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

Abstract

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.

• Authors: Leena-Maija Aaltonen, Noora Rautiainen, Jaana Sellman, Kauko Saarilahti, Antti Mäkitie, Heikki Rihkanen, Jussi Laranne, Leenamaija Kleemola, Tuija Wigren, Eeva Sala, Paula Lindholm, Reidar Grenman, Heikki Joensuu
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 90 Issue 2 Pg. 255-60 (Oct 01 2014) ISSN: 1879-355X [Electronic] United States
• PMID: 25304787 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell (pathology, radiotherapy, surgery)
• Dose Fractionation, Radiation
• Finland
• Humans
• Laryngeal Neoplasms (pathology, radiotherapy, surgery)
• Laser Therapy
• Lasers, Gas (therapeutic use)
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Vocal Cords (radiation effects)
• Voice Disorders (etiology, physiopathology)
• Voice Quality (radiation effects)