What is the treatment of choice for Tl squamous cell carcinoma of the larynx?

Editorial What is the treatment of choice for Tl squamous cell carcinoma of the larynx? The management of Tl laryngeal squamous cell carcinoma has a long and interesting history characterized by various phases and developments, and it remains a topic of widespread controversy in the world, largely because of the absence of a definitive prospective comparative analysis of treatment options. Cancer of the larynx is a relatively rare disease, but it is the commonest head and neck cancer, excluding skin cancer. 1 Traditionally, Tl squamous cell carcinoma of the larynx is treated with equal effectiveness by either conservative surgery or radiotherapy, as assessed by univariate and multivariate analysis. 2 The preferred treatment modality at present is highly dependent on geography, with radiation tending to be the treatment of choice in Canada, northern Europe, Australasia and South Africa, whereas surgery is more usually used in southern Europe and in many centres of the United States. Since the 1970s, CO 2 laser has been used to treat patients with T1A glottic carcinomas. 3 In the past two decades, several reports Indian and American colleagues have presented convincing evidence that endoscopic CO 2 laser surgery can be considered a valid alternative for Tl glottic and supraglottic squamous cell carcinomas. 4–20 The majority of patients neither require a tracheotomy nor the use of tube feeding. Conversely, as a result, open neck surgery for non-advanced laryngeal cancer has been recommended less. Clinicians generally used the term 'early' cancer in an arbitrary way, and we take this opportunity to clarify the terminology in order to avoid any misinterpretation. Ferlito et al. 21 considered 'early' laryngeal cancer to be confined to the lamina propria, but potentially to be capable of forming lymph node metastases when localized in the supraglottic area. The lesion does not invade muscle or cartilage. Therefore, 'early' cancer includes Tl lesions but excludes Tis, T2, T3 and T4 lesions. Microinvasive carcinoma and superficial extending carcinoma are subtypes of 'early' cancer. Early stages are not synonymous of 'early' cancer. To avoid an inadequate or overzealous approach to treatment and prognosis, a clinical diagnosis of 'early' invasive laryngeal cancer should be substantiated by careful microscopic pathological evaluation, which should exclude both carcinoma in situ and, particularly, deeply infiltrating carcinoma. 21 In recent years endoscopic surgery and radiotherapy have undergone significant technical improvements, however, complications may result if either treatment methods are used. 2,15 Some causes of …