Outcomes of Different Treatment Options for Early-stage Laryngeal Cancer: A Systematic Review and Meta-analysis

Abstract Radiotherapy (RT) and laser surgery (LS) are commonly used treatment modalities for early-stage (T1–T2) laryngeal squamous cell carcinoma. This study aimed to compare these approaches with respect to oncologic outcomes and functional considerations. Random-effects meta-analyses were performed on comparative studies evaluating primary RT versus LS. Outcomes assessed included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), recurrence, local control, and laryngeal preservation. Heterogeneity was evaluated using I² and τ² statistics, and publication bias was assessed using Egger’s test and funnel plots. Sensitivity analysis excluded studies prior to 2000, and subgroup analyses explored differences based on tumor stage, treatment era, and LS technique. The results demonstrated comparable survival outcomes (OS, DSS, and DFS) between RT and LS. Laryngeal preservation and local control were also similar overall, although some variability was observed depending on surgical technique and treatment era. Initially higher recurrence rates associated with LS diminished after excluding older studies, suggesting potential era- related effects. Functional outcomes varied, with perceptual and acoustic measures often favoring LS, while patient-reported outcomes were inconsistent, including one randomized trial favoring RT. In conclusion, RT and LS are comparable first-line treatment options for early-stage laryngeal cancer, providing similar survival and laryngeal preservation outcomes at approximately five years. Treatment decisions should be individualized based on tumor characteristics, surgical technique, and patient preferences regarding voice outcomes.