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Laryngology/Broncho-Esophagology

Long-term Control Trends in Early Glottic Cancer: A Systematic Review

Monday, October 2, 2023
5:42 PM - 5:48 PM East Coast USA Time
Location: 106BC

    Presenting Author(s)

  • Zara R. Sragi, BS

    Medical Student
    Icahn School of Medicine at Mount Sinai
    West Bloomfield, MI, United States

    • Author(s)

  • GR

    Gabriel Rivera Rivera, MD

    Icahn School of Medicine at Mount Sinai, USA

  • Mia M. Saade, BS

    Medical Student
    Icahn School of Medicine at Mount Sinai
    New York, NY, United States

  • Abdurrahman Al-Awady, BS

    Mount Sinai Research Fellow
    Icahn School of Medicine at Mount Sinai
    Fleming Island, FL, United States

  • Joshua D. Barlow, BA

    Medical Student
    Icahn School of Medicine at Mount Sinai
    New York, NY, USA

  • Diana N. Kirke, MD

    Assistant Professor
    Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
    New York, NY, United States

    • Senior Author(s)

  • MC

    Mark S. Courey, MD

    Professor
    Mount Sinai Health System
    New York, NY, United States

Disclosure(s):
Zara R. Sragi, BS: No relevant relationships to disclose.
Mia M. Saade, BS: No relevant relationships to disclose.
Abdurrahman Al-Awady, BS: No relevant relationships to disclose.
Diana N. Kirke, MD: No relevant relationships to disclose.
Mark S. Courey, MD: No relevant relationships to disclose.
Introduction: Management of early glottic cancer has changed over the years following advancements in radiation therapy (RT) and improvements in microsurgical techniques. Current treatment methods include RT, transoral laser microsurgery, and adjuvant chemotherapy. To determine the best treatment option for early glottic cancer, we conducted a systematic review of the literature to evaluate the long-term local control rate (LCR) of these methods.

Methods: A search was performed in EMBASE, MEDLINE, and Cochrane Central databases on 10/4/2022. Search terms included variations of “early glottic”, “carcinoma”, and “oncological outcomes”. The initial search yielded 1732 articles, with 501 advancing to full-text screening. The inclusion criteria included a reported 5-year LCR and case series with a minimum of 5 patients.

Results: 62 studies met the inclusion criteria with a sample size of 5-831. Of those, 12 examined carcinoma in situ (Tis), 63 T1, and 45 T2, with many studies evaluating multiple stages simultaneously. The Tis 5-year LCR was 88.8% for surgery and 82.3% for RT (p= .88). The T1 5-year LCR was 86.5% for surgery and 87.4% for RT (p= .20). The T2 5-year LCR was 75.2% for surgery, 94.4% for combination therapy, and 74.3% for RT, where combination therapy produced a statically significant outcome compared to the other two (p < .05). The overall control rate in T2 cancer was significantly worse compared to Tis and T1 (75.4% vs. 87.0% and 87.1%). The LCR in T2b was significantly worse compared to T2a (61.8% vs. 78.7%, p < .05). Anterior commissure involvement, cord immobility, and vertical extension were associated with a higher chance of recurrence.

Conclusions: RT and surgery provide similar control of glottic cancer, with no method being superior. Combination chemotherapy with RT or surgery produced excellent control of T2 cancer, compared to either treatment alone. The choice between treatment modalities should be based on patient goals and clinician guidance. Future studies should focus on other prognostic factors that could play a role in disease control, such as the presence of multifocal versus unifocal disease.