***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Carcinoma of the larynx is the most common cancer affecting the head and neck region . In Northern Europe , early laryngeal cancer is almost universally treated by irradiation , but elsewhere it is treated by surgery . The main aim of this study was to determine whether there was any difference in survival between the two main therapeutic options . The secondary aim was to assess speech and voice quality in a small , r and omized sample of patients from each treatment group Cancer of the larynx is the most prevalent non-cutaneous malignancy of the head neck region and its treatment presents a threat to both natural speech and survival . This study examines the manner in which two separate specialties in the same and different geographic regions vary in their opinions about the treatment of  glottic laryngeal cancer .  The goal was to define options available to patients and to classify controversies about optimal treatment which might be resolved in clinical trials . Question naires depicting different presentations of glottic larynx cancer were mailed to 1649 otolaryngologists and radiation oncologists in North America , Europe and Australasia . Half the doctors were asked to describe their preferred treatment for a patient while the others were asked to imagine that they themselves were the patient . In all the disease situations opinions varied significantly with respect to the treatment modality advised ( whether to employ surgical or radiotherapy approaches ) and in more extensive disease situations the intention of treatment also varied depending on whether a curative approach should involve conservation or loss of the larynx . Doctors also recommended similar treatment for their patients as they would for themselves . Apart from disease extent the most significant variables influencing recommendations were the physicians ' specialty ( P = 0.0001 ) and where they practice ( P = 0.0001 ) . These findings demonstrate diversity of opinion which is influenced more profoundly by the traditions of the specialties and geographic location of practice than by the reported results of treatments for laryngeal cancer . Convictions about optimal management have become barriers to the assessment of the relative value of different treatments and to ensuring that patients are fully informed about management options . The profession should regard as a high priority efforts to resolve these therapeutic conflicts which are associated with major differences in quality of life Both radiotherapy and laser surgery give excellent results in the treatment of T1a glottic carcinoma . In this study , we compared the outcome of these treatment options . Demographic details and continuous follow-up with exact cause of death have been recorded prospect ively for 351 patients with T1a glottic carcinoma at a tertiary referral centre in two consecutive decennia 1986–2005 . Patients were treated with radiotherapy ( 163 patients ) until 1996 when laser surgery was adopted as primary treatment ( 188 patients ) . The minimum follow-up time was 29 months . Neither the estimated 5-year disease-free survival , the disease-specific survival nor the crude survival differ between the two treatment options . The incidence of mainly local recurrences was equal during the first 3 years , followed by an increase in number of recurrences in the laser-operated patients . The odds ratio for a laryngectomy was 13.5 in patients treated with radiotherapy ( P = 0.002 ) , but mortality due to recurrence did not differ between the groups . The incidence of second primaries was equal ( 11 % ) but death due to second primaries differed significantly , favouring laser-treated patients ( P = 0.003 ) . In conclusion , the relative risk for a laryngectomy when a tumour recurs is 12.7 times higher in patients primarily treated with irradiation for T1a laryngeal carcinoma , compared with patients treated with laser surgery . Regarding the treatment costs , treatment impact on patients and organ preservation , we consider laser therapy to be the better treatment option for patients with T1a glottic cancer as no difference in survival could be observed OBJECTIVE To compare the functional and oncologic outcomes of transoral CO₂ laser microsurgery relative to radiotherapy for early-stage glottic carcinoma . DESIGN Functional analysis : population -based , prospect i ve , nonr and omized consecutive series of stage 1 and 2 glottic carcinoma treated with laser surgery ( n = 54 ) or radiotherapy ( n = 25 ) . Oncologic analysis : population -based , historical cohort comparing laser surgery ( n = 54 ) and radiotherapy ( n = 76 ) . SETTING Academic cancer centre . METHODS AND OUTCOME MEASURES Functional results were prospect ively collected prior to treatment and at 3 , 6 , 12 , and 24 months following treatment using vali date d performance scales assessing general level of function , speech , and swallowing . Oncologic results were collected from a larger cohort from the cancer registry of CancerCare MB . RESULTS Laser surgery result ed in a voice that was less likely to be understood all the time ( Performance Status Scale for Head and Neck Cancer Patients : underst and ability score < 100 ; OR = 12.2 ; p = .03 ) and a higher likelihood of having a Voice H and icap Index ( VHI-10 ) score of 10 or more ( OR = 16.2 ; p = .001 ) . Five-year laryngectomy-free survival rates for laser versus radiation were 87 versus 76 % ( p = .16 ) . Subset analysis revealed that stage 1 5-year laryngeal preservation rates  for laser ( n = 51 ) versus radiation ( n = 46 ) were 100 versus 86 % ( p = .02 ) . CONCLUSIONS There is a higher likelihood of hoarseness after laser surgery , but the severity of this h and icap is mild in most patients . Laser microsurgery results in excellent laryngeal preservation rates , which may exceed those of radiation In 1980 - 1987 , a cooperative r and omized study of 363 patients with stage III laryngeal cancer ( T1 - 3N0 - 1M0 ) was carried out . In 249 patients tumor was located in the vestibular space and in 114 in the vocal cord area ; 78.5 % of the patients had no regional metastases ( N0 ) and 21.5 % had metastases ( N1 ) .  Combined therapy was applied to 251 patients , 135 of which were first exposed to radiotherapy and then to surgery and 116 were first exposed to surgery and then radiotherapy .  In 71 patients , regional zones underwent preventive treatment ( in 24 patients elective radiotherapy and in 47 preventive removal of the cervical fat were used ) . In 112 patients , the therapeutic protocol was modified due to different reasons ( 69 patients underwent only surgery and 43 radical radiotherapy ) . The therapeutic results were assessed in terms of three parameters : incidence of relapses and regional metastases , relapse-free time , and survival . This approach revealed no significant differences in the efficacy of the different protocol s of the combined treatment . The 5-year survival rate of the patients with vestibular and cord space tumor  was 77.9 % and 80.7 % respectively , when treated according to the radiotherapy + surgery protocol , and 82.8 % and 89.2 % , respectively , when treated according to the surgery + radiotherapy protocol . Comparison of preventive approaches showed that the 5-year survival rate increased by 92 % as a result of removal of the subcutaneous fat from the neck area Background : Transoral laser assisted microsurgical resection of early glottic laryngeal cancer is a relatively new treatment modality that is practised in many centres across the UK . In the absence of the results from r and omised clinical trials , clinicians may be guided by an expert panel consensus statement on transoral laser assisted microsurgical resection of early squamous cell cancer of the larynx 
    Output:
    
RESULTS There is no evidence in favor of 1 treatment modality when considering likelihood of local control or overall survival .
There is a suggestion that RT may be associated with less measureable perturbation of voice as compared to surgery , but no significant differences were seen in patient perception .
The likelihood of laryngeal preservation may be higher when surgery can be offered as initial treatment .
For patients with early ( T1 ) glottic cancer , treatment options include the equally effective  endolaryngeal surgery , with or without laser , or radiation therapy .