Superior Regional Control and Laryngeal Function Preservation With Radiotherapy Versus Partial Laryngectomy: A Propensity Score-Matched Analysis of 562 Early Glottic Cancer Patients

Objectives: We aimed to compare the outcomes of patients with T1-T2N0M0 glottic squamous cell carcinoma who underwent either partial laryngectomy (PL) or radiotherapy (RT). Methods: A retrospective analysis of 562 patients treated with RT (n = 151) or PL (n = 411) was conducted. The Kaplan-Meier method was used to estimate outcomes. The risk factors were identified using univariate and multivariate Cox regression analyses. Propensity score matching (PSM) was used to adjust for baseline variations. Results: Post-PSM, the 5-year overall survival (89.4% vs. 88.4%, p = 0.879), 5-year cancer-specific survival (91.9% vs. 90.1%, p = 0.554), and 5-year local relapse-free survival (87.2% vs. 89.3%, p = 0.487) rates did not differ significantly between the two groups. However, the 5-year regional relapse-free survival rate was significantly higher in the RT group than that in the PL group (99.3% vs. 93.3%, p = 0.009). Recurrence was most likely to occur in the lymph nodes at levels II and III. Supraglottic engagement has emerged as an independent prognostic factor for regional relapse in T2 stage diagnosed PL. The RT group demonstrated significantly superior speech function (mean: 6.065) compared to the PL group (mean: 10.650, p < 0.0001). Conclusions: RT yielded survival rates, local control, and laryngeal preservation comparable to PL. RT is associated with a higher regional control rate in T2 patients. Supraglottic involvement is an independent risk factor for regional relapse in patients with T2 disease after PL. The RT group exhibited extremely low complication rates and significantly improved speech function.