Challenging a dogma e Surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy D. Thurnher a , B.M. Erovic a , F. Frommlet b , W. Brannath b , K. Ehrenberger a , B. Jansen c , E. Selzer d , M.C. Grasl a, * a Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria b Department of Medical Statistics, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria c Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria d Department of Radiotherapy and Radiobiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria Accepted 20 June 2007 Available online 8 August 2007 Abstract Aims: The aim of this study was to compare laser surgery, conventional endoscopic surgery and radiotherapy in the treatment of early T1a glottic cancer. Methods: We conducted a retrospective analysis of patients with early vocal cord cancer (who underwent either conventional surgery via endoscopy or laryngofissur, or primary radiotherapy) at the Medical University of Vienna. By univariate and multivariate Cox regression models the influence of treatment and other parameters on survival and locoregional control were analysed. Results: 337 Patients were analyzed with a mean follow-up period of 133.8 months. Overall survival rates where similar in all three treat- ment groups. Five-year, 10-year and 15-year estimates of disease specific survival for laser-treated patients were 100%, for conventional surgery were 100%, 98% and 98%, and for radiotherapy were 96%, 92% and 91%, respectively. Locoregional recurrences were observed after laser surgery in 10%, after conventional surgery in 13% and after radiotherapy in 30% of the patients treated. According to the log- rank test, time to relapse was significantly shorter for irradiated patients compared to patients who underwent surgery ( p < 0.0001). Mortality caused by the laryngeal tumour was significantly higher in the radiotherapy group ( p ¼ 0.003). Conclusion: Patients undergoing laser or conventional surgery have a significantly lower incidence of locoregional recurrences and longer disease-free intervals when compared to patients treated by radiotherapy. Ó 2007 Elsevier Ltd. All rights reserved. Keywords: Early glottic cancer; Endolaryngeal laser surgery; Radiotherapy Introduction It is generally assumed e and has almost become a dogma e that early glottic cancer can be successfully treated with equivalent efficiency by either microendoscopic laser excision or conventional surgery, or by radiotherapy. Based on this premise, advantages or disadvantages of differing treatment modalities were solely discussed with respect to differences regarding aspects such as quality of life (e.g. voice preservation). Whereas primary surgery is the preferred procedure in most European countries, radiother- apy is more widely used in Northern Europe and in the United States. Apart from institutional preferences, choice of initial treatment is often made on the basis of arguments related to the patient’s age, patients/physicians preferences, or the presumed likelihood of the occurrence of functional impairments. Since treatment results between radiotherapy and surgery are reported to be very similar, the choice of op- timal treatment for early stage carcinoma of the larynx is the subject of controversy in the otolaryngologic literature. 1e6 Some clinicians favouring radiotherapy base their arguments on the promise that radiotherapy assures an excellent voice conservation. 7e10 Other authors claim that voice quality ob- tained after laser excision is comparable to that obtained * Corresponding author. Tel.: þ43 1 40400 3349; fax: þ43 1 40400 3355. E-mail address: matthaeus.grasl@meduniwien.ac.at (M.C. Grasl). 0748-7983/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2007.06.008 Available online at www.sciencedirect.com EJSO 34 (2008) 692e698 www.ejso.com