Long-Term Laryngeal Function and Quality of Life Following Treatment of Early Glottic Cancer: A Meta-Analysis

To review the literature concerning long-term functional outcomes and quality of life (QoL) in patients undergoing transoral laser microsurgery (TLM) versus radiotherapy (RT) for early glottic cancer.

A systematic search was conducted across PubMed, Scopus, and Cochrane Library from inception until April 2024.

Articles considered were primary studies directly comparing the 2 treatment modalities in a population of T1 and T2 glottic cancer. Interest outcomes were patient report outcome measures (PROMs) of vocal function and QoL, clinician-reported measures, and acoustic analyses parameters.

There was no significant difference between TLM and RT in grade, roughness, breathiness, asthenia, strain (relative risk, 1.11; 95% confidence interval [CI], 0.60-2.07; I² = 90.96; P < .001), Voice Handicap Inventory-30 scores (standardized mean difference [SME] 0.51; 95% CI, -0.04-1.07; I² = 89.72; P < .001), or fundamental frequency (SME 0.56; 95% CI, -0.14-1.25; I² = 91.12; P < .001). The TLM group had significantly better performance with regards to jitter (SME 0.54; 95% CI, 0.08-1.00; I² = 79.42; P < .001) and shimmer (SME 0.53; 95% CI, 0.11-0.95; I² = 74.94; P < .001). The risk of bias was assessed to be serious.

The findings suggest comparable long-term PROMs between TLM and RT in the treatment of early glottic carcinoma, with TLM showing better acoustic analysis outcomes. However, the available evidence remains scarce, of high heterogeneity, and at risk of bias. A direct comparison between TLM and RT through large randomized controlled trials is needed to provide more substantial evidence to determine the optimum treatment.