Comparison of Voice Outcomes in Early Glottic Cancer Patients after Laser Surgery or Radiotherapy

Abstract

Background and ObjectivesZZRadiotherapy and laser surgery are the main treatment modalities for early glottic cancer. However, which treatment has better voice outcome is unclear. Few studies have considered the effect of radiation dose on voice outcomes after radiotherapy. The purpose of this study was to compare voice outcomes in early glottic cancer patients between two treatment modalities and to identify whether radiation dose affects voice outcomes. Subjects and MethodZZFrom January 1995 to December 2010, 66 patients with the early glottic cancer who underwent laser surgery (n=27) or radiotherapy (n=39) were retrospectively investigated. Voice quality was assessed using Computerized Speech Lab and F0, Jitter, Shimmer and noise to harmonic ratio were evaluated. For aerodynamic test, maximum phonation time was also evaluated. ResultsZZF0 differed statistically between the laser surgery group and radiotherapy group. In laser surgery group, F0 was elevated after surgery. On the other hand, F0 decreased statistically after radiotherapy. In the radiotherapy group, the dose was statistically different between the lower and higher dose groups. In T2 stage disease, which received a higher radiation dose, voice outcomes were poorer than in T1a or T1b stage diseases. ConclusionZZIn early glottic cancer, F0 differed statistically between the laser surgery group and the radiotherapy group: F0 decreased statistically after radiotherapy. In the radiotherapy group, voice quality was affected by radiation dose as the higher dose resulted in poorer voice outcomes.

Perceptual and Acoustic Outcomes of Early-Stage Glottic Cancer After Laser Surgery or Radiotherapy: A Meta-Analysis

“…We compared parameters of acoustic analysis (jitter, shimmer, and NHR) and parameters of perceptual analysis (GRBAS) in early glottic cancer through a meta-analysis. The meta-analysis included the following studies: van Gogh et al [17], Luo et al [10], Czecior et al [11], Ahn et al [12], Nunez Batalla et al [18], Wedman et al [21], and McGuirt et al [24]. We found no significant differences between LS and RT groups in acoustic analysis parameters.…”

“…Voice quality was assessed on the GRBAS scale based on grade (G), roughness (R), breathiness (B), asthenia (A), and strain (S). Ratings based on these five aspects of voice quality varied from 0 (normal), to 1 (mild), 2 (moderate), and 3 (severe) [10-12].…”

“…The RT group showed more severe insufficiency of glottal closure due to laryngeal stroboscopy than the LC group, suggesting ventricular closure during phonation and hyperadduction of the arytenoid cartilage. According to a psychoacoustic analysis [10-12,17], patients who received RT had higher frequency of normal or mild coarse voice whereas those who received LC exhibited higher frequency of moderate or severe coarse voice, indicating that RT was better than LC [18-24]. However, Tamura et al [20] have revealed that both groups show similar voice preservation results, suggesting that LC does not affect the voice considerably.…”