Injection laryngoplasty during transoral laser microsurgery for early glottic cancer: A randomized controlled trial

Abstract

Background Transoral laser microsurgery is widely used for treating T1/T2 glottic cancers. Hyaluronic acid (HA) is commonly used in vocal cord augmentation. We investigated the impact of intra-operative injection laryngoplasty on voice outcomes in early glottic cancer. Methods Twenty patients were randomized to the treatment group receiving HA injection to the vocal cord contralateral to the lesion; or the control group, receiving no injection. Patients had a Voice Handicap Index-10 (VHI-10) questionnaire and a Maximum Phonation Time (MPT) measurement preoperatively and at 3, 12 and 24 months post-operatively. Mean change in VHI-10 and MPT, compared to baseline and between time points, were compared. Survival estimates were calculated. Results Mean VHI-10 scores improved over time amongst all patients. There were no changes in mean VHI-10 from pre-operative values to 3, 12 or 24 months post-operatively. There were no significant differences when comparing various timepoints between groups. There were no significant changes in MPT amongst the groups, or the time-points compared. Two-year overall survival was 91.7%; disease free survival was 80.9%; no difference in recurrence free survival was seen between the groups. Conclusion Subjective voice scores improved over time in both groups; there were no improvements in VHI-10 or MPT scores in the injection group, over control, at any time points. We saw no significant impact for intra-operative HA injection laryngoplasty on subjective or objective voice outcomes following surgery for early glottic cancers. Graphical abstract

Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022

“…The treatment of early-stage glottic cancer, was examined in 44 studies, [29][30][31][35][36][37][38]40,41,45,46,48,50-59,62,64,65,71,72,74-77,79-82,89-94 mainly with transoral laser microsurgery and RT modalities (Figure 2). techniques with different laser modalities and robotic-assisted transoral surgery were observed, however, not only surgical techniques improved, as RT is using intensity-modulated radiation to precisely select normal tissues and targets for treatment, providing curative treatment with less toxicities.…”

“…44,58,75,77 As T1-T2 glottic cancer survival outcomes rates of laryngeal preservation are good and similar following laser surgery and RT, 6 recent studies have focused on the improvement of functional voice outcomes. 5,85 Relative to transoral laser microsurgery using a CO₂ laser, that performed with an angiolytic potassium titanyl phosphate laser for early-stage glottic cancer 85 Other therapeutic modalities for early-stage glottic cancer that have been assessed include intraoperative hyaluronic acid injection during transoral laser microsurgery, which had no significant effect on survival, 38 and altered (hypo-and hyper-) fractionation RT, which was found to result in fewer local failure events than did conventional RT. 80 The selection of the appropriate treatment modality is individualized by assessing clinicopathological factors, patient characteristics, as well as preferences and expectations and, finally, the availability of human and technological resources, however, the larynx preservation approaches have become the standard of care for early-stage glottic cancer.…”

“…The PubMed database search yielded a total of 260 studies (Table A1), of which 68 (26 MAs, 24 RCTs, and 18 SRs) fulfilled the selection criteria 9,13–15,29–31,33,35–94 . The countries in which the largest numbers of studies were performed were China ( n = 18), the United Kingdom ( n = 6), and Italy ( n = 5; Figure 1).…”

“…The main characteristics of the included publications are summarized in Table 3. The treatment of early‐stage glottic cancer, was examined in 44 studies, 29–31,35–38,40,41,45,46,48,50–59,62,64,65,71,72,74–77,79–82,89–94 mainly with transoral laser microsurgery and RT modalities (Figure 2).…”

“…The PubMed database search yielded a total of 260 studies (Table A1 ), of which 68 (26 MAs, 24 RCTs, and 18 SRs) fulfilled the selection criteria. 9 , 13 , 14 , 15 , 29 , 30 , 31 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”