Voice quality after organ-preservation therapy with definitive radiotherapy for laryngeal cancer

Telephonic voice intelligibility after laryngeal cancer treatment: is therapeutic approach significant?

The aim was to investigate telephonic voice intelligibility in patients treated for laryngeal cancer using different approaches. In total, 90 patients treated for laryngeal cancer using different approaches and 12 healthy volunteers were recruited. Each patient and each healthy control read a list of words and sentences during a telephone call. Six auditors listened to each telephonic recording and transcribed the words and sentences they understood. Mean intelligibility rates for each treatment were assessed and compared. Regarding words, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by total laryngectomies. The best intelligibility was found for transoral laser microsurgery, followed by radiotherapy alone. For sentences, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by chemoradiotherapy. The best intelligibility was found for radiotherapy alone and transoral laser microsurgery. More aggressive surgery as well as chemoradiotherapy correlated with significantly poorer outcomes. Transoral laser microsurgery or radiotherapy alone ensured the best telephonic voice intelligibility. Intermediate-advanced T stages at diagnosis also showed significantly poorer intelligibility outcomes, suggesting that T stage represents an independent negative prognostic factor for voice intelligibility after treatment.

Simulation study of high-dose-rate brachytherapy for early glottic cancer

PURPOSE

External beam radiation therapy (EBRT) is effective for early glottic cancers, with cure rates of ∼90% for T1 tumors. EBRT has strengths but also disadvantages including radiation to healthy tissues and duration of 5-7 weeks. With advances in laryngeal framework surgery, new devices can provide reliable, minimally invasive access to the larynx. Such devices could be modified to insert brachytherapy catheters. Brachytherapy could provide focused radiation while limiting dose to normal structures in the larynx and neck. As a preliminary step, we performed simulations comparing EBRT to high-dose-rate brachytherapy to assess if this approach could provide dosimetric advantage.

METHODS AND MATERIALS

One- and 2-catheter brachytherapy simulations were performed for 3 patients with T1 glottic carcinoma. Percentage of dose delivered to the target and adjacent structures was compared with conventional EBRT using 3D and intensity-modulated radiation therapy approaches.

RESULTS

Percentage of structures exposed to 50% of the dose was lower for brachytherapy compared with 3D EBRT and intensity-modulated radiation therapy, particularly for the cricoid and contralateral arytenoid. Dose was also lower for the carotid-internal jugular vein complexes compared with 3D EBRT. Dose profiles did not differ significantly between 1- and 2-catheter simulations.

CONCLUSION

Brachytherapy can decrease radiation to normal tissues including laryngeal cartilages and carotid-internal jugular vein complexes. Recent advancements allowing catheter placement may afford the potential to decrease radiation to healthy tissues with decreased treatment time. However, careful, stepwise evaluation of feasibility and outcomes in model systems is required before recommending this approach for such high cure rate cancers in humans.

Voice outcome in patients treated for laryngeal cancer: efficacy of voice rehabilitation

OBJECTIVE

To investigate the efficacy of voice rehabilitation regarding acoustically measured voice quality as well as self-perceived function after radiotherapy for laryngeal cancer.

STUDY DESIGN

Prospective intervention study.

METHODS

Twenty male patients irradiated for laryngeal cancer participated in the study. Voice recordings and self-assessment of voice function (hoarseness, vocal fatigue, and vocal loudness) were made one and 6 months after completion of radiotherapy. The recordings were analyzed with the program Praat. Ten of the patients received 10 sessions of structured voice rehabilitations between the recordings and 10 worked as a control group.

RESULTS

Jitter and shimmer improved for both groups. Harmonics-to-noise-ratio and maximum phonation time improved for the patients who received voice rehabilitation while it deteriorated for the control group. The self-assessment questions about vocal fatigue and vocal loudness showed improvement for both groups while hoarseness showed no change.

CONCLUSION

General improvement was seen for both the study group and the control group. Despite the lack of statistical significant difference, there are trends where greater improvement in perturbation and self-assessment measures are noted in the study group. The results suggest positive effects of voice rehabilitation in both voice quality and self-perceived function.