Skip to main content

Voice outcomes following transoral laser microsurgery for early glottic squamous cell carcinoma

  • J T Kennedy (a1), P M Paddle (a1), B J Cook (a1), P Chapman (a2) and T A Iseli (a1)...

Early glottic cancer may be treated with primary radiotherapy or transoral laser microsurgery with comparable survival. The choice of therapy therefore depends on patient preference after discussion of risks, benefits and alternatives.

Materials and methods:

All previously untreated patients undergoing transoral laser microsurgery for T1 or T2 glottic cancer at St Vincent's Hospital between July 1997 and December 2004 had their staging and demographics recorded. Surgery was categorised according to the European Laryngological Society. A voice recording was made pre-operatively then at 12 weeks post-operatively and scored by two independent speech therapists on the Oates Russell Voice Profile – a scale of zero (normal) to five (severe dysphonia). Follow up was for a minimum of two years.

Results and analysis:

Fifty-three patients with a mean age of 56 were included. The observed survival was T1 89.4 per cent and T2 85.3 per cent after a mean follow up of 47 months. Nineteen patients staged T1 underwent cordectomy. A second procedure was required in 22.2 per cent, however, none required a laryngectomy. Thirty-four patients staged T2 underwent hemilaryngectomy. A second procedure was required in 41.2 per cent including 8.8 per cent requiring salvage laryngectomy. One patient died with unresectable nodal disease. The mean Oates Russell Voice Profile for T1 disease was 2.37 and for T2 2.68 (range 1 to 4) indicating a mild (2) to moderate (3) degree of voice impairment.


Survival outcomes following transoral laser microsurgery are comparable to treatment with radiotherapy. Voice impairment is usually mild to moderate following transoral laser microsurgery for early glottic cancer but overall may be greater than in radiotherapy patients. The repeatability of transoral laser microsurgery may result in a lower laryngectomy rate compared with published series using radiotherapy.

Corresponding author
Address for correspondence: Mr Tim Iseli, Suite 90, level 9, 166 Gipps St, East Melbourne VIC 3002, Australia. Fax: 613 9288 4650 E-mail:
Hide All
1 AIHW & AACR. Cancer in Australia 2001. Canberra: AIHW & AACR, 2004;78–9 available at: [20 February 2006]
2 Hoffman, HT, Karnell, LH. Laryngeal cancer. In: Steele, GD, Jessup, JM, Winchester, DP, Menck, HR, Murphy, GP, eds. National Cancer Database Annual Review of Patient Care, 1995. Atlanta: American Cancer Society, 1995;84100
3 Dey, P, Arnold, D, Wight, R, MacKenzie, K, Kelly, C, Wilson, J. Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database Syst Rev 2003;2: CD002027. DOI: 10.1002/14651858.CD002027
4 Strong, MS, Jako, GJ. Laser surgery in the larynx: early clinical experience with continuous CO2 laser. Ann Otol Rhinol Laryngol 1972;1:791–3
5 Steiner, W. Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 1993;14:116–21
6 Shah, JP, Karnell, LH, Hoffman, HT, Ariyan, S, Brown, G, Fee, E et al. Patterns of care for cancer of the larynx in the United States. Arch Otolaryngol Head Neck Surg 1997;123:475–83
7 Parson, JT, Greene, BD, Speer, TW, Kirkpatrick, SA, Barhorst, DB, Yanckowitz, T. Treatment of early and moderately advanced vocal cord carcinoma with 6 MV X-rays. J Radiat Oncol Biol Phys 2001;50:953–9
8 Remacle, M, Eckel, HE, Antonelli, A, Brasnu, D, Chevalier, D, Friedrich, G et al. . Endoscopic cordectomy: a proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 2000;257:227–31
9 Oates, J, Russell, A. Learning voice analysis using an interactive multi-media package: development and preliminary evaluation. J Voice 1998;12:500–12
10 Cragle, S, Brandenburg, J. Laser cordectomy or radiotherapy: cure rates, communication and cost. Otolaryngol Head Neck Surg 1993;108:648–51
11 Casiano, RR, Cooper, JD, Lundy, DS, Chandler, JR. Laser cordectomy for T1 glottic cancer: a 10-year experience and videostroboscopic findings. Otolaryngol Head Neck Surg 1991;104:831–5
12 Epstein, BE, Lee, DJ, Kashima, H, Johns, ME. Stage T1 glottic carcinoma: results of radiation therapy or laser excision. Radiology 1992;101:4954
13 Hoyt, DJ, Lettinga, JW, Leopold, KA, Fisher, SR. The effect of head and neck radiation therapy on voice quality. Laryngoscope 1992;102:477–80
14 Rydell, R, Schalen, L, Fex, S, Elner, A. Voice evaluation before and after laser excision vs. radiotherapy of T1A glottic carcinoma. Acta Otolaryngol (Stockh) 1995;115:560–5
15 Schuller, DE, Trudeau, M, Bistline, J, LaFace, K. Evaluation of voice by patients and close relatives following different laryngeal cancer treatments. J Surg Oncol 1990;44:1014
16 Ton-Van, J, Stern, JC, Buisset, E, Coche-Dequeant, B, Vankemmel, B. Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas. Am J Surg 1991;162:337–40
17 Howell-Burke, D, Peters, LJ, Goepfert, H, Oswald, MJ. T2 glottic cancer: recurrence, salvage, and survival after definitive radiotherapy. Arch Otolaryngol Head Neck Surg 1990;116:830–5
18 DeSanto, LW. Early supraglottic cancer. Ann Otol Rhinol Laryngol 1990;99:593–8
19 Morris, MR, Canonico, D, Blank, C. A critical review of radiotherapy in the management of T1 glottic carcinoma. Am J Otolaryngol 1994;15:276–34
20 Jorgensen, K, Godballe, C, Hansen, O. Cancer of the larynx treatment results after primary radiotherapy with salvage surgery in a series of 1005 patients. Acta Oncologica 2002;41:6976
21 Chevalier, D, Laccourreye, O, Brasnu, D, Laccourreye, H, Piquet, JJ. Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncology results with 112 patients. Ann Otol Rhinol Laryngol 1997;106:364–9
22 Shah, JP, Loree, TR, Kowalski, L. Conservation surgery for radiation failure in carcinoma of the glottic larynx. Clin Otolaryngol 1994;19:105–8
23 Eckel, HE. Local recurrence following transoral laser surgery for early glottic carcinoma: frequency, management and outcome. Ann Otol Rhinol Laryngol 2001;110:715
24 Steiner, W, Vogt, P, Ambrosch, P, Kron, M. Transoral carbon dioxide laser microsurgery for recurrent glottic carcinoma after radiotherapy. Head & Neck 2004;26:477–84
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed