Surgery versus radiation for T1 glottic carcinoma: Second primary considerations

Although early glottic carcinoma is managed with radiation therapy (RT) or surgery, there is limited data on differences in second primary cancers of the larynx. We utilized the Surveillance, Epidemiology, and End Results (SEER) database to query T1 glottic carcinomas and assess the incidence of second primary laryngeal malignancies. Cumulative hazard for second primary laryngeal malignancies was compared with the log-rank method. Among 844 surgical and 2,272 RT cases, observed-to-expected incidence ratios of laryngeal second primaries were 10.19 (5.89–16.55) and 6.87 (4.64–9.81) per 10 thousand person-years, respectively. Mean person-years at risk were comparable at 8.16 years (surgery) and 8.01 years (RT), and relative increased risk of laryngeal second primary was 20.95 (surgery) versus 14.09 (RT) per 10 thousand person-years. Mean times to development of a second primary were also comparable (304 vs. 305 months, P = 0.898). Thus, second laryngeal primary development is analogous between cases treated with surgery alone versus RT. Continued discussion and investigation of surgery versus RT for early glottic squamous cell carcinoma will need to leverage these findings, along with ongoing investigation of voice and survival outcomes, to develop more well-informed treatment algorithms. Laryngoscope, 129:2713–2715, 2019.