Laser Microsurgery Versus Radiotherapy Versus Open Partial Laryngectomy for T2 Laryngeal Carcinoma: A Systematic Review of Oncological Outcomes

Abstract

Introduction: The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO2 transoral laser microsurgery [CO2 TOLMS]), radiotherapy (RT), or open partial laryngectomy (OPL). Methods: A systematic search was performed using the MEDLINE database, Scopus, and Google scholar. The inclusion criteria were studies of patients with T2N0 glottic tumor, treated with either primary CO2 TOLMS, definitive curative RT, or primary OPL, and with reported oncological outcome at 5 years calculated with a Kaplan-Meier or Cox regression method. Results: The results of the current review show that local control (LC) is higher with OPL 94.4%, while there are no differences in LC at 5-year posttreatment for patients treated with RT, compared to those treated with CO2 TOLMS (respectively, 75.6% and 75.4%). Primary treatment with OPL and CO2 TOLMS results in higher laryngeal preservation than primary treatment with RT (respectively 95.8%, 86.9%, and 82.4%). Conclusion: First-line treatment with OPL and CO2 TOLMS should be encouraged in selected T2 patients, because it results in higher laryngeal preservation and similar LC compared to primary treatment with RT. The involvement of the anterior commissure in the craniocaudal plane and T2b impaired vocal cord mobility have a poorer prognosis and LC compared to patients with T2a tumors for both CO2 TOLMS and RT.

Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature

“…Patients with head and neck cancer have numerous reasons for fatigue and possibly hypersomnolence. Surgical and radiation treatment are debilitating, and recovery is often protracted [38]. Poor nutritional intake, depression, anxiety, and pain can be other causes of fatigue.…”

Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments

“…On the contrary, controversy exists in the literature regarding the indications of tumors with invasion of the vertical plane of the anterior commissure where, if feasible, supracricoid laryngectomy has demonstrated better local control than TOLMS. 20,21 Although it was not the focus of the present study, our results clearly show that supraglottic tumors have better local control with TOLMS than glottic ones. These findings have been previously corroborated by other studies, 22,23 confirming that, in terms of local control, the best indication for TOLMS are pure supraglottic tumors.…”

Cell‐Free Human Papillomavirus‐DNA for Monitoring Treatment Response of Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta‐Analysis

“…The actual gold standard for the follow-up of this population is represented by 18 F-fluorodeoxyglucose positron emission tomography and computed tomography (PET-CT), whose noninferiority to planned neck dissection (ND) was stated through a retrospective analysis. 14 Nonetheless, the positive predictive value of PET-CT in HPV-associated HNSCC is particularly low (0%-30%), 15,37 and even in association with other imaging examinations, the evidence of persistence or relapse of disease can be challenging, particularly after chemoradiation. 38,39 Consequently, patients with HPV-associated HNSCC are prone to experience unnecessary diagnostic or therapeutic procedures, such as ND.…”

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