Subjective voice quality, communicative ability and swallowing after definitive radio(chemo)therapy, laryngectomy plus radio(chemo)therapy, or organ conservation surgery plus radio(chemo)therapy for laryngeal and hypopharyngeal cancer

Abstract

This retrospective analysis focusses on the impact of therapy on perceived long-term post-cancer treatment function. A validated questionnaire including items and components for the assessment of communicative ability, quality of voice and swallowing was sent to 129 patients. All patients were treated between 1998 and 2007. A total of 76 patients (58.9%) with carcinoma of the larynx or hypopharynx replied to the questionnaire. Data was evaluated retrospectively. Therapy delivered was definitive radio(chemo)therapy (defchRT/RT) (21/76, 28%), laryngectomy + radio(chemo)therapy (LE + chRT/RT) (28/76, 37%), or larynx conservation surgery + radio(chemo)therapy (LCS + chRT/RT) (27/76, 36%). Radiotherapy was administered using 2D- or 3D-conformal planning. The most common concomitant chemotherapy delivered was cisplatin + 5FU. For statistical analyses of the components, averages were calculated and tested using the Kruskal–Wallis test and the U-test of Mann and Whitney. Differences were assessed by the Monte Carlo method or Fisher's exact test. The single item rates were compared with Fisher's exact test. Mean follow-up was 56.7 months (range, 8–130 months). After defchRT/RT, patients trended towards more substantial–strong hoarseness compared with LCS + chRT/RT (P = 0.2). After LE, patients were dissatisfied with their artificial larynx/electrolarynx and the tone of their voice (P = 0.3, P = 0.07) and communicative ability (P = 0.005, P = 0.008) compared with those treated with defchRT/RT and LCS + chRT/RT, respectively. Dysphagia and additional percutaneous endoscopic gastrostomy (PEG) feeding were more frequent after defchRT/RT in comparison with the other two groups (P < 0.05). Voice quality and communicative ability were slightly worse after defchRT/RT and LE + chRT/RT, but satisfying with all treatment modalities. Further development of the therapy approach is necessary to reduce long-term side effects, with measures of post-treatment function as important endpoints.

Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

“…Eleven studies used swallow-related questionnaires such as the MDADI, 23 48 Other methods to collect swallow-related data such as semi-structured interviews, 19,28,33,42,54 clinical assessments, 19,33,49,54,56 data collected by the speech-language therapist, 27,28,31 or self-designed questionnaires 21,29,39,49 were described too. Eleven studies used swallow-related questionnaires such as the MDADI, 23 48 Other methods to collect swallow-related data such as semi-structured interviews, 19,28,33,42,54 clinical assessments, 19,33,49,54,56 data collected by the speech-language therapist, 27,28,31 or self-designed questionnaires 21,29,39,49 were described too.…”

“…37 Only four studies compared preoperative to postoperative data from the questionnaires. 20,27,29,36,37,43 The prevalence of OD after TLE ranged from 35% to 89% 21,22,32,39,42,43 and the incidence of OD after TLE was 58%. (Chemo)radiotherapy performed either preoperatively or postoperatively adversely affected swallowing.…”

Unmet supportive care needs in patients treated with total laryngectomy and its associated factors

“…4,6,8,9,11 Although highest in the treatment and early follow-up phase, 2,8-10 supportive care needs may remain through the long-term follow-up. [14][15][16] In addition, they have often been treated with (chemo)radiation and/or neck dissection, which may induce problems, such as dysphagia and shoulder complaints. These patients encounter several adjustments in normal daily functioning, which they have to live with for the rest of their lives, including adjustments in airway management, smell, swallowing, and speech.…”

Evidence and evidence gaps of laryngeal cancer surgery

“…A systematic review by Hutcheson et al [148] described an incidence of shunt insufficiencies of up to 29%. In summary, however, many patients are not satisfied with their voice and ability of communication after total laryngectomy [149]. …”

“…Patients who received primary radiochemotherapy for organ preservation have significantly higher dysphagia rates compared to laryngectomees [142], [149]. Furthermore, patients after total laryngectomy alone have better swallowing function than patients after total laryngectomy and adjuvant radiation or salvage laryngectomy [145], [153], [154].…”