Functional outcomes in early (T1/T2) supraglottic cancer: a systematic review

Abstract

ObjectivesOrgan preserving surgery (OPS) and radiotherapy (RT) are both accepted treatment options for early stage supraglottic cancer (SGC). Radiation has supplanted surgery in most cases, because of the perception that surgery results in poorer functional outcomes. However, evidence suggests that OPS with a neck dissection may be associated with improved survival. Our objective was to conduct a systematic review of the literature to compare functional outcomes of OPS and RT for early SGC.MethodsWe searched Medline, EMBASE and Cochrane Central Register of Controlled Trials to identify studies. Studies were included if they reported functional outcomes on 10 or more patients with early stage SGC treated with radiation or OPS, including open partial laryngectomy, transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Two reviewers independently screened articles for relevance using pre-determined criteria.ResultsFrom 7720 references, we included 10 articles (n = 640 patients). 50% (n = 320) of patients were treated with surgery. Three head-to-head RT versus OPS papers were included, however different outcome measures were used for each group. Intractable aspiration management (including total laryngectomy or permanent tracheostomy) following OPS was reported in five papers representing 186 patients; the definitive intractable aspiration management rate was 2.6% (95% CI 1.0–6.8%). Four papers reported permanent G-tube rate for the surgical group (n = 198), calculating a rate of 5.3% (95% CI 2.6–10.5%), this was not reported for the RT group in any papers. One study reported quality of life. Two studies reported objective voice measures.ConclusionsThis systematic review revealed a paucity of objective measures and significant data heterogeneity, rendering the comparison of functional outcomes following OPS versus RT for early SGC limited. Future research should include objective measures of functional outcomes including laryngectomy rate, g-tube rate, tracheostomy dependence, quality of life, and voice quality measures.

An Observational Cohort Study on 194 Supraglottic Cancer Patients: Implications for Laser Surgery and Adjuvant Treatment

“…A second important reason is that supraglottic cancers more often present with nodal involvement at the time of diagnosis [ 8 , 11 , 13 ]. This is ascribed to the richer lymphatic supply of the supraglottic area [ 9 , 10 ]. Thus, even in T1 and T2 supraglottic carcinomas, treatment of the neck has to be considered.…”

“…The 5-year overall survival (5-year OS) rate for localized disease is approximately 45–50% in supraglottic cancer compared to 85–90% in glottic cancer, indicating a 30–40% poorer 5-year OS in tumors of the supraglottis [ 4 , 8 ]. The poorer prognosis is thought to be a consequence of abundant lymphatic drainage of the supraglottic region, resulting in higher rates of regional and distant metastases [ 9 , 10 ]. Moreover, cancers of the glottis often cause hoarseness and thus are relatively often diagnosed at an early stage, whereas supraglottic and subglottic cancers more often present with nodal involvement at the time of diagnosis [ 11 ].…”

Neck Dissection in Salvage Surgery for Larynx Cancer: National Cancer Database Review

“…Early-stage laryngeal cancers may be treated with surgery or primary radiation therapy alone. 20-24 Landmark clinical trials have shown that combination chemoradiation therapy are effective at organ preservation for certain advanced laryngeal cancers. 3,5,6 For those with persistent or recurrent disease after non-surgical treatment, salvage laryngeal surgery is the standard treatment with excellent control rates.…”

A systematic review on the guidelines for nutritional assessment for head and neck cancer patients managed by surgery

“…[ 9 ] Postsurgically, HNC cases undergo alterations in the short- and long-term swallowing pattern which subsequently requires enteral feeding. [ 10 ] With a compromised deglutition functioning, maintaining a nutrition balance is a big challenge in such cases. [ 11 ] A multicentric study reported that pain and scar in the region of surgery may dissuade the patients from consuming food normally.…”