Are Patient-Reported Voice Outcomes Better after Surgery or after Radiation for Treatment of T1 Glottic Carcinoma?

Background

Patients with early glottic carcinoma have several treatment options; endoscopic surgical resection and radiation therapy (XRT) are the most common choices. Both the carcinoma itself and its treatment can have an impact on voice. A variety of factors may be considered when a management plan is considered. Survival and overall organ preservation following treatment of T1 glottic carcinomas are thought to be similar between surgery and XRT. Some question remains, however, about phonatory function following treatment; other factors such as location of tumor and psychosocial considerations may also play a role in these outcomes. The objective of this review is to examine the current literature with respect to voice outcomes after treatment of T1 glottic carcinomas with surgical excision or with XRT.

Intuitively, it is apparent that not all T1 tumors are equivalent with respect to voice impact, given the variety of tumor location and depth of invasion that could be included within the category of T1. Comparison of treatment modalities in terms of voice impact can be made using a variety of metrics, including patient-reported outcomes, objective acoustic measures, perceptual ratings, aerodynamic measures, and stroboscopic findings. Of these, this review focuses on patient-reported measures; these may be the most meaningful for patients facing a decision regarding treatment modality given the similarity in oncologic outcomes. The focus of this study is to summarize the current state of the literature on patient self-reported voice outcomes after treatment of T1 glottic cancers.

Conclusions

The literature to date suggests that patient-reported voice outcomes as measured by the VHI are similar whether patients with T1 glottic carcinomas are treated with endoscopic surgical resection or XRT. All of the studies with the exception of one demonstrate possible selection bias, in which treatment modalities may be differentially selected. Future efforts may focus on determining how to refine the treatment decision-making tree. Read the full article in The Laryngoscope.