Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO2 transoral laser microsurgery and radiotherapy

Michael F Vaculik; Colin A MacKay; S Mark Taylor; Johnathan R B Trites; Robert D Hart; Matthew H Rigby

doi:10.1186/s40463-019-0367-2

Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO₂ transoral laser microsurgery and radiotherapy

J Otolaryngol Head Neck Surg. 2019 Sep 3;48(1):44. doi: 10.1186/s40463-019-0367-2.

Authors

Michael F Vaculik¹, Colin A MacKay², S Mark Taylor², Johnathan R B Trites², Robert D Hart², Matthew H Rigby³

Affiliations

¹ Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, Canada.
² Dalhousie Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3044, Dickson Bldg. 5820 University Avenue, Halifax, NS, B3H 1V9, Canada.
³ Dalhousie Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3044, Dickson Bldg. 5820 University Avenue, Halifax, NS, B3H 1V9, Canada. mhrigby@dal.ca.

Abstract

Background: The objective of this study is to compare the oncologic outcomes of CO₂ transoral laser microsurgery (TLM) and radiotherapy (RT) for treatment of T1 glottic carcinoma.

Methods: A literature search was conducted in the following databases: Medline/PubMed, Web of Science, EMBASE, and the Cochrane Library. Search results were screened, and publications comparing oncologic outcomes of T1N0M0 glottic carcinoma treated with TLM or RT were included. Data was extracted independently by two authors, and publication quality was graded according to the Oxford Centre for Evidence-based Medicine. Meta-analysis was performed for overall survival, disease specific survival, laryngeal preservation, and local control.

Results: Sixteen studies were included in the meta-analysis, the majority being retrospective cohort studies with two prospective cohort studies. Included studies were rated as either Level II or III evidence. Meta-analysis favoured treatment with TLM for T1 glottic carcinoma patients for the following outcomes: overall survival (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.07-2.14; P = 0.02), disease specific survival (OR, 2.70; CI, 1.32-5.54; P = 0.007), and laryngeal preservation (OR, 6.31; CI, 3.77-10.56; P < 0.00001). There was no difference in local control between TLM and RT in T1 glottic cancer (OR, 1.19; CI, 0.79-1.81; P = 0.40).

Discussion: Our study provides a current and thorough comparison of TLM and RT outcomes in T1 glottic carcinoma. Limitations of our study include lack of randomized control trials, and non-randomized allocation of patients to treatment groups. Our meta-analysis suggests that TLM is the superior modality in terms of overall survival, disease specific survival, and laryngeal preservation. Future prospective randomized controlled studies are required for confirming these findings and developing appropriate clinical practice guidelines.

Level of evidence: 2A; as per the Centre of Evidence Based Medicine.

Keywords: Early glottic cancer; Radiotherapy; Survival; Transoral laser microsurgery.

Publication types

Comparative Study
Meta-Analysis
Systematic Review

MeSH terms

Glottis / surgery*
Humans
Laryngeal Neoplasms / mortality
Laryngeal Neoplasms / radiotherapy*
Laryngeal Neoplasms / surgery*
Laser Therapy* / methods
Microsurgery* / methods
Natural Orifice Endoscopic Surgery
Survival Rate
Treatment Outcome