Evaluation of lasersurgery and radiotherapy as treatment modalities in early stage laryngeal carcinoma: tumour outcome and quality of voice

Abstract

For treatment of early stage (Tis-T2) laryngeal cancer the main choice is between microlaryngoscopy with carbon dioxide laser resection (laser surgery) and radiotherapy. Because both treatments provide excellent tumour control, secondary outcome variables such, as quality of voice may be of importance in treatment preference. In this study tumour outcomes and quality of voice were analysed for a cohort of patients with early stage (Tis-T2) laryngeal (glottic) carcinoma. The "physical subscale" of the voice handicap index questionnaire (VHI) and a validated five-item screening questionnaire were used. Analysis of 89 patients treated with laser surgery and 159 patients treated with radiotherapy revealed a 5-year local control of 75 and 86 % (p = 0.07). Larynx preservation (5-year) was, however, superior in patients treated with laser surgery, 93 vs 83 % (p < 0.05). Tumour outcomes were also analysed per tumour stage and none were of significant difference. Quality of voice was analysed in 142 patients. VHI scores were 12.4 ± 8.9 for laser surgery and 8.3 ± 7.7 for radiotherapy (p < 0.05), with a higher score reflecting a worse outcome. VHI scores per tumour stage for laser surgery and radiotherapy were, respectively, 12.0 ± 9.9 and 7.9 ± 7.5 in T1a (p = 0.06), 16.7 ± 9.0 and 4.9 ± 6.6 in T1b (p < 0.05). Outcomes of the five-item questionnaire showed voice deficiency in 33 % for laser surgery and 23 % for radiotherapy in T1a (p = 0.330) and 75 and 5 % for T1b (p = 0.001). Oncologic outcomes of laser surgery and radiotherapy were comparable. Larynx preservation is, however, preferable in patients initially treated with laser surgery. According to subjective voice analysis, outcomes were comparable in T1a lesions. Depth of laser resection is of influence on voice deficiency displayed by a significantly higher percentage of voice deficiency in patients treated with laser surgery for T1b lesions.

Voice Outcomes of Transoral Laser Microsurgery of the Larynx

“…Several other studies found the same correlation between the extent of the cordectomy (types V and VI) and a worse subjective vocal outcome. 3,16,17 For exclusively T1a lesions treated with TLM, Czecior and colleagues 18 found that 54% of patients had a G score of 0 to 1, 78% an R score of 0 to 1, 96% a B score of 0 to 1, 99% an A score of 0 to 1, and 58% an S score of 0 to 1. Compared with preoperative voice, Aaltonen and colleagues 14 found a significant improvement in average self-reported hoarseness on a visual analog scale of 0 to 100 after 6 months (50/100 vs 59/100 preoperatively), improving further after 12 months (43/100).…”

Voice Outcomes After Transoral Laser Microsurgery for Early Glottic Cancer—Considering Signal Type and Smoothed Cepstral Peak Prominence

“…With arguably comparable, excellent disease-specific outcomes reported for each treatment modality, 7,8 consideration of the postoperative voice plays a significant role when deciding which treatment is the most advantageous. 8 However, there is still considerable debate regarding expected voice outcomes, [9][10][11][12] with widely varying opinion among health care providers on which modality offers the best voice outcome.…”

“…8 However, there is still considerable debate regarding expected voice outcomes, [9][10][11][12] with widely varying opinion among health care providers on which modality offers the best voice outcome. 10 Despite the postoperative voice playing a significant role in treatment decision making, there is no consistent voice profile after TLM.…”

“…10 Despite the postoperative voice playing a significant role in treatment decision making, there is no consistent voice profile after TLM. [8][9][10] Acoustic measures of perturbation and noise have been widely used to investigate voice outcomes after TLM. 11 Perturbation measures calculate the cycle-to-cycle variations in fundamental frequency (jitter) and amplitude (shimmer) 13 and are linked to impaired vocal fold movement 14 and the perceptual quality of vocal hoarseness.…”

The impact of laryngeal biopsy on voice outcomes: a pilot study

“…To date the majority of research on voice outcomes following early glottic cancer (Tis-T2) has explored the impact of either radiotherapy or transoral laser microsurgery on voice quality and functional outcomes [4][5][6]. Findings from this body of research suggests that both methods of organ-preservation treatment impact vocal quality and function to a similar extent, with the majority of patients expected to present with persistent, predominantly mildmoderate changes to voice quality [7][8][9].…”