Risk of dysfunctional larynx after radiotherapy for early-stage glottic laryngeal cancer: A systematic review and meta-analysis

Radiotherapy is a common treatment for early-stage glottic cancer, with recent advances exploring smaller target volumes and (ultra-)hypofractionation. While (ultra-)hypofractionation offers potential advantages in treatment efficiency, concerns remain regarding increased late laryngeal toxicity. This systematic review and meta-analysis assessed the incidence of dysfunctional larynx −defined as the need for tracheostomy or laryngectomy without local recurrence- after radiotherapy for early-stage glottic cancer. This review was conducted following PRISMA guidelines. A comprehensive literature search was conducted up to September 2025. Studies were eligible if they included: (1) patients diagnosed with early-stage glottic carcinoma (cTis-cT2), (2) patients treated with definitive radiotherapy. Exclusion criteria were: (1) concurrent therapies (e.g. chemotherapy), (2) stage 3 or 4 laryngeal carcinoma, (3) unknown late severe toxicity (laryngectomy or tracheostomy), (4) palliative radiotherapy, (5) case reports and (6) not published in English. A total of 49 studies were included. The pooled analysis of all included studies, comprising 7033 patients, found a low overall incidence of 0.3 % for dysfunctional larynx. The risk of dysfunctional larynx remained low (<1%) for studies that used moderate to (ultra-)hypofractionation. These findings support the safety of contemporary radiotherapy approaches for preserving laryngeal function in this patient population.