This practice guideline was developed by the Head and Neck Cancer dsg
using the methods of the practice guidelines development cycle3
. This practice guideline is intended to promote evidence-based practice in Ontario, Canada. The pebc
is editorially independent of Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.
In patients with early (T1) glottic cancer, what is the role of endolaryngeal surgery (with or without laser) compared with radiation therapy, in terms of survival, locoregional control, laryngeal preservation rates, and voice outcomes?
2.2. Target Population
The target population of this guideline is adult patients with previously untreated early (T1) glottic cancers.
2.3. Intended Users
This guideline is intended for use by clinicians and health care providers involved in the management or referral of adult patients with early (T1) glottic cancer.
2.4. Systematic Review
For this project, the core methodology used to develop the evidentiary base was the systematic review. The medline (ovid: 1996 through December, Week 4, 2010), Ovid medline In-Process and Other Non-Indexed Citations (January 10, 2011), embase (ovid: 1996 through January, Week 1, 2011), and Cochrane Library (ovid: 4th Quarter 2010) databases were searched for relevant studies. In addition, proceedings of the meetings of the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and the Canadian Association of Radiation Oncology were all searched for relevant abstracts for the years 2007 to 2010 (the most recently available). Reference lists of studies deemed eligible for inclusion in the systematic review were scanned for additional citations.
Evidence was selected and reviewed by two members of the pebc Head and Neck Cancer dsg and by one methodologist. The body of evidence in this review is composed primarily of retrospective comparative and cross-sectional studies. That evidence forms the basis of the recommendation developed by the Head and Neck Cancer dsg.
2.5. Development of Recommendations
The Head and Neck Cancer dsg reviewed the evidence identified in the literature. Draft recommendations were developed based on that evidence and on the expert opinion of the Head and Neck Cancer dsg.
2.6. Internal Review
Before submission of the draft report for external review, the report was reviewed and approved by the pebc Report Approval Panel, a panel that includes oncologists and whose members have clinical and methodologic expertise.
2.7. External Review
During the guideline development process, 6 targeted peer reviewers from Ontario and Alberta who are considered to be clinical or methodologic experts on the topic were identified by the working group. Several weeks before completion of the draft report, the nominees were contacted by e-mail and asked to serve as reviewers. Three nominees agreed, and the draft report and a questionnaire were sent by e-mail for their review. The questionnaire consisted of items evaluating the methods, results, and interpretive summary used to inform the draft recommendations and whether the draft recommendations should be approved as a guideline.
Feedback was also obtained through a brief online survey of health care professionals who are the intended users of the guideline. All head-and-neck cancer professionals from Ontario in the pebc database were contacted by e-mail to inform them of the survey. Participants were asked to rate the overall quality of the guideline and to state whether they would use or recommend it. Written comments were invited.