Abstract
Dysphonia is common among patients with early stage glottic cancer. Laryngeal videostroboscopy (LVS) has not been routinely used to assess post-radiotherapy (RT) voice changes. We hypothesized that LVS would demonstrate improvement in laryngeal function after definitive RT for early-stage glottic cancer. Blinded retrospective review of perceptual voice and stroboscopic parameters for patients with early glottic cancer and controls. High-volume, single-institution academic medical center. Fifteen patients underwent RT for Tis-T2N0M0 glottic cancer and were evaluated with serial LVS exams pre- and post-RT. Stroboscopic assessment included six parameters: vocal fold (VF) vibration, VF mobility, erythema/edema, supraglottic compression, glottic closure, and secretions. Grade, roughness, breathiness, asthenia, strain (GRBAS) voice perceptual scale was graded in tandem with LVS score. Assessments were grouped by time interval from RT: pre-RT, 0-4, 4-12, and >12 months post-RT. 60 LVS exams and corresponding GRBAS assessments were reviewed. There were significant improvements in ipsilateral VF motion (P = 0.03) and vibration (P = 0.001) and significant worsening in contralateral VF motion (P < 0.001) and vibration (P = 0.008) at >12 months post-RT. Glottic closure significantly worsened, most prominent >12 months post-RT (P = 0.01). Composite GRBAS scores were significantly improved across all post-RT intervals. LVS proved to be a robust tool for assessing pre- and post-RT laryngeal function. We observed post-RT improvement in ipsilateral VF function, a decline in contralateral VF function, and decreased glottic closure. These results demonstrate that LVS can detect meaningful changes in VF and glottic function and support its use for post-RT evaluation of glottic cancer patients.
Highlights
Voice preservation is a key consideration in treatment selection for patients with early stage glottic cancers
We observed post-RT improvement in ipsilateral vocal fold (VF) function, a decline in contralateral VF function, and decreased glottic closure. These results demonstrate that Laryngeal videostroboscopy (LVS) can detect meaningful changes in VF and glottic function and support its use for post-RT evaluation of glottic cancer patients
The proportion of patients treated with conventional RT and intensity modulated radiation therapy (IMRT) was 47 and 53%, respectively
Summary
Voice preservation is a key consideration in treatment selection for patients with early stage glottic cancers. Definitive radiotherapy (RT) has been a mainstay in the management of this disease with excellent local control and survival rates [1,2,3,4]. Concerns remain regarding the late effects of RT including fibrosis, chronic edema, laryngeal stenosis, and xerostomia, all of which can impact voice outcomes and quality of life. The advent of endoscopic laser surgery (ELS) has introduced a relative shift in the treatment paradigm for this disease, as it offers comparable local control and laryngeal preservation rates to RT with limited morbidity and a range of therapeutic options for persistent and recurrent disease including repeat surgery and RT [5]. Efforts have been made to compare voice outcomes between definitive RT and ELS, but results have been highly variable. There is a lack of standardization in the evaluation of posttreatment dysphonia [17, 18]
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