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Evaluation of lasersurgery and radiotherapy as treatment modalities in early stage laryngeal carcinoma: tumour outcome and quality of voice

  • Laryngology
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Abstract

For treatment of early stage (Tis-T2) laryngeal cancer the main choice is between microlaryngoscopy with carbon dioxide laser resection (laser surgery) and radiotherapy. Because both treatments provide excellent tumour control, secondary outcome variables such, as quality of voice may be of importance in treatment preference. In this study tumour outcomes and quality of voice were analysed for a cohort of patients with early stage (Tis-T2) laryngeal (glottic) carcinoma. The “physical subscale” of the voice handicap index questionnaire (VHI) and a validated five-item screening questionnaire were used. Analysis of 89 patients treated with laser surgery and 159 patients treated with radiotherapy revealed a 5-year local control of 75 and 86 % (p = 0.07). Larynx preservation (5-year) was, however, superior in patients treated with laser surgery, 93 vs 83 % (p < 0.05). Tumour outcomes were also analysed per tumour stage and none were of significant difference. Quality of voice was analysed in 142 patients. VHI scores were 12.4 ± 8.9 for laser surgery and 8.3 ± 7.7 for radiotherapy (p < 0.05), with a higher score reflecting a worse outcome. VHI scores per tumour stage for laser surgery and radiotherapy were, respectively, 12.0 ± 9.9 and 7.9 ± 7.5 in T1a (p = 0.06), 16.7 ± 9.0 and 4.9 ± 6.6 in T1b (p < 0.05). Outcomes of the five-item questionnaire showed voice deficiency in 33 % for laser surgery and 23 % for radiotherapy in T1a (p = 0.330) and 75 and 5 % for T1b (p = 0.001). Oncologic outcomes of laser surgery and radiotherapy were comparable. Larynx preservation is, however, preferable in patients initially treated with laser surgery. According to subjective voice analysis, outcomes were comparable in T1a lesions. Depth of laser resection is of influence on voice deficiency displayed by a significantly higher percentage of voice deficiency in patients treated with laser surgery for T1b lesions.

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Author notes

  1. F. J. P. Hoebers

    Present address: Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands

  2. A. J. Remmelts

    Present address: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands

Authors and Affiliations

  1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, PO Box 1066 CX, Amsterdam, The Netherlands

    A. J. Remmelts, W. M. C. Klop, A. J. M. Balm & M. W. M. van den Brekel

  2. Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    W. M. C. Klop, A. J. M. Balm & M. W. M. van den Brekel

  3. Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    F. J. P. Hoebers & O. Hamming-Vrieze

  4. Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands

    M. W. M. van den Brekel

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  1. A. J. Remmelts
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Appendix 1

Appendix 1

See Tables 7 and 8.

Table 7 Overview of five-item questionnaire (designed by VUmc: Amsterdam, The Netherlands)
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Table 8 Overview of voice handicap index (VHI) questionnaire, physical subscale
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Remmelts, A.J., Hoebers, F.J.P., Klop, W.M.C. et al. Evaluation of lasersurgery and radiotherapy as treatment modalities in early stage laryngeal carcinoma: tumour outcome and quality of voice. Eur Arch Otorhinolaryngol 270, 2079–2087 (2013). https://doi.org/10.1007/s00405-013-2460-x

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