Surgery vs Radiation in Early Glottic Cancer

TOPLINE:

In a study of patients with T1 glottic squamous cell carcinomas, a group who received transoral microlaryngeal surgery alone had a higher risk for recurrence than a group who received radiotherapy alone, while 5-year overall survival rates remained similar between the two groups. Patients with T1b tumors had lower survival rates and higher rates of laryngectomy than those with T1a tumors.

METHODOLOGY:

• Radiotherapy is the standard treatment for T1 glottic squamous cell carcinomas, but microlaryngeal surgery has emerged as an alternative, prompting researchers to assess their comparative effectiveness.
• This retrospective observational study included data of 777 patients (12% women; median age, 69 years) with T1a (n = 652) and T1b glottic squamous cell carcinomas (n = 125) from the Swedish Head and Neck Cancer Register, who were treated between 2008 and 2019.
• Overall, 367 patients (47.2%) underwent microlaryngeal surgery alone, 382 (49.2%) received radiotherapy as a single-modality treatment, while 28 (3.6%) received both treatments.
• Study outcomes were 5-year overall survival and risk for recurrence (defined as reappearance more than 6 months after diagnosis) or laryngectomy.

TAKEAWAY:

• Overall survival at 5 years was higher in patients with T1a tumors than in those with T1b tumors (78.5% vs 66.2%; P = .005).
• Compared with radiotherapy alone, microlaryngeal surgery alone showed no significant difference in 5-year overall survival among patients with T1a (79.8% vs 77.5%; P = .53) and T1b (63.8% vs 65.9%; P = .610) tumors. The 5-year survival rate was 72.7% in patients who received both surgery and radiotherapy (all T1a), which was not significantly different from what was seen for those who received radiotherapy alone.
• Most recurrences (80% for T1a and 91% for T1b; 90.5% local) occurred within 3 years, with median times to recurrence of 17.9 months (T1a) and 15 months (T1b).
• At 3 years, recurrence rates were significantly higher after surgery alone than radiotherapy alone — 19.0% vs 6.4% for T1a tumors, and 56% vs 10% for T1b tumors (P < .001 for both comparisons).
• The 3-year cumulative incidence of laryngectomy was significantly higher in the T1b vs T1a group (P = .01). Laryngectomy occurred in 5.0% and 5.2% of patients with T1a tumors after surgery alone and radiotherapy alone, respectively, compared with 16.0% and 10.6% among patients with T1b tumors.

IN PRACTICE:

“The results indicated a significant difference in 5‐year overall survival in favor of T1a vs T1b tumors and that microlaryngeal surgery should be used with caution in patients who have T1b cancer,” the authors wrote.

SOURCE:

The study was led by Hedda Haugen Cange, MD, PhD, Sahlgrenska University Hospital, Goteborg, Sweden. It was published online on June 26, 2025, in Cancer.

LIMITATIONS:

The study was limited by its retrospective, observational design. Data were missing on factors like voice quality, quality of life, and comorbidities, which limited comprehensive assessment. Additionally, the small sample size for T1b tumors reduced the study’s statistical power.

DISCLOSURES:

The study was funded by Laryngfonden. One author reported serving on a Merck Sharp and Dohme End Point Review Committee outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.