Radiotherapy or surgical treatment of early glottic carcinoma: A population-based study from the Swedish Head and Neck Cancer Register evaluating primary treatment outcomes for patients with T1a/T1b tumors

Background

Radiotherapy (RT) has been the treatment of choice for T1 glottic squamous cell carcinomas with curative intent; however, transoral microsurgery (MLS) has gradually taken its place. The objective of this study was to compare the outcomes of the two treatment modalities.

Methods

The Swedish Head and Neck Cancer Register contains records for 783 patients who had T1 glottic squamous cell carcinomas and planned to undergo either RT or MLS with curative intent from 2008 until 2019. These included 652 patients with T1a tumors and 125 patients with T1b tumors, resulting in 777 eligible patients.

Results

Surgical treatment led to an increased risk of recurrence compared with RT for patients who had both T1a and T1b tumors (p < .001). Forty-seven patients (6.0%) underwent laryngectomy after primary treatment. Patients with T1b tumors had a higher risk of undergoing laryngectomy (p = .01), but no significant difference in the frequency of laryngectomy was noted between the treatment modalities. Patients who had T1b tumors had a significantly worse 5-year overall survival rate compared with those who had T1a tumors, but treatment modality did not influence the overall survival rate.

Conclusions

In this population-based study of 777 patients with T1 glottic squamous cell carcinomas, no significant difference in overall survival was observed at 5 years based on treatment modality (MLS or RT). Overall survival was worse for patients with T1b carcinomas, and these patients were at an elevated risk of requiring laryngectomy. An increased risk of recurrence within 3 years was observed after surgical treatment for both T1a and T1b tumors.