Oncologic and Voice Outcomes after Treatment of Early Glottic Cancer: Transoral Laser Microsurgery versus Radiotherapy

Objective: To compare the laryngeal preservation rates and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RI). Design: Multicenter, retrospective consecutive cohort of stage 1 and 2 glottic carcinoma treated With TLM or RT. Setting: Three Canadian academic cancer centres. Methods and Main Outcome Measures: The patients were those of the regional cancer registries associated with each of the participating universities between 2002 and 2010. The primary oncologic end point was organ preservation. The primary functional outcome measure was the Voice Handicap Index (VHI-10). Results: A total of 234 patients were treated for early glottic cancer (143 TLM, 91 RI). At 2 years, the laryngeal preservation rate for stage 1 disease was 100% TLM and 92% RI (p < .004); for stage 2 disease, it was 100% TLM and 88% RI (p = not significant). There was only one laryngectomy in the TLM group over 5 years posttreatment. There were functional data on 132 patients (83 TLM, 49 RI). Median VHI-10 scores were inferior for laser patients at all three time intervals (6, 12, and 24-48 months posttreament) despite a stage bias in favour of TLM (range of median VHI score over time intervals: TLM = 9.5-12, RT = 3.5-8; p = .01.08). However, theses scores represent mild disability in both groups. Conclusions: TLM patients have poorer voice quality than RI patients. However, the advantages of TLM in most patients outweigh the degree of voice handicap. Organ preservation rates for TLM were better than or equal to those of RT for both stage 1 and 2 glottic cancer.