Transoral surgery vs intensity-modulated radiotherapy for early supraglottic cancer: a systematic review

Purpose of review To provide clinicians with a critical review of outcomes for endolaryngeal surgery and intensity-modulated radiation therapy (IMRT) for early-stage supraglottic cancer. Recent findings A total of 971 potential articles were reviewed, with inclusion of 14 studies comparing IMRT with transoral surgery. One study analyzed IMRT, one transoral robotic surgery, and the remaining were transoral laser microsurgery studies. A weighted average and 95% confidence interval of all surgery patients showed a local control of 90.36 +/- 1.14% (n = 118) for T1 lesions, 83.09 +/- 1.36% (n = 232) for T2 lesions, and 86.38 +/- 0.82% (n = 429) overall. The one study examining IMRT outcomes reported a local control of 70 +/- 10.07% and overall survival of 63% over 5 years for T2 lesions (n = 78), with no reported T1 data or secondary outcomes. Summary Endolaryngeal surgery as definitive therapy for T1 and T2 supraglottic cancer has excellent local control. Although endolaryngeal surgery performed better than IMRT, the data are limited, and a definitive comparison with surgery cannot be made. Additional studies are required.