Quality of life and voice outcome of patients treated with transoral CO2 laser microsurgery for early glottic carcinoma (T1\u2013T2): a 2-year follow-up study

Martine Hendriksma,Ton P M Langeveld,Yda Van Loon,Robert J Baatenburg De Jong,W Martin C Klop,Martin De Jong,Elisabeth V Sjögren,Ibtissam El Hasnaoui,Marieke M Hakkesteegt,Peter Paul G Van Benthem,Bas J Heijnen

doi:10.1007/s00405-019-05348-1

Abstract

PurposeLongitudinal 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).MethodsThree 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.ResultsSixty-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.ConclusionsPatients 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.

Highlights

Glottic carcinoma (Tis-T2) can be treated effectively with radiotherapy or transoral C O2 laser microsurgery (TLM)
According to the Dutch Guidelines for laryngeal carcinoma, TLM is the advocated treatment for superficial midcord T1a glottic carcinoma, and radiotherapy is indicated for more extended T1 and T2 glottic carcinomas [1]
The effect of time on the different questionnaires was assessed with the linear mixed model analysis; the model was adjusted for four possible confounders: gender, tumor stage, type of resection, and involvement of the anterior commissure (AC; no involvement vs. unilateral or bilateral involvement)

Summary

Introduction

Glottic carcinoma (Tis-T2) can be treated effectively with radiotherapy or transoral C O2 laser microsurgery (TLM). According to the Dutch Guidelines for laryngeal carcinoma, TLM is the advocated treatment for superficial midcord T1a glottic carcinoma, and radiotherapy is indicated for more extended T1 and T2 glottic carcinomas [1]. There is less data on the functional outcomes of these treatment modalities, such as quality of life (QoL) and voice outcome, in patients with T2 glottic carcinoma [7]. The lack of these data often prohibits adequate comparisons of modalities in patient counseling.

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Results

Conclusion