Voice Outcomes Following Radiation Versus Laser Microsurgery for T1 Glottic Carcinoma

Abstract

Objective Systematic review of literature on patient-reported voice handicap following T1 glottic squamous cell carcinoma treatment using transoral laser microsurgery or radiation therapy. Data Sources PubMed, Web of Science, and Scopus (1997–2013). Review Methods These data sources were searched for papers reporting Voice Handicap Index (VHI) after treatment of early glottic carcinoma. Review and reference crosschecking were performed using a priori selection criteria. Study data were abstracted and publication quality categorized independently by 2 authors. Corresponding authors were contacted to maximize data for analysis. Meta-analysis was performed only with studies that included both treatment modalities, to reduce heterogeneity and maximize rigor; random effects modeling was used to pool results. Results Eighteen publications were identified that reported VHI data following surgery and radiotherapy for T1 glottic carcinoma. No studies were randomized. When studies that reported multiple T-stages or systematic treatment selection bias were excluded, 8 retrospective cohort studies describing 362 patients were suitable for meta-analysis. Follow-up time (mean, 47 months; range, 1–298 mo) and extent of surgical excision varied across studies. Six studies showed no VHI difference between treatment arms; 2 favored radiotherapy over surgery (1 of which reported transmuscular cordectomy for all surgical patients); and none favored surgery. Meta-analysis showed no significant difference in post-treatment VHI between radiotherapy and surgery (mean difference, −5.52; 95% confidence interval, −11.40, 0.36; heterogeneity I2 = 61%, P = .01). Conclusion VHI scores were comparable following transoral laser microsurgery and radiation therapy for T1 glottic carcinoma in the current literature, suggesting no clinically significant difference in functional voice outcomes between treatment types.

Oncologic outcomes of KTP laser surgery versus radiation for T1 glottic carcinoma

“…A study of 75 patients by De Santis et al found no difference in 5‐year disease‐free survival, overall survival, or laryngeal preservation for patients with T1 and T2 carcinoma treated with TLM versus radiation . A meta‐analysis of voice outcomes by Greulich et al showed similar subjective and objective outcomes between TLM and EBRT …”

Voice outcome after unilateral ELS type III or bilateral type II resections for T1‐T2 glottic carcinoma: Results after 1 year

“…In addition to oncological outcome, functional outcome—mainly voice outcome—is an important factor when choosing a primary treatment for these patients. It has been shown that the postoperative voice outcome in limited resections such as subepithelial and subligamental resections (type I‐II according to the European Laryngological Society [ELS] classification) is normal or near to normal and that voice outcome for TLM and RT in these lesions is comparable . However, the postoperative voice is generally poorer in more extended resections (type III‐IV) than in superficial resections (type I‐II) .…”

Evidence and evidence gaps of laryngeal cancer surgery

“…Currently, 3 meta-analyses of retrospective studies are available that compare the voice quality after transoral laser surgery with primary radiotherapy of T1 carcinomas [23], [39], [40], furthermore, there is one meta-analysis on T1 and T2 carcinomas [21] (Table 3 (Tab. 3)).…”

“…None of the meta-analyses showed a significant difference of the voice quality between transoral laser therapy and radiotherapy. 3 meta-analyses showed a tendency to better vocal quality after radiotherapy [21], [23], [40], whereas 1 analysis revealed a tendency of better voice quality after laser therapy [39]. …”