Surgery Alone Treatment vs. Surgery with Adjuvant Therapy for Laryngeal Mucoepidermoid Cancer: A Systematic Review

Mucoepidermoid carcinoma (MEC) of the larynx is an extremely rare malignancy, accounting for less than 1% of primary laryngeal tumors. The optimal role of adjuvant therapy, particularly radiotherapy (RT), remains unclear due to limited evidence. This systematic review aimed to evaluate oncologic outcomes and the impact of adjuvant treatment in patients with early- and advanced-stage laryngeal MEC.

A systematic literature search was performed according to PRISMA 2020 guidelines in PubMed/Embase, Scopus, and Cochrane for studies published up to 31 July 2025.

Twenty-two studies, encompassing 55 patients, were included. Early-stage (T1-T2) patients (n = 28) treated with surgery alone achieved a 5-year local control of disease (LCD) of 85%-88% and disease-free survival (DFS) of 77%, whereas those receiving adjuvant RT showed 100% LCD and DFS, although differences were not statistically significant. In advanced-stage (T3-T4) patients (n = 27), adjuvant RT was associated with improved 2- and 5-year LCD reached 100% vs. 56% and 38% in surgery-only patients (OR 0.59; 95% CI, 0.34-0.83; p = 0.012). DFS at 5 years was 80% in the adjuvant group compared with 36% in surgery alone.

Surgical excision with negative margins remains the cornerstone of treatment for early-stage laryngeal MEC, with limited added benefit from adjuvant RT. In advanced-stage or high-grade disease, postoperative RT significantly improves LCD and may enhance DFS. Chemotherapy remains reserved for rare, high-risk cases.