Survival and Larynx Preservation in Early Glottic Cancer: A Randomized Trial Comparing Laser Surgery and Radiation Therapy

Pakkanen, Pihla; Irjala, Heikki; Ilmarinen, Taru; Halme, Elina; Lindholm, Paula; Mäkitie, Antti; Wigren, Tuija; Aaltonen, Leena‐Maija

doi:10.1016/j.ijrobp.2022.01.010

Cited by 13 publications

(19 citation statements)

References 21 publications

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“…Here, surgery as primary treatment for patients with T1a glottic LSCC was performed in 24% of the patients during 2000–2004 compared with 40% during 2010–2015. Our and other studies show similar results in survival regardless of single treatment modality for patients with T1 glottic LSCC 26–28 . In the case of recurrent T1 disease, it could be beneficial to have surgery as the primary treatment since RT/CRT then still remains a treatment option and TL could be avoided.…”

Section: Discussionsupporting

confidence: 81%

“…Our and other studies show similar results in survival regardless of single treatment modality for patients with T1 glottic LSCC. 26 , 27 , 28 In the case of recurrent T1 disease, it could be beneficial to have surgery as the primary treatment since RT/CRT then still remains a treatment option and TL could be avoided. In either case, it is of paramount importance to select an appropriate modality at a multidisciplinary tumor board meeting depending on the patient and tumor characteristics.…”

Section: Discussionmentioning

confidence: 99%

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Treatment and outcome among patients with laryngeal squamous cell carcinoma in Stockholm—A population‐based study

Blomkvist

Marklund

Hammarstedt‐Nordenvall

et al. 2023

Laryngoscope Investig Oto

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Objective Survival of patients with advanced laryngeal squamous cell carcinoma (LSCC) remains poor and management protocols warrant further development. We thus investigated treatment and outcome‐related factors for LSCC in Stockholm, Sweden. Methods In a retrospective setting, 520 patients with LSCC diagnosed during 2000–2014, were included. Data on stage, treatment, and outcome were correlated with recurrence‐free and overall survival (RFS and OS, respectively). Results Five‐year OS for all patients was 65%. Five‐year RFS for T1a, T1b, T2, T3, and T4 glottic LSCC was 90%, 91%, 77%, 47%, and 80%, respectively. The corresponding figures for T1, T2, T3, and T4 supraglottic LSCC were 64%, 66%, 64%, and 86%. Conclusion Patients with a T3 glottic LSCC had unexpectedly poor survival, especially when compared with patients with a T4 tumor. Patients with T4 disease were primarily treated with laryngectomy and postoperative radiotherapy (RT)/chemoradiotherapy (CRT), while most patients with T3 LSCC were treated with RT/CRT.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Treatment and outcome among patients with laryngeal squamous cell carcinoma in Stockholm—A population‐based study

Blomkvist

Marklund

Hammarstedt‐Nordenvall

et al. 2023

Laryngoscope Investig Oto

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“…Due to the unavailability of the VHI in the Finnish language at the time point of randomization, this endpoint could not be investigated. Recently, long-term results after a median follow-up of 6.6 years were published and reported a similar 5-year OS (TLM: 87%, RT: 92%) and larynx preservation rates TLM: 97%, RT: 92%) [40].…”

Section: Discussionmentioning

confidence: 76%

VoiceS: voice quality after transoral CO2 laser surgery versus single vocal cord irradiation for unilateral stage 0 and I glottic larynx cancer—a randomized phase III trial

Reinhardt

Giger

Seifert

et al. 2022

Trials

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Background Surgery and radiotherapy are well-established standards of care for unilateral stage 0 and I early-stage glottic cancer (ESGC). Based on comparative studies and meta-analyses, functional and oncological outcomes after both treatment modalities are similar. Historically, radiotherapy (RT) has been performed by irradiation of the whole larynx. However, only the involved vocal cord is being treated with recently introduced hypofractionated concepts that result in 8 to 10-fold smaller target volumes. Retrospective data argues for an improvement in voice quality with non-inferior local control. Based on these findings, single vocal cord irradiation (SVCI) has been implemented as a routine approach in some institutions for ESGC in recent years. However, prospective data directly comparing SVCI with surgery is lacking. The aim of VoiceS is to fill this gap. Methods In this prospective randomized multi-center open-label phase III study with a superiority design, 34 patients with histopathologically confirmed, untreated, unilateral stage 0-I ESGC (unilateral cTis or cT1a) will be randomized to SVCI or transoral CO2-laser microsurgical cordectomy (TLM). Average difference in voice quality, measured by using the voice handicap index (VHI) will be modeled over four time points (6, 12, 18, and 24 months). Primary endpoint of this study will be the patient-reported subjective voice quality between 6 to 24 months after randomization. Secondary endpoints will include perceptual impression of the voice via roughness – breathiness – hoarseness (RBH) assessment at the above-mentioned time points. Additionally, quantitative characteristics of voice, loco-regional tumor control at 2 and 5 years, and treatment toxicity at 2 and 5 years based on CTCAE v.5.0 will be reported. Discussion To our knowledge, VoiceS is the first randomized phase III trial comparing SVCI with TLM. Results of this study may lead to improved decision-making in the treatment of ESGC. Trial registration ClinicalTrials.gov NCT04057209. Registered on 15 August 2019. Cantonal Ethics Committee KEK-BE 2019-01506

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“…techniques with different laser modalities and robotic-assisted transoral surgery were observed, however, not only surgical techniques improved, as RT is using intensity-modulated radiation to precisely select normal tissues and targets for treatment, providing curative treatment with less toxicities. 44,58,75,77 As T1-T2 glottic cancer survival outcomes rates of laryngeal preservation are good and similar following laser surgery and RT, 6 recent studies have focused on the improvement of functional voice outcomes. 5,85 Relative to transoral laser microsurgery using a CO₂ laser, that performed with an angiolytic potassium titanyl phosphate laser for early-stage glottic cancer 85 Other therapeutic modalities for early-stage glottic cancer that have been assessed include intraoperative hyaluronic acid injection during transoral laser microsurgery, which had no significant effect on survival, 38 and altered (hypo-and hyper-) fractionation RT, which was found to result in fewer local failure events than did conventional RT.…”

Section: Resultsmentioning

confidence: 99%

Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022

Arboleda,

Neves,

Kohler

et al. 2023

Cancer Reports

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BackgroundThe treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision‐making about this treatment according to the tumor site, clinical stage, and patient medical status.AimThe present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period.Methods and ResultsClinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta‐analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early‐stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised.ConclusionNCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non‐surgical techniques. The guidelines support decision‐making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.

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Survival and Larynx Preservation in Early Glottic Cancer: A Randomized Trial Comparing Laser Surgery and Radiation Therapy

Cited by 13 publications

References 21 publications

Treatment and outcome among patients with laryngeal squamous cell carcinoma in Stockholm—A population‐based study

Treatment and outcome among patients with laryngeal squamous cell carcinoma in Stockholm—A population‐based study

VoiceS: voice quality after transoral CO2 laser surgery versus single vocal cord irradiation for unilateral stage 0 and I glottic larynx cancer—a randomized phase III trial

Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022

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