Prospective evaluation of voice outcome during the first two years in male patients treated by radiotherapy or laser surgery for T1a glottic carcinoma

Christine D L Van Gogh,Johannes A Langendijk,Hans F Mahieu,Irma M Verdonck-De Leeuw,Jeanne Wedler-Peeters

doi:10.1007/s00405-012-1947-1

Abstract

In this prospective cohort study, we assessed voice outcome in patients before and up to 2 years after treatment for early glottic cancer either by radiotherapy or by laser surgery; 106 male patients, treated for T1aN0M0 glottic cancer either by endoscopic laser surgery (n = 67) or by radiotherapy (n = 39), participated in the study. Patients’ voices were recorded and analysed pre-treatment and 3, 6, 12 and 24 months post-treatment at their routine visit at the outpatient clinic. Average fundamental frequency (F0), percent jitter, percent shimmer and normalized noise energy (NNE) were determined. After 2 years, local control rate was 95% in the radiotherapy group and 97% in the laser surgery group. Larynx preservation rate was 95% after radiotherapy and 100% after laser surgery. Voice outcome recovers more quickly in patients treated with laser surgery in comparison to radiotherapy: 3 months after laser surgery there is no longer a difference with regard to normal voices except for the fundamental frequency, which remains higher pitched, even in the longer term. For patients treated with radiotherapy it takes longer for jitter, shimmer and NNE to become normal, where jitter remains significantly different from normal voices even after 2 years. According to these results, we believe that laser surgery is the first treatment of choice in the treatment of selected cases of T1a glottic carcinomas with good functional and oncological results.

Highlights

Until about a decade ago, radiotherapy was the first choice of treatment for patients with early glottic cancer
Voice outcome recovers more quickly in patients treated with laser surgery in comparison to radiotherapy: 3 months after laser surgery there is no longer a difference with regard to normal voices except for the fundamental frequency, which remains higher pitched, even in the
It must be kept in mind that there is some selection bias because of the deliberate selection of tumours treatable by laser surgery, it can be concluded that laser surgery for T1a glottic carcinomas results in excellent treatment outcome

Summary

Introduction

Until about a decade ago, radiotherapy was the first choice of treatment for patients with early glottic cancer. Cure rates are the major criterion in determining the treatment of choice. Since both treatment modalities provide good local control of approximately 90%, other criteria become important in determining the first treatment of choice [1,2,3,4,5,6]. One of these other criteria is the consideration that radiotherapy can be delivered only once at the same target area, while laser surgery can be performed repeatedly. Another argument against radiotherapy is that laser surgery is much more cost-effective than radiotherapy [7,8,9]

Methods

Results

Conclusion