Balancing survival rates and quality-of-life outcomes after transoral laser microsurgery for locally advanced glottic cancer

Purpose This study aims to analyze resectable T3-T4a glottic cancer patients treated with TOLM at a tertiary hospital, evaluating survival, function, and QoL in organ-preserved cases. Methods Patients with diagnosis of laryngeal glottic squamous cell carcinoma pT3-pT4a N < 3 M0 treated with primary curative intention TOLM from 2005 to 2021 were included. Statistical analysis was performed, including survival rates. Quality of life was evaluated using VHI-10, EORTC-QLQ-C30 and EORTC-QLQ-HN43. Results 82 patients were included in this study, predominantly male, with a mean age of 65.5 years old. Laryngeal preservation rate was 76.83%. 5-year overall survival was 68.3%, 5-year Disease Specific Survival was 80.9%, 5-year Local disease-free survival was 91.2%. Medium VHI-10 score was 9.20 (SD +/- 5.90), with nearly two thirds (63.33%) having a normal score. On the QLQ-C30 questionnaire, five of the six functional scales were over 80. On the QLQ-HN43 all the scales (single and multi-item) scored less than 16. Conclusion TOLM achieved comparable survival rates to radical surgery and other organ-preserving methods for locally advanced glottic cancer, as well as good functional outcomes with minimal post-surgical symptoms and mild voice impairment.