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Evaluation of Voice After Definitive Radiotherapy in Patients of Early Stage Squamous Cell Carcinoma of Larynx (Glottis): A Prospective Observational Study

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Abstract

Post treatment voice quality is an important consideration in choosing the management option for laryngeal cancer. We assessed voice quality after radiotherapy in patients of early squamous cell carcinoma of glottis comprehensively using Videolaryngostroboscopy (VLS), Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scores and Voice Handicap Index (VHI)-10. Fifty four consenting patients of early squamous cell carcinoma of glottis (Tis, T1 and T2) awaiting definitive radiotherapy were recruited consecutively. Voice was evaluated by VLS, GRBAS scores and VHI-10 before radiotherapy as well as 3 months and 12 months after radiotherapy. There were 52 males and 2 females in the study. Hoarseness of voice was the commonest presenting symptom. Mean duration of symptoms was 2.45 months (± 0.80), ranging from 1 to 4 months. 35 (64.82%) were T1 while 19 (35.18%) were T2 lesions. They received 60–70 Gy of radiotherapy in 28–35 fractions. There was only one recurrence on follow up for 12 months. On VLS at 12 months post-RT the periodicity, phase symmetry, mucosal waves and amplitude were normal in 74.07%, 70.37%, 56.67% and 78.7% cases respectively. Complete glottic closure was obtained in 72.22%. The voice was ‘acceptable’ (Grade 1 or 2 on VLS parameters) in more than 90% cases. Mean total GRBAS score was 3.39 (± 2.67). Mean total VHI-10 was 6.7 (± 1.75). All indices were significantly better than pre RT levels. Good quality of voice can be expected after radiotherapy for early glottic cancer in majority of patients.

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References

  1. Merrill RM, Anderson AE, Sloan A (2011) Quality of life indicators according to voice disorders and voice-related conditions. Laryngoscope 121(9):2004–2010. https://doi.org/10.1002/lary.21895

    Article  PubMed  Google Scholar 

  2. Merrill RM, Tanner K, Merrill JG, McCord MD, Beardsley MM, Steele BA (2013) Voice symptoms and voice-related quality of life in college students. Ann Otol Rhinol Laryngol 122(8):511–519. https://doi.org/10.1177/000348941312200806

    Article  PubMed  Google Scholar 

  3. Bobdey S, Jain A, Balasubramanium G (2015) Epidemiological review of laryngeal cancer: an Indian perspective. Ind J Med Paediatr Oncol 36(3):154–160. https://doi.org/10.4103/0971-5851.166721

    Article  Google Scholar 

  4. Schultz P (2011) Vocal fold cancer. Euro Ann Otorhinolaryngol Head Neck Dis 128:301–308. https://doi.org/10.1016/j.anorl.2011.04.004

    Article  CAS  Google Scholar 

  5. Campos RJ, Maciel CT, Cesca MG, Leite IC (2011) Voice analysis after cancer treatment with organ preservation. Head Neck Oncol 3:19. https://doi.org/10.1186/1758-3284-3-19

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bless DM, Hirano M, Feder RJ (1987) Videostroboscopic evaluation of the larynx. Ear Nose Throat J 66:289–296

    CAS  PubMed  Google Scholar 

  7. Hirano M (1981) “GRBAS” scale for evaluating the hoarse voice & frequency range of phonation. In: Hirano M (ed) Clinical examination of voice, vol 5. Springer, New York, pp 83–89

    Google Scholar 

  8. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T (2004) Development and validation of the voice handicap index-10. Laryngoscope 114(9):1549–1556. https://doi.org/10.1097/00005537-200409000-00009

    Article  PubMed  Google Scholar 

  9. Marciscano AE, Charu V, Starmer HM, Best SR, Quon H, Hillel AT et al (2017) Evaluating post-radiotherapy laryngeal function with laryngeal videostroboscopy in early stage glottic cancer. Front Oncol. https://doi.org/10.3389/fonc.2017.00124

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ansarin M, Santoro L, Cattaneo A, Massaro MA, Calabrese L, Giugliano G, Maffini F et al (2009) Laser surgery for early glottic cancer impact of margin status on local control and organ preservation. Arch Otolaryngol Head Neck Surg 135(4):385–390. https://doi.org/10.1001/archoto.2009.10

    Article  PubMed  Google Scholar 

  11. Kuper H, Boffetta P, Adami HO (2002) Tobacco use and cancer causation: association by tumour type. J Intern Med 252:206–224. https://doi.org/10.1046/j.1365-2796.2002.01022.x

    Article  CAS  PubMed  Google Scholar 

  12. Boffetta P, Hashibe M (2006) Alcohol and cancer. Lancet Oncol 7:149–156. https://doi.org/10.1016/S1470-2045(06)70577-0

    Article  CAS  PubMed  Google Scholar 

  13. Lee SH, Hong KH, Kim JS, Hong YT (2019) Perceptual and acoustic outcomes of early-stage glottic cancer after laser surgery or radiotherapy: a meta-analysis. Clin Exp Otorhinolaryngol 12(3):241–248. https://doi.org/10.21053/ceo.2018.00990

    Article  PubMed  PubMed Central  Google Scholar 

  14. Langevin SM, Michaud DS, Marsit CJ et al (2013) Gastric reflux is an independent risk factor for laryngopharyngeal carcinoma. Cancer Epidemiol Biomark Prev 22(6):1061–1068. https://doi.org/10.1158/1055-9965

    Article  Google Scholar 

  15. Watson M, Drosdowsky A, Frowen J, Corry J (2018) Voice outcomes after radiotherapy treatment for early glottic cancer: long-term follow-up. J Voice 32(5):636–642. https://doi.org/10.1016/j.jvoice.2017.08.025

    Article  PubMed  Google Scholar 

  16. Tripathi N, Verma RK, Panda NK, Ghosal S, Sharma A (2014) Early evaluation of voice quality in glottic cancer(T1, T2) following curative radiotherapy. Rev Laryngol Otol Rhinol (Bord) 135(2):91–96

    CAS  PubMed  Google Scholar 

  17. Wedman J, Heimdal JH, Elstad I, Olofsson J (2002) Voice results in patients with T1a glottic cancer treated by radiotherapy or endoscopic measures. Eur Arch Otorhino Laryngol 259(10):547–550. https://doi.org/10.1007/s00405-002-0478-6

    Article  CAS  Google Scholar 

  18. Oridate N, Homma A, Suzuki S, Nakamaru Y, Suzuki F, Hatakeyama H et al (2009) Voice-related quality of life after treatment of laryngeal cancer. Arch Otolaryngol Head Neck Surg 135:363–368. https://doi.org/10.1001/archoto.2009.8

    Article  PubMed  Google Scholar 

  19. Goor KM, Peeters AJGE, Mahieu HF, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM et al (2007) Cordectomy by CO2 laser or radiotherapy for small T1a glottis carcinomas: costs, local control, survival, quality of life, and voice quality. Head Neck 29:128–136. https://doi.org/10.1002/hed.20500

    Article  PubMed  Google Scholar 

  20. Nunez Batalla F, Caminero Cueva MJ, Senaris Gonzalez B, Llorente Pendas JL, Gorriz Gil C, Lopez Llames A et al (2008) Voice quality after endoscopic laser surgery and radiotherapy for early glottic cancer: objective measurements emphasizing the voice handicap index. Eur Arch Otorhinolaryngol 265:543–548. https://doi.org/10.1007/s00405-007-0512-9

    Article  PubMed  Google Scholar 

  21. Dinapoli N, Parrilla C, Galli J, Autorino R, Micciche F, Bussu F et al (2010) Multi -disciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in a homogenous patient population. Strahlenther Onkol 186:607–613. https://doi.org/10.1007/s00066-010-2142-1

    Article  PubMed  Google Scholar 

  22. Aaltonen LM, Rautiainen N, Sellman J, Saarilahti K, Mäkitie A, Rihkanen H et al (2014) Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy. Int J Radiat Oncol Biol Phys 90(2):255–260. https://doi.org/10.1016/j.ijrobp.2014.06.032

    Article  PubMed  Google Scholar 

  23. Peeters AJGE, van Gogh CD, Goor KM, Verdonck- de Leeuw IM, Langendijk JA, Mahieu HF (2004) Health status and voice outcome after treatment for T1a glottic carcinoma. Eur Arch Otorhinolaryngol 261:534–540. https://doi.org/10.1007/s00405-003-0697-5

    Article  PubMed  Google Scholar 

  24. Ma Y, Green R, Pan S, McCabe D, Goldberg L, Woo P (2019) Long term voice outcome following radiation versus laser microsurgery in early glottis cancer. J Voice 33(2):176–182. https://doi.org/10.1016/j.jvoice.2017.10.018

    Article  PubMed  Google Scholar 

  25. Musio D, De Felice F, Bigelli C, Bulzonetti N, Guarnaccia R, Tombolini M et al (2014) An analysis of the global and partial voice handicap index in patients with early glottic carcinoma treated with high level of irradiation. J Cancer Ther 5:21–27. https://doi.org/10.4236/jct.2014.51003

    Article  Google Scholar 

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Funding

We are grateful to the Director General, Armed Forces Medical Services, India for providing financial aid for this study through Armed Forces Medical Research Committee Project No 4650/2015.

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Authors and Affiliations

  1. Department of ENT-Head Neck Surgery, Base Hospital Delhi Cantt, New Delhi, India

    Awadhesh Kumar Mishra

  2. Venkateshwar Hospital, Dwarka, New Delhi, India

    Vivek Raj Sinha

  3. Command Hopital (SC), Pune, 411040, India

    Virender Suhag

  4. Military Hospital, Pathankot, India

    Ajith Nilakantan

Authors
  1. Awadhesh Kumar Mishra
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  2. Vivek Raj Sinha
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  3. Virender Suhag
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  4. Ajith Nilakantan
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Contributions

AKM: Study Supervision, Data analysis, Drafting manuscript, Approval of final version. VRS: Study concept, Data acquisition, manuscript revision, Approval of final version. VS: Study design, Data acquisition, Drafting manuscript, Approval of final version. AN: Study Concept, Data Analysis, Manuscript revision, Approval of final version.

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Correspondence to Awadhesh Kumar Mishra.

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All authors declare that there is no conflict of interest.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration (as amended). The study was approved by the Institutional Ethics Committee of Army Hospital (R&R) Delhi Cantt. Informed consent was taken from all participants to participate and for publication.

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Mishra, A.K., Sinha, V.R., Suhag, V. et al. Evaluation of Voice After Definitive Radiotherapy in Patients of Early Stage Squamous Cell Carcinoma of Larynx (Glottis): A Prospective Observational Study. Indian J Otolaryngol Head Neck Surg 74 (Suppl 2), 2386–2394 (2022). https://doi.org/10.1007/s12070-020-02193-1

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  • DOI: https://doi.org/10.1007/s12070-020-02193-1

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