Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and meta-analysis

Abstract

Transoral laser microsurgery (TLM) and radiotherapy (RT) are both accepted treatment modalities for glottic cancer. The objective of the study was to assess the oncologic outcomes and life quality of TLM in comparison with RT for T1 glottic carcinoma. We searched Medline/PubMed, Web of knowledge, EMBASE, the Cochrane Library, the Wiley online library, Springer, Google, China National Knowledge Infrastructure (CNKI), etc. We screened the literature, assessed the quality of the studies, and extracted the relevant data through the establishment of inclusion and exclusion criteria. Meta-analysis was done using the Cochrane collaboration' s RevMan 5.0 for data analysis. A total of 11 studies were included in this meta-analysis. The laryngeal preservation for patients undergoing TLM was significantly better than that for RT (P < 0.00). The laser surgery significantly improved the overall survival of patients with T1 glottic carcinoma (P = 0.04). No statistically significant differences were found between TLM and RT regarding the local control (P = 0.91). The funnel plot demonstrates no apparent publication bias in the overall survival and laryngeal preservation comparison. Our meta-analysis suggested that laser surgery was a preferred method than radiotherapy with respect to significantly better overall survival and laryngeal preservation. But the local control was not significant different. Further prospective randomized controlled studies will be needed.

Oncologic outcomes of KTP laser surgery versus radiation for T1 glottic carcinoma

“…Grade I laryngeal radiotoxicity includes hoarseness and slight arytenoid edema, whereas grade II includes moderate arytenoid edema and chondritis, as well as skin erythema and esophagitis . A 2017 meta‐analysis by Mo et al of 11 studies comparing functional and oncologic outcomes of TLM versus radiation therapy found significantly improved laryngeal preservation rate and overall survival in the TLM group . However, this analysis did not take into account clinical and demographic factors of each patient group, and the local control rate was not significantly different between the two groups.…”

Transoral laser microsurgery for glottic cancer in the elderly: Efficacy and safety

“…On the other hand, TLM in early laryngeal cancer has been demonstrated to be an effective treatment, with a 5‐year recurrence‐free survival rates that ranges from 80% to 95%, and preservation of the larynx in more than 90% of cases . Recent systematic reviews and meta‐analyses have shown the excellent results of TLM as definitive therapy for T1 and T2 glottic carcinomas, with local control rates similar to radiotherapy, the treatment most frequently used for these cancers in the western world …”

“…5,6,8 Recent systematic reviews and meta-analyses have shown the excellent results of TLM as definitive therapy for T1 and T2 glottic carcinomas, with local control rates similar to radiotherapy, the treatment most frequently used for these cancers in the western world. [23][24][25] In elderly patients, the results of the reviewed studies showed that age does not affect the oncological results, with local control rates with TLM over 85% and 5-year DSS over 90%. In our series, a slightly lower local control rate (83.5%) was observed, although with a comparable 5-year DSS (95%), that could be attributable to the significant number of cases with anterior commissure involvement (33%), a parameter that has been related to a higher incidence of local recurrence.…”

The voice quality after laser surgery versus radiotherapy of T1a glottic carcinoma: systematic review and meta-analysis

“…RT can protect the laryngeal function and also can achieve similar therapeutic effects of surgery for patients of T1a glottic carcinoma 10,13,19. With the development of science and technology, modern RT technology tends to be more targeted accurately.…”