Related Experiment Video
Updated: Sep 10, 2026
Lateral Molar Approach-Driven Transoral Endoscopic Procedure for Benign Infratemporal Fossa Tumor Resection
Published on: August 15, 2025
Chemoradiotherapy versus transoral laser microsurgery for early T-stage (cT1-T2) hypopharyngeal cancer: A prospective
Ciou Nan Ye1, Chuan Hung Sun2, Yuan Jhen Hsu2
1Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; Department of Otolaryngology, Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Background:
Early T-stage (cT1-T2) hypopharyngeal squamous cell carcinoma (HSCC) presents a therapeutic challenge in balancing oncological control with functional preservation.
Objectives:
To compare the oncological and functional outcomes between transoral laser microsurgery (TLM)-based treatment pathway and definitive radiation-based (radiotherapy with or without concurrent chemotherapy, RT/CCRT) treatment pathway for early T-stage HSCC.
Design, Setting, And Participants:
This prospective randomized pilot study was conducted at a tertiary care hospital from 2016 to 2021. Seventeen treatment-naïve patients with cT1-T2 HSCC were included.
Interventions:
Participants were randomized to undergo either TLM-based pathway (n = 9) or definitive RT/CCRT (n = 8).
Primary Outcomes:
The primary endpoint was the functional laryngeal preservation rate at last follow-up (minimum follow-up: 1 year).
Key Results:
In the TLM group, 55.6% (5/9) of patients required adjuvant CCRT due to adverse pathological features. The 1-year functional laryngeal preservation rate was significantly higher in the RT/CCRT group than in the TLM group (100% vs. 44.4%; Cramer's V = 0.61; 95% CI, 0.39-0.88; P = 0.029). Regarding voice quality, RT/CCRT demonstrated favorable outcomes with lower jitter (0.76% vs. 1.68%; effect size, 0.49; 95% CI, -0.02 to 0.76; P = 0.046). A potential trend favoring the RT/CCRT group was observed for disease-free survival (Hazard Ratio, 0.26; 95% CI, 0.03-2.30; P = 0.189).
Harms:
No grade 4 or higher treatment-related adverse events (CTCAE v5.0) were reported in either arm. However, a potential trend toward a higher incidence of hypopharyngeal fibrosis with narrowing was observed in the TLM group (Cramer's V = 0.52; P = 0.082).
Conclusion:
For early T-stage (cT1-T2) HSCC, definitive RT/CCRT suggested potential functional advantages in laryngeal preservation and acoustic quality over a TLM-based pathway, likely by avoiding the cumulative morbidity of trimodality therapy in pathologically node-positive or high-risk disease. While oncological control appeared comparable, these findings remain hypothesis-generating given the limited pilot cohort, warranting validation in larger multicenter trials.
Trial Registration:
Not prospectively registered (Pilot trial approved by IRB of Taichung Tzu Chi Hospital, REC105-07).
