transoral laser surgery (TLM) versus radiotherapy (RT) in early glottic carcinoma

Summary Background Laryngeal carcinoma is one of the most common cancers of the upper aerodigestive tract, with a strong link to smoking and alcohol consumption. Most cases are diagnosed at an early stage (T1–T2), especially in the glottis, where symptoms like hoarseness allow early detection. Early-stage tumors have a high probability of cure (80–90%), and treatment aims to: • Achieve oncological control • Preserve laryngeal function (voice, swallowing, breathing) Treatment Options The main treatments for early glottic cancer are: • Transoral Laser Microsurgery (TLM) • Radiotherapy (RT) Both have similar survival rates (around 87–98%), so the choice depends on: • Voice quality after treatment • Treatment duration • Cost • Patient condition and preference ➤ Advantages of TLM • Minimally invasive • No tracheostomy required • Low bleeding • Faster recovery • Short hospital stay • Lower costs • إمكانية re-treatment in case of incomplete margins ➤ Limitations of RT • Long treatment duration (6–7 weeks) • Side effects (e.g., mucosal damage, xerostomia) • Less flexibility for retreatment Study Design • Retrospective study • 20 patients with early glottic carcinoma o 10 treated with TLM o 10 treated with RT Outcomes evaluated: • Overall Survival (OS) • Disease-Free Survival (DFS) • Functional outcomes (voice, swallowing) • Patient subjective perception Results • TLM group: o OS: 88% o DFS: 90% • RT group: o OS: 78% o DFS: 71% Differences were not statistically significant Functional outcomes: • Moderate dysphonia in both groups • No swallowing disorders reported • Older patients (>70) perceived less voice-related disability • Younger patients reported more impact on quality of life Discussion Both treatments provide: • High oncological control • Comparable functional results TLM offers practical advantages (cost, recovery, repeatability), while RT remains a valid non-surgical option. The study highlights the importance of patient-centered evaluation, especially subjective perception of voice quality. Conclusion • TLM and RT are equally effective for early glottic carcinoma • No significant differences in survival or functional outcomes • Treatment choice should be individualized, considering: o Patient preference o Functional expectations o Clinical conditions o Economic factors