Comparison of Voice and Life Quality and Stroboscopy after a Lasersurgery and Radiotherapy
Authors:
A. Slavíček 1,2; M. Zábrodský 1; L. Mrzena 1; A. Bahannan 1; L. Černý 2; Z. Valenta 4; R. Lohynská 3
Authors place of work:
Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK
Katedra otorinolaryngologie IPVZ, Praha
; přednosta prof. MUDr. J. Betka, DrSc.
Foniatrická klinika 1. LF UK a VFN Praha
1; přednostka doc. MUDr. O. Dlouhá, CSc.
2; Klinika radioterapie a onkologie FN Motol, Praha
3; Ústav lékařských informací Akademie věd, Praha
4
Published in the journal:
Otorinolaryngol Foniatr, 57, 2008, No. 3, pp. 128-137.
Category:
Original Article
Summary
Endoscopic laser-assisted cordectomies classified by Remacle and Rudert (type I-V cordectomies) comprise a vast range of procedures from simple vocal cord stripping or submucosal cordectomy (type I) through more extensive surgery (subligamentous cordectomy- type II, transmuscular cordectomy- type III) to complete (type IV) or extended cordectomies (type V) used when tumour involves the anterior commisure, arytenoid region, subglottic region etc. Endoscopic laser-assisted surgery of the larynx is usually indicated in early stages of infiltrative malignant disease of the glottic region (T1a-b, T2) or in preneoplastic conditions (laryngeal intraepithelial neoplasia - LIN I, II or III). Radiotherapy is also believed to be an equivalent type of oncological therapy for these diseases. Both surgery and radiotherapy can worse one of the main functions of the human larynx- the human voice.
Because the overall survival rates and local control rates are quite similar in both types of therapy, one should always have in mind something that is beyond the main goal of achieving radical removal of the tumour- patient’s quality of life (QoL) and quality of voice. It is very interesting to compare QoL and voice quality in different types of treatment. The possibility to conserve the radiotherapy for the possible recurrence of the disease should be also considered.
128 patients diagnosed with an early glottic cancer or severe dysplastic lesion of the glottis and treated by means of surgical removal of the disease or radiotherapy have been included into a retrospective study conducted by the Department of Otorinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine of the Charles University in collaboration with the Department of Phoniatrics of the 1st Faculty of Medicine of the Charles University.
Patients were divided into 2 groups according to the selected treatment modality. Stroboscopic findings (symmetry, amplitude, periodicity of the mucosal wave, extension of non-vibrating mucosal segment, time of and completeness of the glottic closure), total fonation time, vocal range according to the voice range profile (VRP- phonetograph), subjective voice quality analysis and objective voice analysis (using MDVP software) were compared between patients in both groups. Moreover we compared similar parameters in the groups of patients treated by different types of cordectomy. QoL 30 questionnaire and Voice Handicap Index tool were chosen for the quality of life evaluation.
There were no statistically significant differences in the above mentioned parameters when comparing patients treated by cordectomy type I-III and by radiotherapy. In contrast patients treated by cordectomy type IV and V showed significantly worse results compared to both of the above mentioned groups.
Surgical therapy (type I-III cordectomies) in early stages of disease can be considered highly efficient treatment modality according to these results and could be considered the method of choice in this indication taking into account the possibility of radiotherapy as an invaluable treatment option for the recurrent disease.
There were no statistically significant differences in results between patients treated by endoscopic laser-assisted coredectomy type I-III or by radiotherapy. Vast majority of evaluated parametres in laser cordectomy IV and V subgroups were found significantly worse when comapared with radiotherapy or cordectomy I-III subgroups.
Key words:
cordectomy, stroboscopy, voice quality.
Zdroje
1. Aref, A. A., Dworkin, J., Devi, S., Denton, L., Fontanesi, J.: Objective evaluation of the quality of voice following radiation therapy for T1 glottic cancer. Radiotherapy and Oncology, 45, 1997, s. 149-153.
2. Bahannan, A., Zabrodsky, M., Cerny, L., Chovanec, M., Lohynska, R.: Quality of life following endoscopic resection or radiotherapy for early glottic cancer. Saudi Medical Journal, 28, 2007, s. 598-602.
3. Bertino, G., Bellomo, A., Ferrero, F., Ferlito, A.: Acoustic analysis of voice quality with or without false fold displacment after cordectomy. Journal of Voice, 15, 2001, s. 131-140.
4. Betka, J., Taudy, M., Kasík, P., Klozar, J., Slavíček, A., Skřivan, J.: Clinical aplication of the CO2 laser in head and neck surgery. Čs. Otolaryngol., 42, 1993, s. 203-216.
5. Dagli, A. A., Mahieu, H., Feesten, J. M.: Quantitative analysisn of voice quliity in eearly glottic laryngeal carcinomas treated with radiotherapy. Eur. Arch. Otolaryngol., 254, 1997, s.78-80.
6. Finizia, C., Dotevall, H., Lundström, E., Lindström, J.: Acoustic and perceptual evaluation of voice and speech quality. Arch. Otolaryngol. Head Neck Surg., 125,1999, s. 157-163.
7. Harrison, L. B., Solomon, B., Miller, S. et al.: Prospective computer.assisted voice analysis for the patienr with early stage glottic cancer: a preliminary report of the functional result of laryngeal irradiation. Int. J. Radiat. Oncol. Biol. Phy., 19, 1990, s. 123-127.
8. Hirano, M., Hirade,Y.: CO2 laser for treating glottic carcinoma. Acta Oto-Rhino-Laryngol. (Suppl.), 458, 1988, s. 154-157.
9. Höfler, H., Biigenzah, W.: Die Stimmqualität nach CO2 - Laserchordectomie. Laryng. Rhinol. Otol., 65, 1986, s. 655-658.
10. Lohynska, R., Slavicek, A., Bahannan, A., Novakova, P.: Predictors of local failure in early laryngeal cancer. Neoplasma, 52, 2005, s. 483-488.
11. Peretti, G., Piazza, C., Balzanelli, C., Cantarella, G., Nicolai, P.: Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas. Ann. Otol. Rhinol. Laryngol., 112, 2003, s.174-174.
12. Peretti, G., Nicolai, P., Piazza, C. et al.: Oncological results of endoscopic resetions of Tis and T1 glottic carcinoma by CO2 laser. Ann. Otol. Rhinol. Laryngol., 110, 2001, s. 820-826.
13. Piazza, C., Cantarella, G., Balzanelli, C., Nicolai, P.: Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas.
14. Remacle, M., Antonelli, A., Brasnu, D., Chevalier, D. et al.: Endoscopic cordectomy, a proporsl for classification by the Working Comittee, Europeana Laryngological Society. Eur. Arch. Otorhinolaryngol., 257, 2000, s. 227-231.
15. Remacle, M.: Optimal treatment for T1 and T2 glottic cancers. Acta Oto-Rhino-Laryngologica, 53, 1999, s.175-178.
16. Remacle, M., Jamart, J., Minet, M., Watelet, J. B., Delos, M.: CO2 laser in the diagnosis and treatment of early cancer of the vocal fold. Eur. Arch. Otorhinolaryngol., 254, 1997, s.169-176.
17 Rosen, C. A.: Stroboscopy as research instrument: Development of a perceptual evaluation tool. Laryngoscope, 115, 2005 s. 423-428.
18 Rovirosa, A. et al.: Acoustic analysis after radiotherapy in T1 vocal cord carcinoma. A new approach to the analysis of voice quality. Int. J. Radiation Oncology Biol. Phys., 47, 2000, s. 73-79.
19 Rudert, H.: Endoscopic resections of glottic and supraglottic carcinomas with the CO2 laser. Eur. Arch. Otorhinolaryngol., 252, 1995, s.146-148.
20. Steiner, W.: Results of curative laser microsurgery of laryngeal carcinomas. Am. J. Otolaryngol., 14, 1993, s. 116-121.
21. Tsunoda, K., Soda,Y., Tojima, H. et al.: Stroboscopic observation of the larynx after radiation in patients with T1 glottic carcinoma. Acta Otolaryngol. (Suppl.), 527, 1997, s. 165-166.
22. Uloza, V.: Effects on voice by endolaryngeal microsurgery. Eur. Arch. Otorhinolaryngol., 256, 1999, s. 312-315.
23. Vokřál, J.: Akustické parametry chraptivosti. Doktorská dizertační práce, Fakulta elektronická ČVUT, 1998, 97 s.
24. Woo, P. C., Colton, R., Brewer, D.: Aerodynamic and stroboscopic findings before and after microlaryngeal phonosurgery. Journal of Voice, 8, 1994, s.186-194.
Štítky
Audiology Paediatric ENT ENT (Otorhinolaryngology)Článok vyšiel v časopise
Otorhinolaryngology and Phoniatrics
2008 Číslo 3
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