Laser Microsurgery Versus Radiotherapy Versus Open Partial Laryngectomy for T2 Laryngeal Carcinoma: A Systematic Review of Oncological Outcomes
Flaminia Campo, Jacopo Zocchi, Massimo Ralli, Daniele De Seta, Francesca Russo, Diletta Angeletti, Antonio Minni, Antonio Greco, Raul Pellini, Marco de Vincentiis
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 (CO 2 transoral laser microsurgery [CO 2 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 CO 2 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 CO 2 TOLMS (respectively, 75.6% and 75.4%). Primary treatment with OPL and CO 2 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 CO 2 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 CO 2 TOLMS and RT.