Function preservation using transoral laser surgery for T2–T3 glottic cancer: oncologic, vocal, and swallowing outcomes

Abstract

Aim of this study was to retrospectively analyze oncologic and functional results of a cohort of T2 and selected T3 glottic tumors treated by transoral laser surgery (TLS). Eighty-nine patients affected by T2 and T3 glottic tumors were treated by TLS from 2005 to 2010 at an academic institution by Type V cordectomies using an "en bloc" or, more frequently, a "piece-meal" technique depending on a number of variables. Kaplan-Meier curves were used to evaluate 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates. Univariate analysis of the impact of different variables was performed. At least 1 year after surgery, we examined: subjective voice evaluation by voice handicap index (VHI), perceptive analysis by GRBAS scale, objective measurements with multidimensional voice program (MDVP), swallowing assessment with the M.D. Anderson Dysphagia Inventory (MDADI), videonasal endoscopic evaluation of swallowing (VEES), and videofluoroscopy (VFS). Fifty-nine patients were pT2 and 30 pT3. The 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates were 92.4, 98.7, 68.5, and 82.1 %, respectively. VHI mean score was 20 (mild dysphonia). Mild and moderate dysphonias were detected by GRBAS in 82 and 18% of patients, respectively. Mean values of Jitter, Shimmer, and noise-to-harmonic ratio by MDVP resulted 7.87%, 24.8%, and 0.37, respectively. Mean value of MDADI was 95.75. Only 2% of patients at VEES and 4% at VFS showed tracheal aspiration. Our results highlight that T2 and selected T3 glottic tumors treated by TLS have favorable oncologic and functional outcomes.

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

“…It has been reported that calculating perturbation and noise measures for aperiodic signal types 3 and 4 yields unreliable results, and therefore it has been recommended that perturbation and noise measures be calculated from type 1 and some type 2 signals only. 33,37 The studies reporting perturbation outcomes after TLM 12,[17][18][19][20][21][22]40 did not conduct signal typing to determine which signals could be reliably analyzed, suggesting the need to reconsider the reliability of such results.…”

“…16,18,19 Comparisons were also difficult owing to the various software programs used. Although most studies 12,17,19,[21][22][23][24] used the Multidimensional Voice Profile (Kay Elemetrics, Pine Brook, NJ), 25 other studies 16,18,20 used Doctor Speech (Tiger DRS Inc) 26 and one study 9 used Praat (Paul Boersma, www.praat.org). 27 It has been suggested that there are poor comparisons between perturbation measures generated from various acoustic analysis programs.…”

“…For more extensive resections, low perturbation values were reported 20 ; however, a number of other studies showed high measures. 12,17,19,[21][22][23][24] Owing to the heterogeneity of noise measures used in previous studies, comparisons were difficult to make. Some studies used NHR 12,19,[21][22][23][24] ; however, others used the harmonic-to-noise ratio 9 or normalized noise energy.…”

“…12,17,19,[21][22][23][24] Owing to the heterogeneity of noise measures used in previous studies, comparisons were difficult to make. Some studies used NHR 12,19,[21][22][23][24] ; however, others used the harmonic-to-noise ratio 9 or normalized noise energy. 16,18,19 Comparisons were also difficult owing to the various software programs used.…”

Introduction

“…Laser cutting facilitates the cicatrizazion of tissues, resulting in less post-operative complications and shorter patient recovery time [2,3]. Additional benefits of laser microsurgery in the larynx over other treatment modalities include smaller cost-per-procedure [4] and lower postoperative morbidity [1,3].…”