottic carcinomas, though open approach through laryngofissure should be available for selected cases where anatomical factors present limiting adequate tumor removal.

Transoral Laser Microsurgery for Early Glottic Carcinoma

The application of laser technology to otolaryngology – head and neck surgery has accelerated the development of transoral laser microsurgery, which has a wide range of application in this surgical specialty today. The aim of this paper is to provide a general overview of the surgical techniques of transoral laser microsurgery, particularly in the treatment of early glottic carcinoma.

Lessons Learned from Endoscopic Treatment of Early Glottic Carcinomas: A Primer for the General Otolaryngologist

Objectives: 1) Identify technical considerations involved in performing oncologic resection while maintaining laryngeal function. 2) Analyze on a case-by-case basis what type of treatment protocol to implement and when lesions persist or recur. Methods: A retrospective review was performed to identify all endoscopic laser resections of glottic carcinomas performed over a 4-year period. Records were reviewed to identify technical factors that led to cure vs. recurrent disease; disadvantages of extensive resection vs. adjuvant radiation; when and how often patients returned to the operating room for further resection; how to push surgical limits while maintaining good functional results; and what to expect on examination in the post-operative healing process. Results: Twelve patients were treated during the study period. Difficult exposure was not a contraindication to endoscopic resection, if the lesion did not extend to the anterior commissure. For patients with deeply invasive disease who cannot afford lengthy vocal downtime, radiation therapy is the answer. However, radiation leads to dysphagia and contralateral vocal fold injury that is avoided with surgery. Additionally, good voice can be achieved in patients undergoing intramuscular cordectomy, but it does cause longer vocal downtime compared to radiation. The key to optimal vocal results is achieving glottal closure. Patients should be counseled pre-operatively regarding the possibility of additional surgery. Conclusions: Endoscopic resection can be tailored on an individual basis based on both cancer stage and the patient’s personal needs. Patients should be counseled pre-operatively regarding the advantages and disadvantages of surgery vs. radiation, including side effects and voice results.

Comparison of Subjective and Objective Tools in Transoral Laser Cordectomy for Early Glottic Cancer: Importance of Voice Handicap Index

Several studies in recent years have already reported good oncologic results with laser microsurgery in the treatment of early glottic carcinoma. We conducted a longitudinal voice evaluation, in patients with early glottic cancer who underwent transoral laser cordectomy, in order to assess the voice quality outcome and its relationship with objective and subjective (voice handicap index questionnaire and GIRBAS scale) means. Twenty-four previously untreated patients underwent transoral laser cordectomy for early glottic cancer. All patients underwent subjective and objective voice assessment according to the multidimensional voice protocol recommended by the European Laryngological Society including acoustic, perceptual and stroboscopic analysis combined to patient self assessment of voice (voice handicap index-VHI). These evaluations were performed before treatment and 6 months after the treatment. Vocal fold healing was complete in all cases by 6 months following surgery. Main voice parameters (subjective and objective) resulted improved at the 6-month control after surgery. In particular, voice handicap index (VHI) and GIRBAS scale resulted reliable for voice assessment and for the postoperative follow-up. In conclusion, VHI, GIRBAS, multidimensional voice program (MDVP) and spectroacoustic parameters showed a close trend in the present study, and this confirms the validity of the voice analysis performed by each tool.

Clinical outcome of early glottic carcinoma in Serbia

Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, laser cordectomy, and radiotherapy. The aim of the study was to conduct comprehensive study to evaluate oncological and functional results of different treatment modalities for Tis and T1 glottic carcinoma, identify prognostic factors for the outcome of treatment and decide where we stand in applying worldwide standards of early glottic carcinoma treatment. Prospective study was conducted on 221 patients treated with Tis and T1 glottic carcinoma from 1998 to 2003 (72 patients were treated endoscopically with CO2 laser, 75 patients with cordectomy through laryngofissure and 74 with radiotherapy), with follow-up period from 38 to 107 months. Important demographic and clinical variables were analyzed. Voice quality after the treatment was assessed using multidimensional voice analysis. Comparing oncological results of three modalities of treatment, there were no significant differences. Functional results of treatment were better after laser cordectomy and primary radiotherapy than following the open cordectomy. Five-year survival rate was almost identical in all three groups of patients, and important prognostic factors for survival were age and histological grade of the tumor. Considering that the choice of treatment in our country is also greatly influenced by other paramedical factors, such as distance from treatment facility, reliability of follow-up, significant time delay of radiotherapy because of small number of radiology centers and strong patients' surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.

A meta-analysis for the effectiveness external radiation vs transoral laser surgery for treatment of early glottic carcinoma

To investigate the effectiveness external radiation (XRT) vs transoral laser surgery (TOL) for treatment of early glottic carcinoma. Medline (1990-2010), Embase (1990-2010), Cochrane Library, CBM (1990-2010), CNKI (1994-2010), Wanfang Database were searched for published case-control studies investigating the effectiveness external radiation vs transoral laser surgery for treatment of early glottic carcinoma. The odds ratio was calculated. Meta-analyses were performed by RevMan5. 0. 2 Software. In the complications of this study, there was significant heterogeneity in the literatures, so Meta analysis was given up. In the recurrence and 5-years locoregional control, XRT group was no significant difference with TOL group by eliminating the heterogeneity or using the subgroup analysis, but the results till showed there was less recurrence and more locoregional control in TOL group than those in XRT group. In death of disease, overall survival and laryngeal preservation, the differences were statistically significant. TOL could be complete in the clinic and the cost was much more cheaper than XRT. So TOL could be used as the first choice for the treatment of early glottic carcinoma versus XRT. But for larger tumors, involving the anterior commissure, there was no clear conclusion. Based on literatures, traditional surgery was the proposed choice. We recognize that the datas included in our study are retrospective studies, for a more scientific conclusion, we need more RCTs.