Involvement of the Anterior Commissure in Early Glottic Cancer (Tis-T2): A Review of the Literature

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.

T1 Glottic Cancer: Does Anterior Commissure Involvement Worsen Prognosis?

“…Although it is widely acknowledged that the presence of AC involvement can have a negative impact on the oncologic outcomes of early glottic SCC, the results so far reported in the literature about its predictive value have been inconsistent, and have generated much debate [ 19 , 22 , 23 , 24 , 25 ]. Even though several reviews have analyzed this issue, none of them definitively solved the existing controversy of the prognostic value of AC involvement [ 19 ].…”

“…Although it is widely acknowledged that the presence of AC involvement can have a negative impact on the oncologic outcomes of early glottic SCC, the results so far reported in the literature about its predictive value have been inconsistent, and have generated much debate [ 19 , 22 , 23 , 24 , 25 ]. Even though several reviews have analyzed this issue, none of them definitively solved the existing controversy of the prognostic value of AC involvement [ 19 ]. In fact, the unique AC anatomical characteristics make this laryngeal subsite a challenging area for adequate pretreatment endoscopic and imaging workup by either CT or MR (with a high incidence of false negatives adequately assessed only intraoperatively, after surgical resection, or at longer follow-up), difficult area for surgical resection due to laryngeal exposure, and prone to technical radiotherapy issues at the air–tumor interface within the AC due to its variable degree of vascularization, ossification, and three-dimensional conformation/development further complicating its proper management [ 6 , 8 ].…”

“…Since the binary variables for AC involvement has led to inconsistent results in the literature [ 10 , 19 ], the purpose of this study was to propose a more detailed stratification for tumors involving the AC, in order to better assess its prognostic role in early glottic carcinomas and consequently evaluate its effect on survival. The final aim was to understand if early glottic SCC with AC involvement does deserve a different staging category.…”

Survival and Prognostic Factors for Outcome after Radiotherapy for T2 Glottic Carcinoma

“…In our study, we found that the clinical, binary variable on anterior commissure involvement (yes/no) had no significant impact on oncological outcomes, whereas the vertical involvement of the anterior commissure on imaging showed a significant impact on LC. The varying results found in the literature can be explained by the variations in clinical definition of the anterior commissure area, variation in the detail of the clinical, endoscopic, and radiological evaluation of the lesion in the preoperative setting, the distinctive features, and limitation of each therapeutic modality, the biological behaviors of the tumor, and variations in the rigor of the follow-up policy [40]. These factors, combined with the complicated anatomy of the anterior commissure, the involvement of this subsite may very well be too complex to be included as a binary variable (yes/no) [40].…”

T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO2 Laser Microsurgery a Safe Option?

“…13,18 Despite this, the conclusions are not unanimous and the role of the ACI continues to be controversial. 9,22 To date, there are no prospective reports in this regard, so the objective of this study was to analyze the differences in survival, local control, and organ preservation in T1b glottic SCC patients treated with CO 2 TOLMS according to the presence of ACI. The findings in relation to ACI in our population are similar to previous studies in which an affectation of 69% was found.…”