Abstract
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.
Highlights
Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Charitéplatz 1, Fraunhofer Institute for Open Communication Systems, Kaiserin-Augusta-Allee 31, D-10589 Berlin, Germany; Klinikum Mutterhaus der Borromäerinnen, Academic Teaching Hospital of Johannes Gutenberg-Universität
It represents a sensitive measure of voice function for quantification of vocal performance
T1 and early T2 glottic carcinomas have a very good prognosis due to the early symptom of hoarseness, which usually leads to a quick diagnosis and prompt initiation of published maps and institutional affiliations
Summary
Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. 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). 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. Carcinoma in situ (Tis) must be differentiated from T1 and T2 laryngeal cancer. Invasive T1 glottic cancer is limited to one (T1a) or both (T1b) vocal folds (VF) with normal respiratory but impaired phonatory VF mobility. T1 and early T2 glottic carcinomas have a very good prognosis due to the early symptom of hoarseness, which usually leads to a quick diagnosis and prompt initiation of published maps and institutional affiliations
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