Therapeutic modalities and oncologic outcomes in the treatment of T1b glottic squamous cell carcinoma: a systematic review

Abstract

T1a and T1b glottic squamous cell carcinoma (SCC) are often analyzed together by authors who investigate the oncologic outcomes achieved after different therapeutic options. Nevertheless, T1b definitely represents a more advanced tumor stage compared to T1a glottic SCC. The objective of this review was first to analyze the overall success rates in the treatment of patients affected by T1b glottic SCC. Moreover, a subgroup analysis was planned to specifically compare the outcomes obtained with radiotherapy (RT), transoral laser microsurgery (TLM) and open partial laryngectomies (OPL). An electronic library search of the relevant English literature was performed. Potentially eligible articles were reviewed. Qualified articles were selected and evaluated. Fifty-two studies comprising 2360 patients were included. The overall rate of disease-free survival (DFS) was 85% (95% CI 83-87). The overall rate of overall survival was 85% (95% CI 80-88) while the rate of disease-specific survival (DSS) was found to be 96% (95% CI 90-98). Statistical data concerning outcomes for each therapeutic modality showed an higher DFS rate for subjects treated with RT and OPL, respectively, 87% (95% CI 0.85-0.89) and 83% (95% CI 0.78-0.89), when compared to those who underwent TLM 77% (95% CI 0.69-0.83). In conclusion, our results showed a high level of overall DSS (96%) for patients affected by T1b glottic SCC. Regarding the specific therapeutic options, our subgroup analysis showed as patients treated with TLM present a higher rate of oncological recurrence in comparison to those who underwent RT or OPL. Nevertheless, on the basis of our data it was also noted that no significant differences subsist in terms of survival rates among the three different treatments. Moreover, the absence of a comparative analysis useful to confirm these conclusions must be considered.

A novel modality to cure early glottic carcinoma

“…Literature revealed various advantages of Laser surgery like it showed little bit of laryngeal edema, decreased morbidity rate, few side effects and a quick procedure but on the other hand, reported some side effects as well, including relapse because of incomplete tumorous tissue to preserve the voice. 11,12 These findings are supported by the current study but contradicting to the studies that consider Laser surgery as a best option for early glottic cancer because of better survival and few complications. 1, 13,14 Radiotherapy is considered as a primary treatment option for early stage glottic cancer because of the preservation of laryngeal anatomy and voice as well.…”

Oncological outcomes of CO2 laser cordectomies for glottic squamous cell carcinoma with respect to anterior commissure involvement and margin status

“…The results of the review showed that for this specific stage the therapeutic option of TLM presented higher rate of oncological recurrences (DFS, 77%) compared to RT (DFS, 87%) or open partial laryngectomy (OPL) (DFS, 83%). However, the overall survival rates did not differ significantly and were estimated at the level of 96% .…”

“…T1b glottis carcinoma definitely represents a more advanced stage compared to T1a. Gioacchini et al performed systematic review and identified 52 studies, including 2,360 patients, which had analyzed the overall success rates in the treatment of T1b glottis cancer. The results of the review showed that for this specific stage the therapeutic option of TLM presented higher rate of oncological recurrences (DFS, 77%) compared to RT (DFS, 87%) or open partial laryngectomy (OPL) (DFS, 83%).…”

“…Majority of studies express the results with the local control of T1b glottis carcinoma definitely represents a more advanced stage compared to T1a. Gioacchini et al [3] performed systematic review and identified 52 studies, including 2,360 patients, which had analyzed the overall Fig. 7.…”

“…Both the extent and localization of infiltration in laryngeal structures affect the prognosis of relapse. Different studies estimated the 5-year local control for T1a, T1b, and T2 at respective levels of 90-96%, 77-88%, and 76-88% [1][2][3][4][5]. Another significant prognostic factor is the anterior commissure involvement (ACI).…”