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Laser Surgery vs Radiotherapy

Elisabeth V. Sjögren, MD; Maya A. van Rossum, PhD; Ton P. M. Langeveld, MD, PhD; Marika S. Voerman, BS; Vivienne A. H. van de Kamp, BS; Mark O. W. Friebel, MD; Ron Wolterbeek, MD; Robert J. Baatenburg de Jong, MD, PhD

Arch Otolaryngol Head Neck Surg. 2008;134(9):965-972.

Objective  To compare voice quality after radiotherapy or endoscopic laser surgery in patients with similar T1a midcord glottic carcinomas according to a validated multidimensional protocol.

Design  Retrospective cohort study.

Setting  University cancer referral center.

Patients  Two cohorts of consecutive patients willing to participate after treatment for primary T1a midcord glottic carcinoma with laser surgery (18 of 23 eligible) or radiotherapy (16 of 18 eligible).

Main Outcome Measures  Posttreatment voice quality was evaluated according to a multidimensional voice protocol based on validated European Laryngological Society recommendations, including perceptual, acoustic, aerodynamic, and stroboscopic analyses, together with patient self-assessment using the Voice Handicap Index.

Results  Approximately half of the patients had mild to moderate voice dysfunction in the perceptual analysis (53% [8 of 15] in the radiotherapy group and 61% [11 of 18] in the laser surgery group) and on the Voice Handicap Index (44% [7 of 16] in the radiotherapy group and 56% [10 of 18] in the laser surgery group). The voice profile in the laser surgery group was mainly breathy; in the radiotherapy group, it was equally breathy and rough, with a trend for more jitter in the acoustic analysis. There was no statistical difference in the severity of voice dysfunction between the groups in any of the variables.

Conclusions  Endoscopic laser surgery offers overall voice quality equivalent to that of radiotherapy for patients with T1a midcord glottic carcinoma, although specific voice profiles may ultimately be different for the 2 modalities. We believe that endoscopic laser surgery is the preferred treatment in these patients because it provides oncologic control similar to that of radiotherapy and the additional benefits of lower costs, shorter treatment time, and the possibility of successive procedures.

Author Affiliations: Departments of Ear, Nose, and Throat–Head and Neck Surgery (Drs Sjögren, Langeveld, and Friebel and Mss Voerman and van de Kamp) and Statistics (Dr Wolterbeek), Leiden University Medical Center, Leiden, Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam (Dr van Rossum), and Department of Otorhinolaryngology–Head and Neck Surgery, Erasmus Medical Center Rotterdam, Rotterdam (Dr Baatenburg de Jong), the Netherlands.

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