Risk factors for radiation failure in early-stage glottic carcinoma: A systematic review and meta-analysis
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Date
2016
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Abstract
Background Radiotherapy is one of the main treatment modalities for early-stage glottic carcinoma. Unfortunately, local failure may occur in a group of cases with T1-T2 glottic carcinoma. This meta-analysis sought to determine risk factors for radiation failure in patients with early-stage glottic carcinoma. Methods A systematic and comprehensive search was performed for related studies published between 1995 and 2014. The primary end-point was 5-year local control. Data extraction and analysis were performed using the software STATA/SE 13.1 for Windows. Results Twenty-seven studies were eligible. A higher risk of radiation failure was demonstrated in male patients [relative risk (RR): 0.927, p < 0.001] and those with low hemoglobin level (RR: 0.891, p < 0.001) with a high agreement between studies (I-squared = 0.0%). Moreover, T2 tumors (RR: 0.795, p < 0.001), tumors with anterior commissure involvement (RR: 0.904, p < 0.001), tobacco use during/after therapy (RR: 0.824, p < 0.001), and “bulky” tumors (RR: 1.270, p < 0.001] or tumors bigger in size (RR: 1.332, p < 0.001]. Poorly differentiated tumors had a questionable risk of local failure, although a moderate to high interstudy heterogeneity was determined. A statistically significant contribution was not detected for age, presence of comorbidity, alcohol use or subglottic extension. Conclusion This is the first meta-analysis which assessed the potential risk factors for radiation failure in patients with early-stage glottic carcinoma. Gender and pretreatment hemoglobin level are major influential factors associated with radiation failure in patients with early-stage glottic carcinoma. However, prospective, randomized clinical trials may permit better stratification of their relative contributions, and those who may benefit more from upfront surgery. © 2016
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Adult , Aged , Female , Glottis , Humans , Laryngeal Neoplasms , Male , Middle Aged , Risk Factors , hemoglobin , alcohol consumption , anterior commissure , Article , cancer radiotherapy , cancer size , cancer staging , comorbidity , early cancer , groups by age , hemoglobin blood level , human , larynx carcinoma , meta analysis , personalized medicine , priority journal , radiation injury , risk factor , sex difference , systematic review , tobacco use , treatment failure , tumor differentiation , tumor microenvironment , adult , aged , female , glottis , larynx tumor , male , middle aged , pathology