Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: A systematic review and meta-analysis

Guimarães, André Vicente; Dedivitis, Rogério Aparecido; Matos, Leandro Luongo de; Aires, Felipe Toyama; Cernea, Cláudio Roberto

doi:10.1038/s41598-018-30218-x

Cited by 72 publications

(70 citation statements)

References 26 publications

(32 reference statements)

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“…This is consistent with previous studies. A recent meta‐analysis by Guimaraes et al of eight studies with over 1000 patients with Tis and T1a glottic tumors demonstrated higher laryngectomy rates among early laryngeal cancer patients who required salvage following primary radiation therapy . This is reflected in the 2018 American Society of Clinical Oncology recommendation 1.5 .…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, we undertook a more focused analysis of LASCC patients. Patients with early stage glottic squamous cell carcinoma (SCC) (T1 and T2 lesions) generally demonstrate excellent treatment response and overall prognosis . Despite the lack of randomized controlled trials, many numerous retrospective studies, systematic reviews, and meta‐analysis have shown relative equivalency between surgery, (open or endoscopic) and external beam radiation therapy (EBRT) .…”

Section: Introductionmentioning

confidence: 99%

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Early glottic cancer in a veteran population: Impact of race on management and outcomes

et al. 2019

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Objectives Multiple population studies have shown racial discrepancies in head and neck cancer treatment and outcomes. We sought to characterize the impact of race on clinical outcomes for patients with early glottic squamous cell carcinoma (SCC) in a tertiary institution which provides equivalent access to care. Methods We retrospectively reviewed all early glottic (T1–T2) squamous cell carcinoma at a single institution, the Michael E. DeBakey Veterans’ Administration Medical Center (MEDVAMC). Data collected included demographic information, primary and adjuvant treatment modalities, time to diagnosis, time to treatment, recurrences, recurrence treatment modality, secondary malignancies, recurrence‐free survival (RFS), and overall survival (OS). Results One hundred seventeen patients with a primary diagnosis of T1–T2 glottic squamous cell carcinoma were included. Black and white patients demonstrated equivalent rates of recurrence, RFS, and OS. There was no significant difference in treatment delivery by race for all recorded parameters. T1b tumors were associated with an increased risk of recurrence which did not translate into a statistically significant decrease in RFS or OS. Surgical treatment was associated with increased recurrence but similar RFS and OS compared to radiation‐based treatment. Secondary malignancies were common; 12% of patients were diagnosed with a second primary lung cancer during the study period. Conclusion At our institution, race did not impact survival when access to care, treatment selection, and delivery are equivalent for early glottic SCC. Secondary lung cancer is a critical risk factor for mortality in this patient group and requires long‐term surveillance and monitoring. Level of Evidence 4 Laryngoscope, 130:1733–1739, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early glottic cancer in a veteran population: Impact of race on management and outcomes

et al. 2019

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“…The disadvantages of radiotherapy include local temporary or persistent edema, glottis stenosis, xerostomia, and hypothyroidism. 9 There is also a small risk of radiation-induced malignancy. The most important factor in laser surgery is to get adequate exposure of the tumor during microlaryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

Role of lasers in glottic malignancies: our experience

Natarajan

Nandhan

Dham

et al. 2020

Int J Otorhinolaryngol Head Neck Surg

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Background: Laryngeal malignancy is one of the commonest head and neck cancers encountered in India. Most tumors are glottic in origin. Radiation, partial or total laryngectomy gives very good cure rates for these tumors. Lasers have emerged as an integral part of the treatment paradigm for patients with laryngeal cancer. Laser surgery is one of the primary treatment options for early-stage glottic tumors and can also be used for advanced laryngeal tumors. Methods: Fifty patients with laryngeal cancer were treated with laser over a 10-year period. Majority of patients were males with an average age of 46 years. Most patients had early (T1, T2) laryngeal malignancy (90%). There were a few patients with advanced laryngeal tumor (10%). All patients had tumor biopsy and simultaneous laserization of the tumor followed by radiation in T1 and T2 disease and chemo radiation in T3 disease. A few patients who had recurrence of disease after radiation (4%) were medically unfit for laryngectomy and underwent laserization of the tumor. Results: Laser surgery proved to be an important tool in the management of glottic tumors and is commonly utilized in the treatment of early-stage disease. It has also been successful for debulking of large tumors. Careful case selection is important for good outcomes. Conclusions: Transoral laser microsurgery and radiotherapy are useful treatment modalities in the management of early glottic malignancies. Lasers have proved to be effective in glottic malignancies with excellent oncologic and functional outcomes.

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“…https://www.nice.org.uk/guidance/ng36), with salvage laryngectomy or radiotherapy for recurrence . Rates of local control and 5‐year survival in early‐stage tumours are similar following radiotherapy or TLM (~80%), and meta‐analyses in early glottic cancers suggest improved survival following TLM, with uncertainty regarding vocal quality outcomes . Options for T3/T4 LSCC include radiotherapy, concurrent platinum‐based chemo‐radiotherapy, primary partial or total laryngectomy .…”

Section: Introductionmentioning

confidence: 99%

“…1 Rates of local control and 5-year survival in early-stage tumours are similar following radiotherapy or TLM (~80%), and meta-analyses in early glottic cancers suggest improved survival following TLM, with uncertainty regarding vocal quality outcomes. 3,4 Options for T3/T4 LSCC include radiotherapy, concurrent platinum-based chemo-radiotherapy, primary partial or total laryngectomy. 2,5 Post-radiotherapy recurrence is a major problem, with radiotherapy failure rates of 9%-21% in T1 glottic and 28%-37% in T2 glottic LSCC.…”

mentioning

confidence: 99%

Radioresistant laryngeal cancers upregulate type 1 IGF receptor and exhibit increased cellular dependence on IGF and EGF signalling

Qureishi

Rieunier

Shah

et al. 2019

Clinical Otolaryngology

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Objectives Patients failing radiotherapy for laryngeal squamous cell carcinoma (LSCC) often require salvage total laryngectomy which has major functional consequences, highlighting a need for biomarkers of radiotherapy resistance. In other tumour types, radioresistance has been linked to epidermal growth factor receptor (EGFR) and type 1 insulin‐like growth factor receptor (IGF‐1R). Here, we evaluated IGF‐1R and EGFR as predictors and mediators of LSCC radioresistance. Design We compared IGF‐1R and EGFR immunohistochemical scores in patients with LSCC achieving long‐term remission post‐radiotherapy (n = 23), patients treated with primary laryngectomy (n = 22) or salvage laryngectomy following radiotherapy recurrence (n = 18). To model radioresistance in vitro, two LSCC cell lines underwent clinically relevant irradiation to 55 Gy in 2.75 Gy fractions. Results Type 1 insulin‐like growth factor receptor expression was higher in pre‐treatment biopsies of radiotherapy failures compared with those in long‐term remission and was upregulated post‐radiotherapy. Patients undergoing primary laryngectomy had more advanced T/N stage and greater tumour IGF‐1R content than those achieving long‐term remission. Pre‐treatment EGFR did not associate with radiotherapy outcomes but showed a trend to upregulation post‐irradiation. In vitro, radiosensitivity was enhanced by inhibition of EGFR but not IGF. Repeated irradiation upregulated IGF‐1R in BICR18 and SQ20B cells and EGFR in SQ20B, and enhanced SQ20B radioresistance. Repeatedly irradiated SQ20B_55 cells were not radiosensitised by inhibition of IGF and/or EGFR, but IGF‐1R:EGFR co‐inhibition suppressed baseline cell survival more effectively than blockade of either pathway alone, and more effectively than in parental cells. Conclusions Radiation upregulates IGF‐1R and may enhance IGF/EGFR dependence, suggesting that IGF/EGFR blockade may have activity in LSCCs that recur post‐radiotherapy.

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Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: A systematic review and meta-analysis

Cited by 72 publications

References 26 publications

Early glottic cancer in a veteran population: Impact of race on management and outcomes

Early glottic cancer in a veteran population: Impact of race on management and outcomes

Role of lasers in glottic malignancies: our experience

Radioresistant laryngeal cancers upregulate type 1 IGF receptor and exhibit increased cellular dependence on IGF and EGF signalling

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