Voice quality after endoscopic laser surgery and radiotherapy for early glottic cancer: objective measurements emphasizing the Voice Handicap Index

Spectro-acoustic voice parameters in transoral laser microsurgery vs exclusive radiotherapy for early-stage glottic carcinoma: A systematic review and meta-analysis

PURPOSE

In early glottic squamous cell carcinoma, similar results have been described in terms of disease control between transoral laser microsurgery (TLM) and radiation therapy (RT). During the past two decades, several studies compared subjective vocal outcomes of exclusive RT with those of TLM, showing a trend towards improving results for TLM over time. However, the objective differences in terms of spectro-acoustic voice parameters between exclusive RT and TLM have been less frequently investigated. The aim of this systematic review with meta-analysis was to evaluate voice quality after TLM and RT treatment for early glottic carcinoma, based on acoustic analysis parameters including jitter, shimmer, noise to harmonic ratio, fundamental frequency and maximum phonation time.

MATERIAL AND METHODS

A search of the English published literature was conducted on the Pubmed, Scopus and Cochrane databases following PRISMA guidelines.

RESULTS

A total of 441 titles were retrieved from the search. After full-text screening and application of inclusion/exclusion criteria, 12 articles were included. We found no significant differences between TLM and RT treatment in the considered acoustic analysis parameters, except for Shimmer, with more favorable values reported in the RT group.

CONCLUSIONS

Considering the spread of the disease and expecting an improvement in long-term survival over time, well-designed and multicentric studies involving larger populations with a long-term follow up are mandatory to better assess objective voice outcomes in terms of spectro-acoustic voice parameters.

Is CO2 laser microsurgery better than radiotherapy in early glottic cancer: a meta-analysis

The choice between radiotherapy (RT) and CO2 laser surgery (CO2-LS) for early glottic cancer remains controversial. We systematically examined electronic databases in order to identify prospective trials comparing patients who had undergone CO2-LS or RT to treat early glottic cancer. Eleven studies involving 1053 patients were included. In the selected literature, the parameter setting of CO2 laser equipment can be summarized as wavelength 10.6 µm, superpulsed mode, continuous setting, power tailored on target structures (1-3 W for subtle resections and 4-15 W for cutting a larger tumor), and approximately 2080-3900 W/cm2 of laser energy. Using RevMan 5.3, we estimated pooled odds ratios (ORs) for dichotomous variables and pooled mean differences (MDs) for continuous variables, along with associated 95% confidence intervals (CIs). The heterogeneity in the treatment variables was measured using Higgins' inconsistency test and expressed as I2 values. The continuous variables were then depicted as histograms developed using PlotDigitizer 2.6.8. Compared to patients treated with CO2-LS, those treated with RT had better jitter (MD 1.27%, 95% CI 1.21 ~ 1.32, P < 0.001), and high scores on the "Grade (MD 6.54, 95% CI 5.31 ~ 7.76, P < 0.001), Breathiness (MD 9.08, 95% CI 4.02 ~ 14.13, P < 0.001), Asthenia (MD 2.13, 95% CI 0.29 ~ 3.98, P = 0.02), and Strain (MD 3.32, 95% CI 0.57 ~ 6.07, P = 0.02)" scale. Patients treated with CO2-LS had worse local control rates (OR 3.14, 95% CI 1.52 ~ 6.48, P = 0.002) while lower incidence of second primary tumor (OR 0.30, 95% CI 0.15 ~ 0.61, P < 0.001). It is hoped that retrospective analysis can provide suggestions for early glottis patients to choose personalized treatment.

Evaluation of Voice After Definitive Radiotherapy in Patients of Early Stage Squamous Cell Carcinoma of Larynx (Glottis): A Prospective Observational Study

Post treatment voice quality is an important consideration in choosing the management option for laryngeal cancer. We assessed voice quality after radiotherapy in patients of early squamous cell carcinoma of glottis comprehensively using Videolaryngostroboscopy (VLS), Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scores and Voice Handicap Index (VHI)-10. Fifty four consenting patients of early squamous cell carcinoma of glottis (Tis, T1 and T2) awaiting definitive radiotherapy were recruited consecutively. Voice was evaluated by VLS, GRBAS scores and VHI-10 before radiotherapy as well as 3 months and 12 months after radiotherapy. There were 52 males and 2 females in the study. Hoarseness of voice was the commonest presenting symptom. Mean duration of symptoms was 2.45 months (± 0.80), ranging from 1 to 4 months. 35 (64.82%) were T1 while 19 (35.18%) were T2 lesions. They received 60-70 Gy of radiotherapy in 28-35 fractions. There was only one recurrence on follow up for 12 months. On VLS at 12 months post-RT the periodicity, phase symmetry, mucosal waves and amplitude were normal in 74.07%, 70.37%, 56.67% and 78.7% cases respectively. Complete glottic closure was obtained in 72.22%. The voice was 'acceptable' (Grade 1 or 2 on VLS parameters) in more than 90% cases. Mean total GRBAS score was 3.39 (± 2.67). Mean total VHI-10 was 6.7 (± 1.75). All indices were significantly better than pre RT levels. Good quality of voice can be expected after radiotherapy for early glottic cancer in majority of patients.

Voice outcomes in patients with advanced laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

Objective

Patients with locally advanced laryngeal and hypopharyngeal cancer (LHC) are often treated with chemo-radiotherapy to avoid total laryngectomy, although voice problems may occur even if not markedly manifest. We sought to evaluate the impact of chemoradiation on voice and quality of life.

Methods

We studied 21 patients with locally advanced LHC with tumour control at least two years after chemo-radiotherapy. None manifested clinical symptoms related to the treatment and maintained an activity considered as within normal limits. All patients had a voice handicap index (VHI) of less than 15. Voice function was evaluated by perceptual vocal analysis (CAPE-V) and aerodynamic and acoustic study. Quality of life was assessed with the EORTC-H&N35 (voice items 46, 53 and 54).

Results

Voice changes were frequent, with alterations in all CAPE-V attributes, and predominantly type II and III spectrograms in acoustic analysis (78%). The EORTC-H&N35 scale showed a reduction in scores in 10-40% of items related to voice.

Conclusions

Subclinical voice disorders are common after chemo-radiotherapy. Although patients consider vocal impairment to be very minor and to not interfere with their daily life, it may contribute to a reduced quality of life.

Voice handicap Index in Parkinson's patients: Subthalamic versus globus pallidus deep brain stimulation

PURPOSE

Subthalamic nucleus (STN) and globus pallidus interna (GPI) are the two most common sites for deep brain stimulation (DBS) in people with Parkinson's disease (PWP). Voice impairments are a common symptom of Parkinson's disease and information about voice outcomes with DBS is limited. Most studies in speech-language pathology have focused on STN-DBS and few have examined the effects of GPI-DBS. This was an initial effort to examine the impact of DBS location on Vocal Handicap Index (VHI) scores, which assess the impact of a voice disorder on an individual.

METHOD

Twenty-four gender-matched PWP (12 STN-DBS and 12 GPI-DBS) completed the VHI post-DBS implantation. Two-tailed independent samples t-tests were used to compare each VHI scale score (physical, functional, emotional, total) and patient factors between the two groups.

RESULTS

No significant differences in total or subscale VHI scores were identified between the two DBS groups. A trend toward greater impairment in PWP with GPI-DBS was noted. An association between higher VHI scores and DBS settings was found.

CONCLUSIONS

Studies directly comparing speech outcomes for different DBS targets are lacking. The current findings provide new insights concerning voice outcomes following DBS by adding to the limited literature directly comparing speech outcomes in multiple DBS targets. Limitations and directions for future research are discussed.

Multimodal Evaluation of Voice Outcome in Early Glottic Cancers Treated With Definitive Radiotherapy

BACKGROUND/AIM

We employed a multimodal evaluation of voice outcome (MEVO) model to assess long-term voice outcome in early glottic cancer (EGC) patients treated with primary radiotherapy (RT). The model consisted of objective and subjective vocal evaluation during follow-up, by a dedicated Speech Pathologist and Speech Therapist.

PATIENTS AND METHODS

MEVO methodology includes Self-perception Voice Handicap Index (VHI-30), evaluation of parameters Grade (G), Roughness (R), Breathiness (B), Asthenia (A) and Strain (S) according to GRBAS scale, objective analysis and aerodynamics using the PRAAT software and laryngeal evaluation with videostroboscope (VS).

RESULTS

The MEVO methodology was described and tested on a sample of 10 EGCs submitted to definitive RT (total dose 66-70 Gy). Mean follow-up was 48.9 months (range=9-115). VHI was mild-moderate in 90% of patients; overall voice function (GRBAS) was normal-mildly impaired in 70% of patients; VS evaluation showed normal vocal cord motion in 90% of patients, but complete glottic closure in 60%. PRAAT scores confirmed these findings.

CONCLUSION

A multidimensional voice evaluation is time consuming, but useful to objectify vocal impact of radiotherapy. The MEVO model allowed to quantify vocal dysfunction, showing a good objective vocal outcome.

T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO2-Laser Microsurgery Using the VEM

Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO₂ transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year recurrence-free, overall, and disease-specific survival rates (Kaplan–Meier method) were 71.4%, 94.4%, and 100.0%. Voice function was preserved; the objective parameter VEM (64 ± 33 vs. 83 ± 31; mean ± SD) and subjective vocal measures (G: 1.9 ± 0.7 vs. 1.3 ± 0.7; VHI-9i: 18 ± 8 vs. 9 ± 9) even improved significantly (p < 0.001). The VEM best reflected self-perceived voice impairment. It represents a sensitive measure of voice function for quantification of vocal performance.

Is Single Cord Irradiation Going to Be a New Standard for T1a Glottic Carcinoma?

Purpose and Objective: To evaluate the disease-free survival, overall survival, dosimetric, and voice handicap index (VHI) results of T1a glottic invasive squamous cell carcinoma (SCC) patients who underwent hypofractionated single vocal cord irradiation (HSVCI).

Materials and Methods: The data of 18 patients with stage T1a glottic SCC were collected prospectively and analyzed retrospectively between July 2016 and July 2019. Patients were immobilized using a custom-fitted thermoplastic face and shoulder mask in hyperextension position. The CT scan was performed with 1-mm-thick slices. A planned target volume (PTV) margin of 3 mm was given to clinical target volume (CTV) in all directions, and 13 organs at risk were identified. Patients were prescribed a total of 5760–5808 cGy in 15–16 fractions. Patients had daily cone-beam computed tomography (CBCT), and the treatment was carried out with the physician. VHI test was applied to patients before and at the end of radiotherapy (RT) and 1, 2, 3, 4, and 6 months after the completion of RT.

Results: Local control and overall survival rate is 100% for a median of 18 months (6–44 months) of follow-up. A patient was diagnosed with 2nd primary lung cancer and active treatment still continues. All patients completed the treatment within the scheduled time. Grade 1–2 dysphagia and dermatitis occurred in all patients, and no grade 3 and above side effects were observed. The mean values of VHI were 37.00, 39.83, 38.28, 17.17, 12.22, 8.56, and 6.06 at the beginning of RT, at the end of RT, and 1, 2, 3, 4, and 6 months after RT, respectively.

Conclusion: Compared to surgery and conventional laryngeal radiotherapy, HSVCI is an alternative treatment method for T1a glottic cancer by reducing the treatment time to 3 weeks, facilitating recurrence treatment, and providing effective sound quality without compromising local control. Considering that ~80% of recurrences in glottic cancer occur within the first 2 years, 100% local control in a median of 18 months is extremely successful, but long-term follow-up is essential to observe possible late side effects.

Emerging Concepts and Novel Strategies in Radiation Therapy for Laryngeal Cancer Management

Laryngeal squamous cell carcinoma is the second most common head and neck cancer. Its pathogenesis is strongly associated with smoking. The management of this disease is challenging and mandates multidisciplinary care. Currently, accepted treatment modalities include surgery, radiation therapy, and chemotherapy—all focused on improving survival while preserving organ function. Despite changes in smoking patterns resulting in a declining incidence of laryngeal cancer, the overall outcomes for this disease have not improved in the recent past, likely due to changes in treatment patterns and treatment-related toxicities. Here, we review emerging concepts and novel strategies in the use of radiation therapy in the management of laryngeal squamous cell carcinoma that could improve the relationship between tumor control and normal tissue damage (therapeutic ratio).

Oncological and functional outcomes after repeat transoral laser microsurgery for the treatment of recurrent early glottic cancer

BACKGROUND

Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures.

METHOD

A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018.

RESULTS

Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373).

CONCLUSION

Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.

Comparison of Voice Quality of Life in Early Stage Glottic Carcinoma Treated with Endoscopic Cordectomy Using Radiofrequency Microdissection Electrodes, Laser Cordectomy, and Radiotherapy

PURPOSE

To compare the quality of life of patients with early glottic carcinoma who have been treated using three treatment modalities: endoscopic cordectomy using radiofrequency microdissection electrodes (ECRM), transoral laser cordectomy, and radiotherapy (RT). ECRM, transoral laser cordectomy, and RT can all be used as alternatives to invasive open surgery to treat the early stages of glottic cancer such as stage T1. Patients treated using these different modalities could have different outcomes with respect to voice quality of life.

MATERIALS AND METHODS

The voice quality of life was measured in patients who underwent ECRM, transoral diode laser excision, or RT for early laryngeal cancer. Post-treatment quality of voice was assessed using the Turkish version of the Voice-Related Quality of Life questionnaire in all patients after 1 year of cancer-free survival. A comparison was then made between the outcomes of the three groups.

RESULTS

The total score of the ECRM group, when compared independently to that of the laser and the RT groups, was found to be statistically higher in both cases. However, no statistically significant differences were found between laser and RT groups in terms of any parameters. There was a statistically significant difference between the RT group and the other groups in terms of percentage jitter, percentage shimmer, and fundamental frequency (F0) (P < 0.05). While the RT group had the longest maximum phonation time (P < 0.001), no significant differences were found between the maximum phonation time of the ECRM and the laser groups (P < 0.001).

CONCLUSIONS

Overall, the worst outcome with respect to voice quality of life is seen with ECRM. Since there were no significant differences in quality of life between the other two treatment modalities, it is recommended to leave the choice between RT and laser surgery up to the patient.

Voice Quality After Radiotherapy and Cordectomy in Early-Stage Glottic Carcinomas

Laryngeal carcinomas are the most common upper respiratory tract cancers and most commonly involve the glottic region. The aim of this study is to evaluate the voice quality after radiotherapy (RT) and microsurgical cordectomy (MC) treatments using Voice Handicap Index (VHI) and Grade, Roughness, Breathiness, Astenicity, and Strain (GRBAS) perceptual evaluation scale in patients with early-stage glottic carcinoma. A total of 37 patients with early-stage glottic carcinomas, 19 patients had RT and 18 patients with MC, were included in our study. The patients were evaluated in terms of their sound quality by using VHI-10 and GRBAS perceptual assessment scale 3 months after the treatment was completed. Although the findings were better in favor of RT according to GRBAS perceptual assessment scale of patients who received RT (n = 19) and MC (n = 18), no statistically significant difference was found between the 2 groups (P = .613). Patients in both groups were evaluated with VHI-10, emotional (P = .036) and physiological (P = .038) scores were significantly higher in MC group and no significant difference was found in functional scores (P = .192). However, there was no statistically significant difference between the 2 groups in terms of voice quality (P = .185). In early-stage (Tis, T1a, T1b) glottic carcinoma, there was no significant difference between RT and MC in terms of voice quality. Therefore, the choice of treatment modality in patients with early-stage glottic carcinoma should be taken into account in terms of the patient's occupation, comorbid diseases, cost of treatment, hospital stay, and, most importantly, patient preference.

Checking for voice disorders without clinical intervention: The Greek and global VHI thresholds for voice disordered patients

Voice disorders often remain undiagnosed. Many self-perceived questionnaires exist for various medical conditions. Here, we used the Greek Voice Handicap Index (VHI) to address the aforementioned problem. Everyone can fill in the VHI questionnaire and rate their symptoms easily. The innovative feature of this research is the global cut-off score calculated for the VHI. Therefore, the VHI is now capable of helping clinicians establish a more customizable treatment plan with the cut-off point identifying patients without normal phonation. For the purpose of finding the global cut-off point, a group of 180 participants was recruited in Greece (90 non-dysphonic participants and 90 with different types of dysphonia). The voice disordered group had higher VHI scores than those of the control group. In contrast to previous studies, we provided and validated for the first time the cut-off points for all VHI domains and, finally, a global cut-off point through ROC and precision-recall analysis in a voice disordered population. In practice, a score higher than the well-estimated global score indicates (without intervention) a possible voice disorder. Nevertheless, if the score is near the threshold, then the patient should definitely follow preventive measures.

Oncological and functional outcomes following transoral laser microsurgery in patients with T2a vs T2b glottic squamous cell carcinoma

Background

There is a paucity of evidence comparing oncological and voice outcomes between T2a and T2b glottic squamous cell carcinoma (SCC) patients treated with transoral laser microsurgery (TLM). This study identified functional and oncological outcomes in this cohort.

Methods

Retrospective review of prospectively collected data of patients treated with TLM for T2 glottic SCC from 2003 to 2017.

Results

In total, 75 patients were included. Five-year local control rates were significantly different between T2a and T2b patients (75.2% vs 57.0%, p = 0.022). There was no difference in five-year survival between patients with T2a disease and T2b disease (69.5% vs 73.4%, p = 0.627). There was no significant difference in mean VHI-10 scores in the pre-operative period (18.3 vs 21.4, p = 0.409). However, patients with T2b disease had significantly worse perceived voice outcomes post-operatively (6.6 vs 21.3 p = 0.001). Patients with T2a disease saw significant improvements in mean VHI-10 scores following surgery (18.3 vs 6.6, p = 0.000), while T2b patients did not (21.4 vs 21.3, p = 0.979). The overall laryngeal preservation rate was 94.7%, with 11.5% of T2b patients requiring salvage organ sacrifice.

Conclusions

This study highlights positive functional outcomes for T2a glottic SCC. Patients with T2b disease appear to have significantly worse oncological and functional outcomes, including worse voice quality following surgery and higher rates of salvage laryngectomy.

Perceptual and Acoustic Outcomes of Early-Stage Glottic Cancer After Laser Surgery or Radiotherapy: A Meta-Analysis

Laser surgery (LS) or radiotherapy (RT) is normally recommended in early glottic cancer. The objective of this study was to perform a comprehensive meta-analysis of acoustic and perceptual outcomes to compare voice quality of LS or RT in early-stage glottic cancer. Data sources were obtained after searching PubMed, Google Scholar, EBSCO, and RISS using the following search terms: glottic cancer, glottic carcinoma, endoscopic surgery, laser surgery, radiotherapy, radiation, voice, voice quality, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Articles that compared voice outcomes between LS and RT were identified. This meta-analysis included 15 articles with 744 patients, including 400 in the LS group and 344 in the RT group. Random effects models were selected. Forest plots included standardized mean differences, standard errors, variance, 95% confidence intervals (lower limit to upper limit), z-values, and P-values. In perceptual analysis, grade (G) and asthenia (A) of RT were significantly better than LS. There was no statistically significant difference in roughness (R), breath (B), or strain (S) between LS and RT groups. Jitter, shimmer, and noise to harmonic ratio measurements showed significant differences, resulting in enhanced posttreatment effect of RT compared to LS. Results of our meta-analysis suggested that RT might lead to superior voice quality than LS in early glottic cancer.

Quality of life and voice outcome of patients treated with transoral CO2 laser microsurgery for early glottic carcinoma (T1-T2): a 2-year follow-up study

Purpose

Longitudinal studies in laryngeal cancer can provide clinicians information about short-term and long-term functional outcomes, like quality of life (QoL) and voice outcome. This information is important when counseling patients or choosing a primary treatment modality. The present study assessed long-term (2 years) QoL and voice outcome in patients with extended T1 and limited T2 glottic carcinoma treated with transoral CO₂ laser microsurgery (TLM) (unilateral type III or bilateral type II resections).

Methods

Three questionnaires were administered: the Voice Handicap Index (VHI), the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ)-C30, the EORTC QLQ-HN35. A perceptual voice evaluation at six different time points was conducted: preoperatively, and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Fluctuations over time were investigated.

Results

Sixty-one patients were included in the analysis. Patients reported high-level functioning and low symptom scores 2 years postoperatively. Gender significantly affected the VHI scores at 2 years (mean VHI scores: female 8.7 vs. male, 23.9; p = 0.023). The major improvement in VHI scores was observed within the first 6 months. The tumor stage (T1a, T1b, and T2) significantly impacted the grade (mean scores at 2 years: 1.0, 1.9, and 1.7; p = 0.001). These scores stabilized at 6 months.

Conclusions

Patients show good long-term QoL with low symptom scores, a low voice handicap, and mild to moderate dysphonia, 2 years postoperatively. Scores stabilize at 6 months and provide a clear indication of status at 1 and 2 years.

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

Background

Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification.

Methods

Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self‐assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure.

Results

The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5.

Conclusion

Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self‐reported voice impairment.

A comparison of phonatory outcome between trans-oral CO2 Laser cordectomy and radiotherapy in T1 glottic cancer

PURPOSE

This study aimed at comparing phonatory outcomes between Trans-oral Laser Surgery and Radiotherapy in T1 glottic cancer.

INTRODUCTION

Early glottic carcinoma, i.e. T1 stage, can be treated using trans-oral surgery, radiotherapy, or partial open surgery. Trans-oral laser (TOL) surgical techniques and Radiotherapy (RT) have undergone significant advancement in the past few years leading to a decrease in open procedures. Various studies have been published comparing voice quality after TOL surgery and RT. There are few works which consider patients' opinions, i.e. subjective parameters regarding functional voice quality post treatment. This study uses both subjective and objective parameters to evaluate phonatory outcome of both treatment options.

METHODS

Phonatory outcomes were measured in patients who underwent RT and CO₂ Laser excision for early laryngeal cancer. VHI, GRBAS and MDVP were used to measure the vocal outcome of treatment modality after 1 year of cancer-free survival. A comparison was then made between the outcomes in the two groups.

RESULTS

Superior vocal outcomes in G, R and S criteria of the GRBAS scale, a better VHI index, and better jitter, shimmer and NHR were found in patients who underwent CO₂ laser excision as compared to patients who underwent RT. Other parameters were comparable between the two groups.

CONCLUSIONS

TOL surgery provides excellent vocal outcome as compared to RT in management of early glottic cancer and should be considered as the first line of management for the same.

Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: A systematic review and meta-analysis

A therapeutic decision in the treatment of Tis/T1a glottic carcinoma with radiotherapy (RT) or transoral laser surgery (TOS) is still an open issue. Oncologic outcome and voice quality may support the choice for the latter To conduct a systematic review and meta-analysis to compare oncologic and functional outcomes of TOS and RT as treatment options for Tis/T1a glottic cancer. Literature research on online databases was carried out. Potentially eligible articles were reviewed. Relevant articles were selected and evaluated. There was statistical significance favoring patients initially treated with TOS when it comes to overall survival, disease-specific survival and larynx preservation. No difference in local control was found. TMF, Jitter and Shimmmer measurements presented statistically significant results in favor of RT. Self-assessment of voice quality (VHI) and f0 showed no statistically significant differences. Maximum Phonation Time (MPT) had a better response to RT. There is a trend in favor of RT. Tis/T1a glottic cancer patients submitted to TOS had significant overall and disease specific survival and had fewer risks of having a total laryngectomy, when compared to the radiotherapy group. The self-assessment of voice quality and f0 did not show any difference; however, Jitter, Shimmer and MPT measurements favored radiotherapy.

Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant

The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health.

Objective and self-evaluation voice analysis after transoral laser cordectomy and radiotherapy in T1a-T1b glottic cancer

Voice quality outcome becomes an important factor in the choice of the therapeutic option. The differences between radiotherapy and laser cordectomy have been extensively debated in the literature. We analyzed the vocal outcomes after carbon dioxide (CO₂) laser cordectomy and radiotherapy treatment for T1a-b early glottic cancer by means of objective and subjective voice evaluation. A retrospective study was performed on 56 cancer patients, 30 treated with cordectomy and 26 with radiotherapy. All patients underwent laser cordectomy which was performed under general anesthesia using a surgical microscope in laryngeal suspension. The laser we used was an Ultrapulse one, 10.6-μm wavelength, and a power setting of 2 to 4 W in an Ultrapulse mode was selected. Two different sets of data were recorded: (a) voice acoustic analysis (jitter, shimmer, fundamental frequency and noise/harmonic ratio) and (b) voice handicap index (VHI). Data collected were statistically analyzed using SPSS 20.0 for Windows. Jitter, shimmer, and signal-to-noise ratio were significantly altered in both glottic cancer patient groups as compared to the control group. On the contrary, no statistically significant alteration of the fundamental frequency was found in both treatment groups. Interestingly, jitter and shimmer values were significantly more compromised in transoral laser surgery patients as compared with radiotherapy-treated patients. The VHI was also significantly altered in both cancer patient groups as compared to the control group. More importantly, however, the self-evaluation voice analysis was not significantly different between the two treatment groups, contrary to what we observed for two of the four parameters measured in the objective voice analysis. Given the importance of the self-perception of the voice quality, no treatment can be considered superior from the patients' point of view. Therefore, we suggest that priority should be given to the endoscopic surgery, due to lower costs, lower morbidity, and shorter hospitalization.

Life quality improvement in hoarse patients with early glottic cancer after transoral laser microsurgery

BACKGROUND

The purpose of this study was to evaluate the recovery kinetics of voice and quality of life (QOL) over time in patients with early glottic cancer who underwent transoral laser microsurgery (TLM).

METHODS

A prospective cohort study was conducted in which acoustic and aerodynamic voice assessments and QOL analyses were done using health-related questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions [EORTC-QLQ-C30] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions [EORTC-QLQ-H&N35]) were administered at designated times.

RESULTS

Most voice laboratory parameters worsened during the first month, then recovered to baseline after 6 months. The QLQ-H&N35 speech subscale was significantly improved. Among the voice laboratory parameters, pretreatment harmonics-to-noise ratio was an independent predictor (P = .041) for improvement on the speech subscale at the endpoint.

CONCLUSION

Despite an initial deterioration of voice and QOL in the first month, patients who underwent TLM recovered to a plateau since the sixth month and then to better than preoperative status afterward. A greater improvement in QOL was seen in patients with poorer baseline voice quality.

The voice quality after laser surgery versus radiotherapy of T1a glottic carcinoma: systematic review and meta-analysis

Background and objectives

The voice quality assessment of laser surgery (LS) in comparison with radiotherapy (RT) remains uncertain in T1a glottic carcinoma treatment. This systematic review and meta-analysis were conducted to compare the voice quality of the two treatments.

Methods

Searches were conducted in PubMed, EMBASE, and Cochrane with the following index words: glotti*, layn*, vocal cord, vocal, surgery, cordectomy, laser, radiation, irradiation, radiotherapy, cancer, and carcinoma for relative studies that compared the voice quality between LS and RT. Random-effect models were used, and heterogeneity was assessed.

Results

A total of 14 studies were included in the analysis, consisting of 1 randomized controlled trial, 1 prospective study, and 12 retrospective studies. RT has increased the maximum phonation time (MPT; mean difference [MD] =−1.89, 95% confidence interval [CI] =−3.66 to −0.11, P=0.04) and decreased the fundamental frequency (MD =14.06, 95% CI =10.30–17.83, P<0.00001) in comparison with LS. No statistical difference was observed between the two groups in terms of Voice Handicap Index, Jitter, Shimmer, and airflow rate.

Conclusion

RT may be a better choice for T1a glottic carcinoma treatment compared with LS because patients undergoing RT may have the advantage of increased MPT and decreased fundamental frequency. However, more multicenter, randomized, controlled trials are urgently needed to verify these differences.

Voice outcome according to surgical extent of transoral laser microsurgery for T1 glottic carcinoma

OBJECTIVES/HYPOTHESIS

To evaluate the outcomes of transoral laser microsurgery (TLM) for T1 glottic carcinoma using longitudinal voice analysis.

STUDY DESIGN

Retrospective analysis of medical records.

METHODS

We conducted a retrospective review of 57 patients (50 T1a, seven T1b) who underwent TLM for T1 glottic carcinoma, and longitudinal voice analysis was performed before surgery, during the early postoperative period (within 3 months), and during the late postoperative period (more than 6 months). Acoustic, perceptual (Grade, Roughness, Breathiness, Asthenia, Strain scale), and subjective voice analysis using the Voice Handicap Index (VHI) was conducted.

RESULTS

Voice quality deteriorated in the early postoperative period in terms of several parameters. However, no significant differences in voice quality were observed in the late postoperative period, whereas Grade (from 1.85 ± 0.83 to 1.50 ± 0.90) and Roughness (from 1.74 ± 0.73 to 1.48 ± 0.87) had improved significantly. Patients who underwent lesser-extent cordectomy (type I, II) showed improvement in VHI-Physical (from 12.93 ± 11.10 to 6.07 ± 8.69) and Grade (from 1.60 ± 0.68 to 0.98 ± 0.83), whereas improvement was not identified in those who underwent larger-extent cordectomy (type III, IV, V). Improvement in Grade (from 1.70 ± 0.80 to 1.23 ± 0.91) and Roughness (from 1.77 ± 0.73 to 1.25 ± 0.76) was identified in patients who had unilateral tumor without involvement of anterior commissure. However, those with involvement of the anterior commissure or bilateral vocal cord showed a tendency toward deterioration in voice quality.

CONCLUSIONS

Voice quality of patients following TLM for T1 glottic carcinoma may improve significantly over time in cases with lesser-extent types of cordectomy or unilateral tumor without involvement of the anterior commissure.

LEVEL OF EVIDENCE

4 Laryngoscope, 126:2051-2056, 2016.

Subjective and objective voice outcomes after transoral laser microsurgery for early glottic cancer

OBJECTIVES/HYPOTHESIS

Transoral laser microsurgery (TLM) continues to gain popularity as a treatment modality for early glottic cancer. Oncologic outcomes have been well-defined, but there are little data to date describing functional outcomes accounting for stage of resection.

STUDY DESIGN

Retrospective review.

METHODS

We retrospectively reviewed patient-rated voice handicap and observer-rated vocal quality of patients who underwent TLM for early glottic carcinoma. Patients were grouped by European Laryngological Society (ELS) resection type, and the data were combined for ELS type I-III and compared with advanced resections (ELS IV-VI). The Voice Handicap Index (VHI) was used for patient-rated voice outcomes, and voice recordings were graded by two senior speech-language pathologists. Voice recordings and VHI scores were taken preoperatively and at least 1 month postoperatively.

RESULTS

No major complications were encountered. Six of 49 patients underwent repeat resection for suspicious findings with pathology, demonstrating moderate dysplasia in two cases, carcinoma in situ in two cases, and inflamed mucosa only in two cases. There was no significant difference in preoperative VHI scores or objective voice grades among patients who underwent limited (ELS I-III) and those who required more advanced (ELS IV-VI) resection. There was a significant improvement in VHI scores in patients after ELS type I to III resection, from 38.77 to 22.86 (P = .006). There was no significant difference between mean preoperative and postoperative perceptual evaluation scores in patients who underwent ELS type I, II, or III resections (62.25 and 64.32 respectively, P = .621).

CONCLUSIONS

Patients who undergo limited ELS resections can be assured of having a similar to improved voice after healing. Patients who undergo extended resections have poorer vocal outcomes.

LEVEL OF EVIDENCE

4.

Transoral Endoscopic Head and Neck Surgery: The Contemporary Treatment of Head and Neck Cancer

Traditional open surgical approaches are indicated for treatment of select tumor subsites of head and neck cancer, but can also result in major cosmetic and functional morbidity. Transoral surgical approaches have been used for head and neck cancer since the 1960s, with their application continuing to evolve with the changing landscape of this disease and recent innovations in surgical instrumentation. The potential to further reduce treatment morbidity with transoral surgery, while optimizing oncologic outcomes, continues to be investigated. This review examines current literature evaluating oncologic and quality-of-life outcomes achieved through transoral head and neck surgery.

Voice outcomes after laser surgery vs. radiotherapy of early glottic carcinoma: a meta-analysis

BACKGROUND

Radiotherapy and laser resection are established treatment modalities for early glottic carcinoma. To date, there is no confirmed conclusion which treatment is better for early glottic cancer. The objective of this study was to conduct a meta-analysis to compare the voice outcomes after laser resection (LS) and radiotherapy (RT) of Tis-T1N0M0 glottic carcinoma.

METHODS

we searched the relevant electronic studies and performed a meta-analysis based on 13 published studies. The Chi-square based I(2)-statistic test was performed to evaluate possible heterogeneity across the studies. Additionally, random-effects models were used to calculate mean differences with 95% confidence intervals (CIs).

RESULTS

Overall, a total of 13 published studies were included in our study, with 368 patients in the RT group and 440 patients in the LS group, respectively. No significant differences in Voice Handicap Index (VHI), jitter and shimmer were found between RT and endoscopic LS among patients with Tis-T1N0M0 glottic carcinoma and T1aN0M0 laryngeal cancer. However, the acoustic voice analysis parameters of Fo values were significantly lower in RT group than that in LS group.

CONCLUSION

The results from this meta-analysis support that the LS has more advantages than RT in terms of voice quality. However, more studies on voice outcome need to validate our findings.

Voice outcomes following radiation versus laser microsurgery for T1 glottic carcinoma: systematic review and meta-analysis

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 cross-checking 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 posttreatment VHI between radiotherapy and surgery (mean difference, -5.52; 95% confidence interval, -11.40, 0.36; heterogeneity I (2) = 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.

Surgical treatment of glottic cancer: retrospective analysis of 192 cases in a multidisciplinary tertiary care centre in Pune, India

OBJECTIVES

A multidisciplinary team approach is required for the preservation of voice and appropriate management of glottic cancer. This study aimed to investigate the outcomes of surgically treated glottic cancers of all stages. All aspects of surgical management, such as laser cordectomy, partial laryngectomy, total laryngectomy with voice prosthesis, and salvage laryngectomy, conducted at a single tertiary care institute in India, were reviewed.

METHOD

A retrospective analysis of hospital records was performed for 192 glottic cancer patients who were surgically treated between 2003 and 2007.

RESULTS

Patients with tumour stages 1 or 2 glottic cancer treated with laser cordectomy had a local control rate of 85 per cent and five-year survival rate of 98.6 per cent. The findings suggest that the number of partial laryngectomies performed for stage 3 tumours is declining. Patients with a tumour stage 3 lesion with a fixed hemilarynx or a tumour stage 4 lesion, treated with total laryngectomy, were found to have a five-year survival rate of 61.6 per cent. Nodal status was significantly associated with five-year survival rate.

CONCLUSION

Surgery offers a viable five-year survival rate in glottic cancer patients.

Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy

OBJECTIVE

Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial.

METHODS AND MATERIALS

Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO2 laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living.

RESULTS

Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization.

CONCLUSIONS

Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.

Mid-term results of frontovertical partial laryngectomy for early glottic carcinoma with anterior commissure involvement

CONCLUSION

Frontovertical partial laryngectomy is useful for treatment of T1 and T2 glottic squamous cell carcinoma with anterior commissure involvement.

OBJECTIVE

To evaluate the efficiency of frontovertical partial laryngectomy for T1 and T2 glottic carcinoma with anterior commissure involvement.

METHODS

This was a retrospective review of 58 cases of glottic squamous cell carcinoma with anterior commissure involvement (T1, n = 28; T2, n = 30) that were treated by frontovertical partial laryngectomy between August 2000 and August 2010.

RESULTS

Postoperative pathology reports confirmed negative tumor margins in every case. All patients were followed postoperatively, with a median follow-up interval of 55 months. Three patients had local recurrence; there were no patients who had cervical or distant metastases. The 3-year local control rate was 94% according to life tables curves. There were no reports of laryngostenosis or dysphagia in any patients, and mean Voice Handicap Index (VHI) questionnaire scores were 32.9.

Assessment of vocal quality following treatment of advanced pharyngo-laryngeal carcinoma with a protocol of organ preservation

INTRODUCTION AND OBJECTIVES

Advanced laryngeal and pharyngeal cancer, as well as methods to treat them, have a direct impact on voice function, speech communication and deglutition. Such alterations in function can influence employability and general quality of life.

PATIENTS AND METHODS

To characterise the vocal status of the patients treated with an organ-preservation protocol, we report the voice outcomes of 17 patients who were alive and disease free at the time of the survey, with a minimum follow-up of 6 months, after a combination of radiotherapy and chemotherapy to treat advanced cancer. Objective voice assessment by means of spectrographic analysis, the GRBAS perceptual analysis system and the Voice Handicap Index was the methodology followed, which we suggest could be used in future large-scale investigations.

RESULTS

Normal or slightly dysphonic voices were observed in 5 patients (29.4%) and moderate/severe in 12 (70.6%). Spectrographically, the 17 samples were classified as normal in 4 cases (23.4%), Grade I in 3 cases (17.6%), Grade II in 3 (17.6%), Grade III in 4 (23.5%) and Grade IV in 2 (11.7%). The Voice Handicap Index questionnaire, which was completed by the patients themselves, gave normal results in all the patients except for 4 (23.5%).

CONCLUSIONS

The voice acoustic analysis of this series shows that the damage related to the organ-preservation protocol displays a relatively wide range of voice function outcomes. To characterise the vocal status of these patients reliably, we propose using homogeneous instruments (spectrography, GRBAS scale, Maximum Phonation Time and Voice Handicap Index) in future meta-analyses.

Treatment modality: a predictor of continued tobacco use after treatment in patients with laryngeal cancer

Background:

Laryngeal cancer patients who continue to smoke after treatment are at an elevated risk of mortality and morbidity. This study aimed to identify factors associated with continued tobacco use following treatment in patients with laryngeal cancer.

Methods:

A smoking behaviour questionnaire, a self-report measure, was sent to 112 patients who were diagnosed with laryngeal cancer during 2006–2011 at the Brighton and Sussex University Hospitals, Brighton, UK. Patient demographics, tumour and treatment-related variables, comorbidity and socio-economic status were obtained from the medical records.

Results:

Eighty-one per cent of patients responded to the survey; 22 per cent of these reported continued tobacco use after treatment. Treatment modality was found to be a predictor of post-therapeutic smoking (odds ratio: 4.9, p = 0.01); patients who received less invasive therapy (transoral laser microsurgery) were more likely to smoke after treatment.

Conclusions:

The findings of this preliminary study suggest that treatment modality influences smoking behaviour in patients with laryngeal cancer, which may have important implications for the design of anti-smoking interventions.

Evaluation of lasersurgery and radiotherapy as treatment modalities in early stage laryngeal carcinoma: tumour outcome and quality of voice

For treatment of early stage (Tis-T2) laryngeal cancer the main choice is between microlaryngoscopy with carbon dioxide laser resection (laser surgery) and radiotherapy. Because both treatments provide excellent tumour control, secondary outcome variables such, as quality of voice may be of importance in treatment preference. In this study tumour outcomes and quality of voice were analysed for a cohort of patients with early stage (Tis-T2) laryngeal (glottic) carcinoma. The "physical subscale" of the voice handicap index questionnaire (VHI) and a validated five-item screening questionnaire were used. Analysis of 89 patients treated with laser surgery and 159 patients treated with radiotherapy revealed a 5-year local control of 75 and 86 % (p = 0.07). Larynx preservation (5-year) was, however, superior in patients treated with laser surgery, 93 vs 83 % (p < 0.05). Tumour outcomes were also analysed per tumour stage and none were of significant difference. Quality of voice was analysed in 142 patients. VHI scores were 12.4 ± 8.9 for laser surgery and 8.3 ± 7.7 for radiotherapy (p < 0.05), with a higher score reflecting a worse outcome. VHI scores per tumour stage for laser surgery and radiotherapy were, respectively, 12.0 ± 9.9 and 7.9 ± 7.5 in T1a (p = 0.06), 16.7 ± 9.0 and 4.9 ± 6.6 in T1b (p < 0.05). Outcomes of the five-item questionnaire showed voice deficiency in 33 % for laser surgery and 23 % for radiotherapy in T1a (p = 0.330) and 75 and 5 % for T1b (p = 0.001). Oncologic outcomes of laser surgery and radiotherapy were comparable. Larynx preservation is, however, preferable in patients initially treated with laser surgery. According to subjective voice analysis, outcomes were comparable in T1a lesions. Depth of laser resection is of influence on voice deficiency displayed by a significantly higher percentage of voice deficiency in patients treated with laser surgery for T1b lesions.

Middle frontal horizontal partial laryngectomy (MFHPL): a treatment for stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure

Objective

The therapeutic effect of middle frontal horizontal partial laryngectomy (MFHPL) in treating stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure (AVC) was compared with that of the anterior frontolateral vertical partial laryngectomy (AFVPL). The feasibility and practical significance of MFHPL in clinical application was discussed in the present study.

Methods

From January 1996 to January 2010, a total of 65 patients diagnosed with stage T1bN0M0 glottic laryngeal cancer were treated with MFHPL or AFVPL. The postoperative complications, glottic reconstruction, recurrence rate, voice quality and survival rates were evaluated and compared between two treatments.

Results

AFVPL and MFHPL were performed in 34 and 31 patients, respectively. Flexible fiberoptic laryngoscopy revealed that in the MFHPL-treated patients the reconstructed glottis was spacious and symmetric. In contrast, AFVPL treatment resulted in irregular glottic area with poor symmetry and tubular glottis. The incidence of postoperative laryngeal stenosis significantly differed between the MFHPL- and AFVPL-treated groups (P = 0.025). No significant difference was detected in the 3- and 5-year overall- or tumor-free survival rates between two treatments. The Voice Handicap Index (VHI) and maximum phonation time (MPT) after surgery were 51.0±12.99 and 12.42±3.44 sec in the AFVPL-treated group; while in the MFHPL-treated patients they were 31.81±7.48 and 7.65±1.98 sec, respectively. Both differences in VHI (P = 0.012) and MPT (P = 0.024) were significant between two treatments.

Conclusions

MFHPL was comparable to AFVPL with respect to postoperative complications, recurrence rate and survival rates, but possessed advantages over AFVPL in terms of the incidence of laryngeal stenosis and voice quality. Our study indicated that MFHPL has a potential value in clinical practice of treating stage T1b squamous cell carcinoma of the glottic larynx involving AVC.

Preservation of organ function in head and neck cancer

Preservation of function is a crucial aspect for the evaluation of therapies applied in the field of head and neck cancer. However, preservation of anatomic structures cannot automatically be equated with preservation of function. Functional outcome becomes increasingly important particularly for the evaluation of alternative treatment options with equivalent oncological outcomes.AS A RESULT, PRESENT STUDIES TAKE INTO ACCOUNT THREE TOPIC AREAS WITH VARYING EMPHASIS: (1) the effects of cancer therapy on essential physiological functions, (2) additional therapy-induced side-effects and complications, and (3) health-related quality of life. The present article summarizes vital aspects of clinical research from recent years. Functional outcomes after surgical and non-surgical treatment approaches are presented according to tumor localization and staging criteria. Additional methodological aspects relating to data gathering and documentation as well as challenges in implementing the results in clinical practice are also discussed.

Functional organ preservation in laryngeal and hypopharyngeal cancer

The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.

Transoral laser microsurgery elevates fundamental frequency in early glottic cancer

OBJECTIVE

To evaluate the long-term voice characteristics and quality of life of early glottic cancer patients after definitive treatment.

STUDY DESIGN

Case series with chart review in a tertiary care medical center in Taiwan.

METHODS

Forty-two consecutive patients who received radiation therapy (RT) or transoral laser microsurgery (TLM) for early glottic cancer over 12 months were evaluated for voice laboratory data and quality-of-life measurements.

RESULTS

Twenty-four patients received RT, and 18 underwent TLM. There was no difference between the two groups on acoustic and aerodynamic voice measures except for modal fundamental frequency in males. In the Functional Assessment of Cancer Therapy-Head and Neck survey, the TLM group had better communication than the RT group, but there were no differences in voice quality and strength. There was also no significant difference in the Voice Handicap Index 10 evaluation.

CONCLUSIONS

Male patients who received TLM have higher modal fundamental frequency than male patients who received RT and norms. Voice-related life quality is similar in patients regardless of RT or TLM treatment for early glottic cancer, but those who receive TLM have better communication abilities than those who receive RT.

Supracricoid partial laryngectomy with cricothyroidopexy: a treatment for anterior vocal commissure laryngeal squamous carcinoma

BACKGROUND

The clinical efficiency and functional outcomes of supracricoid partial laryngectomy (SCPL) with cricothyroidopexy (CTP) were compared with those of the traditional SCPL with cricohyoidoepiglottopexy (CHEP) in treating laryngeal squamous carcinoma involving anterior vocal commissure (AVC).

METHODS

From January 2000 to June 2009, 50 patients diagnosed with early- or intermediate-stage (T1b-T3 classification) glottic cancer involving AVC were treated with SCPL-CHEP or SCPL-CTP. Postoperative complications, local recurrence, survival rate, and speech performance were compared between these 2 surgical procedures.

RESULTS

Patients undergoing SCPL-CHEP or SCPL-CTP manifested similar levels of postoperative complications, tumor recurrence, and survival rates. However, the SCPL-CTP group showed significantly lower Voice Handicap Index (VHI) scores, higher maximum phonation time, and improved glottic reconstruction and closure than the SCPL-CHEP group.

CONCLUSION

The SCPL-CTP procedure better preserves postoperative speech performance than the SCPL-CHEP procedure, underscoring the moderate effectiveness of SCPL-CTP as a treatment for laryngeal squamous carcinoma involving AVC.