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Otorinolaringologia 2012 December;62(4):191-200

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Early glottic cancer treatment: chasing the evidence

Belzile M. ¹, Fung K. ¹, Palma D. A. ², Yoo J. ¹, Nichols A. C. ¹

¹ Department of Otolaryngology-Head and Neck Surgery, Victoria Hospital-London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; ² Department of Radiation Oncology, Western University, London, ON, Canada

Debate to determine the optimal treatment for early stage squamous cell carcinoma of the vocal cord is still ongoing. Radiotherapy and transoral laser microsurgery remain the most popular therapeutic interventions for this type of cancer. The following review of the recent literature on this topic shows that retrospective studies are not scientifically rigorous enough to clarify this equivocal issue. The body of evidence, largely based on non-randomized data, reiterates the equivalence in terms of local control, disease-free survival and voice-related quality of life. Regarding cost utility analysis, transoral laser microsurgery seems to be superior to radiotherapy when actuarial predictions based on five-year oncological outcomes are used to compare both modalities. Larynx-preservation rate is certainly the most explicit outcome to interpret as we note a trend towards better results for surgery. However, voice quality seems to be slightly better with radiotherapy but the data are still conflicting. Small lesions that are well circumscribed and isolated to one vocal cord (T1a) can safely be amenable to primary surgical therapy with particular attention to clear margins assessment. In the future, efforts should be directed towards identification of biomarkers predictive of the response to radiation therapy. Randomized controlled trials should be designed in this perspective.