Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer

Dey P, Arnold D, Wight R, Kelly CG, McKenzie K

Published Online:

July 7, 2010

Cancer of the larynx (voice box) usually begins in the glottis (vocal cords) as a squamous cell cancer (cancer in the membranes). Most people survive these cancers when they get treatment early (before the cancer spreads further into the larynx and surrounding area). Options include radiotherapy, open surgery (through the neck) or, more commonly now, endolaryngeal excision (surgery reaching the throat via the mouth, sometimes with a laser). The review of trials found there is not enough evidence to show which form of treatment might be better for people with early stage laryngeal squamous cell carcinoma. Such evidence may come from new trials comparing radiotherapy and endolaryngeal excision, which have started.

Abstract (click to read)

Background:

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2002 and previously updated in 2004 and 2007.

Radiotherapy, open surgery and endolaryngeal excision (with or without laser) are all accepted modalities of treatment for early stage glottic cancer. Case series suggest that they confer similar survival advantage. Opinions on optimal therapy vary across disciplines and between countries.

Objectives:

To compare the effectiveness of open surgery, endolaryngeal excision (with or without laser) and radiotherapy in the management of early glottic laryngeal cancer.

Search strategy:

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISCTRN and additional sources for published and unpublished trials. The date of the most recent search was 1 October 2009, following previous searches in 2007, 2006, 2003 and 2002.

Selection criteria:

Randomised controlled trials comparing open surgery, endolaryngeal resection and/or radiotherapy.

Data collection and analysis:

Two authors independently assessed randomised controlled trials identified from the electronic searches for eligibility and methodological quality. All authors of the review discussed the results of these assessments.

Main results:

Only one randomised controlled trial was identified which compared open surgery and radiotherapy among a substantial number of patients with early glottic laryngeal cancer.

Authors' conclusions:

There is currently insufficient evidence to guide management decisions on the most effective treatment. Interpretation of the only large-scale randomised controlled trial comparing open surgery and radiotherapy in patients with early glottic cancer is limited because of concerns about the adequacy of treatment regimens and deficiencies in the reporting of the study design and analysis. Endolaryngeal resection of early glottic tumours is becoming more common. Two multicentre trials comparing endolaryngeal resection with radiotherapy are underway.

This record should be cited as:

Dey P, Arnold D, Wight R, Kelly CG, McKenzie K. Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002027. DOI: 10.1002/14651858.CD002027

Assessed as up to date:

October 1, 2009

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Primary Review Group:

Ear, Nose and Throat Disorders Group

Health topics:

Cancer > Ears, nose, & throat

Ear, nose, & throat > Cancer

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer

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