Change in Voice Quality after Radiotherapy for Early Glottic Cancer

Abstract

Our aim was to track the changes in voice quality for two years after radiotherapy (RT) for early glottic cancer. A videoendostroboscopy, subjective patient and phoniatrician voice assessments, a Voice Handicap Index questionnaire, and objective acoustic measurements (F0, jitter, shimmer, maximal phonation time) were performed on 50 patients with T1 glottic carcinomas at 3, 12, and 24 months post-RT. The results were compared between the subsequent assessments, and between the assessments at 3 months and 24 months post-RT. The stroboscopy showed a gradual progression of fibrosis of the vocal folds with a significant difference apparent when the assessments at 3 months and 24 months were compared (p < 0.001). Almost all of the subjective assessments of voice quality showed an improvement during the first 2 years, but significant differences were noted at 24 months. Jitter and shimmer deteriorated in the first year after RT with a significant deterioration noticed between the sixth and twelfth months (p = 0.048 and p = 0.002, respectively). Two years after RT, only 8/50 (16%) patients had normal voices. The main reasons for a decreased voice quality after RT for early glottic cancer were post-RT changes in the larynx. Despite a significant improvement in the voice after RT shown in a few of the evaluation methods, only a minority of the patients had a normal voice two years post-RT.

Factors Impacting Provider Treatment Decision‐Making in Early Glottic Cancer

“…Generally, provider preference may be driven by individual providers' resources, training, and comfort levels with various approaches, in addition to the way they weigh tumor factors such as laterality, tumor extent and depth, and anterior commissure involvement 13 . However, the exact factors driving provider treatment recommendations for choice of TLMS versus XRT in various early glottic cancers (EGC) are not yet well understood.…”

“…Generally, provider preference may be driven by individual providers' resources, training, and comfort levels with various approaches, in addition to the way they weigh tumor factors such as laterality, tumor extent and depth, and anterior commissure involvement. 13 However, the exact factors driving provider treatment recommendations for choice of TLMS versus XRT in various early glottic cancers (EGC) are not yet well understood. The main objectives of this study are to (1) describe how specialists ranked the importance of voice outcomes and side effects of radiation across several early glottic tumor cases, (2) compare how treatment modality preference differed between specialties, (3) describe how a priori tumor factors influence EGC treatment specialists' decisionmaking, and (4) capture the nuances of EGC presentation through diagrammatic tumor maps.…”