Laser Surgery versus Radiotherapy for T1–T2N0 Glottic Cancer: A Meta-Analysis

Abstract

Background: Laser surgery and radiotherapy are commonly used to treat glottic cancer. Objective of Review: To compare outcomes and cost of laser surgery versus radiotherapy for T1–T2N0 glottic cancer. Type of Review: Meta-analysis. Search Strategy: The Cochrane Central Register of Controlled Trials, Ovid MEDLINE® In-Process & Other Non-Indexed Citations, Embase, Web of Science (1990–2010) were searched electronically. Three Chinese journals in otolaryngology were searched manually. Evaluation Method: Retrieved studies were analyzed with Review Manager 5.0 software. Methodological and outcome heterogeneity was analyzed using the χ² test and the I² test. Homogeneous and heterogeneous data were analyzed using a fixed random effect model. Results: Eleven studies involving 1,135 patients were included in the analysis. The cure rate did not differ between patients receiving laser surgery versus radiotherapy. Results on voice preservation were inconclusive. The overall cost for laser surgery was lower. Conclusions: The quality of the reported clinical studies is limited. No level I data are available. Nonetheless, our analysis suggests that laser surgery and radiotherapy produce comparable outcomes.

Voice Outcomes of Transoral Laser Microsurgery of the Larynx

“…14 In addition, 4 meta-analyses and one systematic review have been published in an attempt to obtain enough data (and statistical power) to draw definitive conclusions as to voice outcomes. 7,[10][11][12][13] The only currently published prospective, randomized study directly comparing voice outcomes between TLM and RT for early glottic cancer included 60 patients, 31 in the TLM group and 25 in the RT group, all treated for T1a glottic carcinoma. 14 At 2 years posttreatment, patient-rated "hoarseness" did not differ between the 2 groups (43/100 vs 35/100 on a visual analog scale of 0-100) but "impact on everyday life" was significantly higher in the TLM group (32/11 vs 8/100).…”

“…There was no significant difference in VHI, although the time of VHI evaluation in the studies was either unreported or 3, 6, or 12 postoperative months. Feng and colleagues 12 were unable to perform a meta-analysis of the 6 trials that they had retained for VHI evaluation because of too much heterogeneity.…”

Audit of transoral laser-assisted microsurgical resection of early laryngeal cancer

“…[5][6][7] To date, no prospective randomised trials comparing radiotherapy and laser surgery for early glottic cancer have been published, and the decision about treatment modality in most centres is mainly based on clinician's preference, local policy and patient's preference. The Early Stage Glottic Cancer: Endoscopic Excision or Radiotherapy ('EaStER') feasibility study trial was initiated but had to be closed in 2008 because of poor recruitment of patients to the trial.…”

Evidence and evidence gaps of laryngeal cancer surgery

“…There are three meta-analyses [21], [22], [23] and one systematic review [24] comparing the local control after transoral laser therapy vs. radiotherapy of T1 and T2 carcinomas of the vocal folds. In summary, those four papers do not show a significant difference of the local control after transoral laser surgery and radiotherapy (Table 1 (Tab.…”

“…In summary, those four papers do not show a significant difference of the local control after transoral laser surgery and radiotherapy (Table 1 (Tab. 1)) [21], [22], [23], [24]. …”