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

Published online by Cambridge University Press:  20 April 2007

J T Kennedy ,
P M Paddle ,
B J Cook ,
P Chapman  and
T A Iseli
J T Kennedy
Affiliation:
Department of Otolaryngology, Head and Neck Surgery St Vincent's Hospital, Victoria, Australia.
P M Paddle
Affiliation:
Department of Otolaryngology, Head and Neck Surgery St Vincent's Hospital, Victoria, Australia.
B J Cook
Affiliation:
Department of Otolaryngology, Head and Neck Surgery St Vincent's Hospital, Victoria, Australia.
P Chapman
Affiliation:
Department of Speech Pathology, St Vincent's Hospital, Victoria, Australia
T A Iseli*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery St Vincent's Hospital, Victoria, Australia.
*
Address for correspondence: Mr Tim Iseli, Suite 90, level 9, 166 Gipps St, East Melbourne VIC 3002, Australia. Fax: 613 9288 4650 E-mail: iselitim@hotmail.com
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Abstract

Introduction:

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.

Conclusions:

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.

Keywords

Laser SurgeryLarynx NeoplasmsVoice

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 121 , Issue 12 , December 2007 , pp. 1184 - 1188
Copyright
Copyright © JLO (1984) Limited 2007

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