Efficacy of laser surgery versus radiotherapy for treatment of glottic carcinoma: a systematic review and meta-analysis

  • Yongxia Ding
  • Binquan WangEmail author
Original Article


Laser surgery and radiotherapy are the two most common ways to treat glottic carcinomas, which is more efficacious and remains controversial. PubMed, Embase, and Cochrane Library were searched to identify relevant studies of laser surgery versus radiotherapy in patients with glottic carcinomas through April 2017. Sensitivity analysis and subgroup analysis were performed to evaluate heterogeneity. Eighteen studies were selected, which included 2480 patients. Patients who had laser surgery had higher rates of laryngeal preservation (OR 3.852; 95% CI 1.922–7.721) and overall survival (OR 1.388; 95% CI 1.063–1.811) versus who had radiotherapy. No significant differences were observed between laser surgery and radiotherapy on local control (OR 1.186; 95% CI 0.759–1.854), recurrence (OR 0.758; 95% CI 0.445–1.289), or disease-specific survival (OR 1.597; 95% CI 0.887–2.876). There were clinical benefits for patients with glottic carcinoma after laser surgery compared with radiotherapy with respect to survival and laryngeal preservation.


Glottic carcinoma Laryngeal preservation Laser surgery Meta-analysis Radiotherapy Recurrence Systematic review 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Not applicable.

Supplementary material

10103_2018_2695_Fig6_ESM.png (275 kb)
Supplementary Fig. 1

Effect of laser surgery on recurrence compared to radiotherapy. (PNG 275 kb)

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High-resolution image (TIF 240 kb)
10103_2018_2695_Fig7_ESM.png (825 kb)
Supplementary Fig. 2

Sensitivity analysis of the meta-analysis. a Overall survival, b disease-specific survival, c laryngeal preservation, d local control, and e recurrence. (PNG 825 kb)

10103_2018_2695_MOESM2_ESM.tif (828 kb)
High-resolution image (TIF 827 kb)
10103_2018_2695_Fig8_ESM.png (391 kb)
Supplementary Fig. 3

Funnel plots of the meta-analysis. a Overall survival, b disease-specific survival, c laryngeal preservation, d local control, and e recurrence. (PNG 391 kb)

10103_2018_2695_MOESM3_ESM.tif (387 kb)
High-resolution image (TIF 386 kb)


  1. 1.
    Schultz P (2011) Vocal fold cancer. Eur Ann Otorhinolaryngol Head Neck Dis 128(6):301–308. CrossRefPubMedGoogle Scholar
  2. 2.
    Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67(1):7–30. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Marioni G, Marchese-Ragona R, Cartei G, Marchese F, Staffieri A (2006) Current opinion in diagnosis and treatment of laryngeal carcinoma. Cancer Treat Rev 32(7):504–515. CrossRefPubMedGoogle Scholar
  4. 4.
    Chu EA, Kim YJ (2008) Laryngeal cancer: diagnosis and preoperative work-up. Otolaryngol Clin N Am 41(4):673–695. CrossRefGoogle Scholar
  5. 5.
    Ambrosch P (2007) The role of laser microsurgery in the treatment of laryngeal cancer. Current Opinion in Otolaryngology & Head and Neck Surgery 15(2):82–88. CrossRefGoogle Scholar
  6. 6.
    Warner L, Chudasama J, Kelly CG, Loughran S, McKenzie K, Wight R, Dey P (2014) Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. The Cochrane Database of Systematic Reviews (12):Cd002027.
  7. 7.
    Sjogren EV, van Rossum MA, Langeveld TP, Voerman MS, van de Kamp VA, Friebel MO, Wolterbeek R, Baatenburg de Jong RJ (2008) Voice outcome in T1a midcord glottic carcinoma: laser surgery vs radiotherapy. Arch Otolaryngol Head Neck Surg. 134(9):965–972. CrossRefPubMedGoogle Scholar
  8. 8.
    Eckel HE (2001) Local recurrences following transoral laser surgery for early glottic carcinoma: frequency, management, and outcome. Ann. Otol Rhino Laryngol 110(1):7–15. CrossRefGoogle Scholar
  9. 9.
    Huang G, Luo M, Zhang J, Liu H (2017) Laser surgery versus radiotherapy for T1a glottic carcinoma: a meta-analysis of oncologic outcomes. Acta Otolaryngol 137(11):1204–1209. CrossRefPubMedGoogle Scholar
  10. 10.
    Huang G, Luo M, Zhang J, Liu H (2017) The voice quality after laser surgery versus radiotherapy of T1a glottic carcinoma: systematic review and meta-analysis. Onco Targets Ther 10:2403–2410.
  11. 11.
    Mo HL, Li J, Yang X, Zhang F, Xiong JW, Yang ZL, Tan J, Li B (2017) Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and meta-analysis. Lasers Med Sci 32(2):461–467. CrossRefPubMedGoogle Scholar
  12. 12.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Cochrane handbook for systematic reviews of interventions (2011). John Wiley & SonsGoogle Scholar
  15. 15.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical Research Ed) 327(7414):557–560. CrossRefGoogle Scholar
  16. 16.
    Ades AE, Lu G, Higgins JP (2005) The interpretation of random-effects meta-analysis in decision models. Medical Decision Making: an International Journal of the Society for Medical Decision Making 25(6):646–654. CrossRefGoogle Scholar
  17. 17.
    Tobias A (1999) Assessing the influence of a single study in the meta-analysis estimate. Stata Tech Bull 8(47)Google Scholar
  18. 18.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Research Ed) 315(7109):629–634CrossRefGoogle Scholar
  19. 19.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Epstein BE, Lee DJ, Kashima H, Johns ME (1990) Stage T1 glottic carcinoma: results of radiation therapy or laser excision. Radiology 175(2):567–570. CrossRefPubMedGoogle Scholar
  21. 21.
    Goor KM, Peeters AJ, Mahieu HF, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM, van Agthoven M (2007) Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas: costs, local control, survival, quality of life, and voice quality. Head & Neck 29(2):128–136. CrossRefGoogle Scholar
  22. 22.
    Kerr P, Mark Taylor S, Rigby M, Myers C, Osborn H, Lambert P, Sutherland D, Fung K (2012) Oncologic and voice outcomes after treatment of early glottic cancer: transoral laser microsurgery versus radiotherapy. J Otolaryngol Head Neck Surg 41(6):381–388Google Scholar
  23. 23.
    Kono T, Saito K, Yabe H, Uno K, Ogawa K (2016) Comparative multidimensional assessment of laryngeal function and quality of life after radiotherapy and laser surgery for early glottic cancer. Head Neck 38(7):1085–1090. CrossRefPubMedGoogle Scholar
  24. 24.
    Krengli M, Policarpo M, Manfredda I, Aluffi P, Gambaro G, Panella M, Pia F (2004) Voice quality after treatment for T1a glottic carcinoma—radiotherapy versus laser cordectomy. Acta oncologica (Stockholm, Sweden) 43(3):284–289CrossRefGoogle Scholar
  25. 25.
    Kujath M, Kerr P, Myers C, Bammeke F, Lambert P, Cooke A, Sutherland D (2011) Functional outcomes and laryngectomy-free survival after transoral CO(2) laser microsurgery for stage 1 and 2 glottic carcinoma. J Otolaryngol Head Neck Surg 40(Suppl 1):S49–S58Google Scholar
  26. 26.
    Low TH, Yeh D, Zhang T, Araslanova R, Hammond JA, Palma D, Read N, Venkatesan V, MacNeil SD, Yoo J, Nichols A, Fung K (2017) Evaluating organ preservation outcome as treatment endpoint for T1aN0 glottic cancer. Laryngoscope 127(6):1322–1327. CrossRefPubMedGoogle Scholar
  27. 27.
    Mahler V, Boysen M, Brondbo K (2010) Radiotherapy or CO(2) laser surgery as treatment of T(1a) glottic carcinoma? European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology—Head and Neck Surgery 267(5):743–750. CrossRefGoogle Scholar
  28. 28.
    Remmelts AJ, Hoebers FJ, Klop WM, Balm AJ, Hamming-Vrieze O, van den Brekel MW (2013) Evaluation of lasersurgery and radiotherapy as treatment modalities in early stage laryngeal carcinoma: tumour outcome and quality of voice. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology—Head and Neck Surgery 270(7):2079–2087. CrossRefGoogle Scholar
  29. 29.
    Rosier JF, Gregoire V, Counoy H, Octave-Prignot M, Rombaut P, Scalliet P, Vanderlinden F, Hamoir M (1998) Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation. Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology 48(2):175–183CrossRefGoogle Scholar
  30. 30.
    Schrijvers ML, van Riel EL, Langendijk JA, Dikkers FG, Schuuring E, van der Wal JE, van der Laan BF (2009) Higher laryngeal preservation rate after CO2 laser surgery compared with radiotherapy in T1a glottic laryngeal carcinoma. Head & Neck 31(6):759–764. CrossRefGoogle Scholar
  31. 31.
    Sjogren EV, Langeveld TP, Baatenburg de Jong RJ (2008) Clinical outcome of T1 glottic carcinoma since the introduction of endoscopic CO2 laser surgery as treatment option. Head & Neck 30(9):1167–1174. CrossRefGoogle Scholar
  32. 32.
    Spector JG, Sessions DG, Chao KS, Haughey BH, Hanson JM, Simpson JR, Perez CA (1999) Stage I (T1 N0 M0) squamous cell carcinoma of the laryngeal glottis: therapeutic results and voice preservation. Head & Neck 21(8):707–717CrossRefGoogle Scholar
  33. 33.
    Stoeckli SJ, Schnieper I, Huguenin P, Schmid S (2003) Early glottic carcinoma: treatment according patient’s preference? Head & Neck 25(12):1051–1056. CrossRefGoogle Scholar
  34. 34.
    Taylor SM, Kerr P, Fung K, Aneeshkumar MK, Wilke D, Jiang Y, Scott J, Phillips J, Hart RD, Trites JR, Rigby MH (2013) Treatment of T1b glottic SCC: laser vs. radiation—a Canadian multicenter study. Journal of Otolaryngology—Head & Neck Surgery = Le Journal D’oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale 42(22).
  35. 35.
    van Gogh CD, Verdonck-de Leeuw IM, Wedler-Peeters J, Langendijk JA, Mahieu HF (2012) Prospective evaluation of voice outcome during the first two years in male patients treated by radiotherapy or laser surgery for T1a glottic carcinoma. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology—Head and Neck Surgery 269(6):1647–1652. CrossRefGoogle Scholar
  36. 36.
    Thurnher D, Erovic BM, Frommlet F, Brannath W, Ehrenberger K, Jansen B, Selzer E, Grasl MC (2008) Challenging a dogma—surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy. European Journal of Surgical Oncology: the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 34(6):692–698. CrossRefGoogle Scholar
  37. 37.
    Milovanovic J, Djukic V, Milovanovic A, Jotic A, Banko B, Jesic S, Babic B, Trivic A, Artiko V, Petrovic M, Stankovic P (2013) Clinical outcome of early glottic carcinoma in Serbia. Auris Nasus Larynx 40(4):394–399. CrossRefPubMedGoogle Scholar
  38. 38.
    Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463CrossRefGoogle Scholar
  39. 39.
    Abdurehim Y, Hua Z, Yasin Y, Xukurhan A, Imam I, Yuqin F (2012) Transoral laser surgery versus radiotherapy: systematic review and meta-analysis for treatment options of T1a glottic cancer. Head & Neck 34(1):23–33. CrossRefGoogle Scholar
  40. 40.
    Feng Y, Wang B, Wen S (2011) Laser surgery versus radiotherapy for T1-T2N0 glottic cancer: a meta-analysis. ORL; Journal for Oto-Rhino-Laryngology and Its Related Specialties 73(6):336–342. CrossRefPubMedGoogle Scholar
  41. 41.
    Jellema AP, Slotman BJ, Doornaert P, Leemans CR, Langendijk JA (2007) Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys 69(3):751–760. CrossRefPubMedGoogle Scholar
  42. 42.
    Lee M, Buchanan MA, Riffat F, Palme CE (2016) Complications after CO2 laser surgery for early glottic cancer: an institutional experience. Head Neck 38(Suppl 1):E987–E990. CrossRefPubMedGoogle Scholar
  43. 43.
    Jamal N, Sofer E, Chhetri DK (2014) Treatment consideration for early glottic carcinoma: lessons learned and a primer for the general otolaryngologist. Otolaryngol Head Neck Surg 150(2):169–173. CrossRefPubMedGoogle Scholar
  44. 44.
    Vilaseca-Gonzalez I, Bernal-Sprekelsen M, Blanch-Alejandro JL, Moragas-Lluis M (2003) Complications in transoral CO2 laser surgery for carcinoma of the larynx and hypopharynx. Head Neck 25(5):382–388. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nursing College of Shanxi Medical UniversityTaiyuanPeople’s Republic of China
  2. 2.Shanxi Key Laboratory of Otolaryngology, Head and Neck CancerTaiyuanPeople’s Republic of China
  3. 3.Department of Otolaryngology, Head and Neck Surgery, The First HospitalShanxi Medical UniversityTaiyuanPeople’s Republic of China

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