Definite Concurrent Chemoradiotherapy or Transoral Laser Microsurgery: Which Is Better in Early Hypopharyngeal Cancer

Introduction: Concurrent chemoradiotherapy (CCRT) and transoral laser microsurgery (TLM) are both employed in the management of early T-stage hypopharyngeal cancer for laryngeal preservation. This prospective randomized controlled trial aims to compare the oncologic and functional outcomes between these two treatment modalities.

Methods: Patients diagnosed with cT1-T2, N0-N2 disease between 2016 and 2021 were randomly allocated to receive either TLM with or without adjuvant CCRT (TLM arm) or definite CCRT (CCRT arm). Oncological and functional outcomes were assessed post-treatment.

Results: The study enrolled 17 patients, with 9 assigned to the TLM arm and 8 to the CCRT arm. After a median follow-up period of 40.5 months, the CCRT arm exhibited superior functional laryngeal preservation rates, defined as the absence of a feeding tube, tracheostomy tube, and maintenance of intact laryngeal anatomical structures (44.4% for TLM vs. 100% for CCRT, p=0.029). Moreover, the CCRT arm demonstrated notably better voice outcomes, as indicated by reduced jitter (2.82% vs. 0.97%, p=0.046). There were no statistically significant differences in 5-year overall survival rates (66.7% vs. 87.5%, p=0.412), the incidence of total laryngectomy following recurrence (33.3% vs. 0%, p=0.206), and all scales of the quality of life questionnaires between the two groups. However, there was a trend towards a higher 5-year recurrence rate (35.2% vs. 0%, p=0.089) and prevalence of post-treatment hypopharyngeal narrowing (44.4% vs. 0%, p=0.082) in the TLM arm.

Conclusions: For patients with early-stage hypopharyngeal cancer, definite CCRT offers superior outcomes in functional laryngeal preservation and voice quality compared to TLM with or without adjuvant treatment, while maintaining similar survival rates and overall quality of life.