Voices heard.

Top Line: Is transoral laser surgery superior to radiation for T1a larynx cancer?

The Study: The goal of treatment for early-stage larynx cancer is to provide a high chance of cure while maintaining larynx function. One surgical technique for larynx preservation is transoral laser surgery (TLS). There is very limited and mostly retrospective data comparing TLS and radiation therapy (RT), which didn’t stop a meta-analysis from concluding that treatment and survival outcomes with TLS are superior to those of definitive radiation. Enter this small randomized trial from Finland, which was designed to compare voice quality between primary radiation and TLS for T1a (tumor limited to one vocal cord) squamous cell carcinoma of the glottic larynx. In the trial, 56 men were randomized to transoral laser surgery (n=31) or radiation therapy (N=25). Only men were enrolled because the primary outcome involved comparison of voice quality. The original results showed that overall perceptual voice quality was similar between treatment modalities 2 years after treatment, however breathiness and hoarseness were more bothersome in the TLS arm. Here the authors report long-term disease and survival outcomes from the trial. Radiation consisted of 66 Gy in 33 fractions. At 5 years, the local recurrence rate was 16% overall. While there were twice as many local recurrences after TLS (n=6), the difference in recurrence free survival between TLS and RT was not significant (81% v 88%). Median time from primary treatment to recurrence was 1.5 years. A higher proportion of patients (18%) actually developed second primary malignancies. Disease specific survival at 5 years was comparable between TLS and RT (97% v 100%). While 5 year overall survival was ~90%, 10 year overall survival was a sobering 20% in both groups.

TBL: This small randomized trial found similar survival outcomes among patients treated with laser surgery or radiation therapy for T1a squamous cell carcinoma of the larynx. | Pakkanen, Int J Radiat Oncol Biol Phys 2022