An Objective Assessment of Voice Production after Radiation Therapy for Stage I Squamous Cell Carcinoma of the Glottis

Lehman, Jeffrey; Bless, Diane M.; Brandenburg, James H.

doi:10.1177/019459988809800205

Cited by 96 publications

(60 citation statements)

References 15 publications

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“…This finding may support the previously postulated notion that radiotherapy for early glottic cancer causes fibrosis in vocal fold tissue. 16 Decorin was found to be preserved, more or less, in all cases with type I postcordectomy scar, while it varied after deeper cordectomy procedures. Decorin is a small chain proteoglycan, which is normally distributed in the superficial layer of the lamina propria of human vocal folds.…”

Section: Discussionmentioning

confidence: 88%

Histologic Characterization of Human Scarred Vocal Folds

et al. 2009

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Objectives: Vocal fold scarring remains a significant problem. Although several animal models have been developed to improve our understanding of the histopathology, the histologic features of scarred human vocal folds have rarely been reported. The present case studies aimed to define the histologic changes of scarred human vocal folds caused by cordectomy or cordotomy.Methods: Ten patients with the scarred vocal folds were involved in this study. Nine patients with early glottic cancer underwent endoscopic cordectomy, and one patient underwent superficial cordotomy for idiopathic scar. The post-cordectomy or cordotomy scar was biopsied or resected 3 to 13 months after the original procedure. After confirming absence of any tumor in cancer patients, the remaining specimens were used in the present study. Histologic examination investigated deposition of extracellular matrix (ECM) including collagen, elastin, hyaluronic acid (HA), fibronectin, and decorin in the lamina propria of the scarred vocal folds.Results: There was a wide range variation in the deposition of ECM in scarred vocal folds.Excessive and disorganized collagen deposition was observed in most cases that had undergone deep resection of the lamina propria, whereas deposition of collagen was mild and well organized after superficial resection. Decorin was retained in all cases after superficial cordectomy or cordotomy, but varied after deep resection. Deposition of elastin, HA, and fibronectin varied regardless of depth of injury. Conclusion:Histology of scarred vocal folds may vary with degree of injury and individual healing mechanism.

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Section: Discussionmentioning

confidence: 88%

Histologic Characterization of Human Scarred Vocal Folds

et al. 2009

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“…Other authors have also demonstrated poor voice quality after endoscopic laser treatment, 34,35 whereas Lehman et al 36 and Schuller et al 37 reported that their patients subjectively assessed their voices as near normal after radiotherapy. The finding of better voice quality after radiotherapy compared with endoscopic laser treatment has been confirmed by other authors.…”

Section: Discussionmentioning

confidence: 98%

The treatment of early laryngeal cancers (T1–T2 N0): surgery or irradiation?

et al. 2004

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Background. Carcinoma of the larynx is the most common cancer affecting the head and neck region. In Northern Europe, early laryngeal cancer is almost universally treated by irradiation, but elsewhere it is treated by surgery. The main aim of this study was to determine whether there was any difference in survival between the two main therapeutic options. The secondary aim was to assess speech and voice quality in a small, randomized sample of patients from each treatment group.Methods. The subjects investigated were 488 patients with T1 -2, N0 squamous cell carcinoma of the larynx. The patients form an unselected sequential group of our institution's experience with treating this disease over three decades. Four hundred nineteen patients were treated by irradiation, and 69 were treated with surgery. Most surgical patients were treated earlier in the series, whereas radiotherapy later became the treatment of choice. The primary outcome measures were recurrence at the primary site, recurrence in the neck, and tumor-specific survival. The secondary outcome measure was speech and voice quality. Statistical analysis was by univariate and multivariate analysis of association and survival. Surgery included horizontal or vertical partial laryngectomy and various minor procedures on the glottis, including cordectomy. Over a 30-year period, radiotherapy was administered to a dose of 60 -66 Gy given over 30 -33 daily fractions.Results. Surgery tended to be performed early on in the series and radiotherapy thereafter. Surgery was more likely to be carried out for supraglottic disease. These differences apart, the radiotherapy and surgery groups of patients were well matched.The 5-year tumor-specific survival for those treated by irradiation was 87% and for surgery it was 77% ( p = .1022). Glottic cancer and T1 disease were associated with high 5-year survivals: 90% and 91%, respectively. Supraglottic site and T2 disease both had a poorer prognoses: 79% and 69%, respectively. The differences for both sets of data were significant. There was no significant difference in primary site recurrence rates for the two treatment modalities, but regional recurrence was higher in the surgery group. Further analysis demonstrated that this was not a function of surgery per se but rather of the unit's policy toward the N0 neck at the time surgery was carried out. Regarding speech and voice quality, radiotherapy was far superior to surgery. All patients in the radiotherapy group but only 3 of 10 in the surgery group were judged to have a good or normal voice ( p = .0017).Conclusions. Both surgery and irradiation are equally effective at treating early laryngeal carcinoma. Speech and voice quality were highly significantly better in patients treated by irradiation than in those treated by surgery. A

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“…Voice impairment in patients after treatment for early glottic cancer has been reported in several studies, ranging from 14 to 92% of the patients [1,6,9,16,24,25]. Furthermore, several studies on the inXuence of voice problems on quality of life revealed that in 27 up to 58% of the patients experienced diYculties in communication abilities leading to a disrupted social life [3,8,12,17,[19][20][21][22]25].…”

Section: Introductionmentioning

confidence: 99%

Voice in early glottic cancer compared to benign voice pathology

Gogh

Mahieu

Kuik

et al. 2007

Eur Arch Otorhinolaryngol

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The purpose of this study is to compare (Dutch) Voice Handicap Index (VHIvumc) scores from a selected group of patients with voice problems after treatment for early glottic cancer with patients with benign voice disorders and subjects from the normal population. The study included a group of 35 patients with voice problems after treatment for early glottic cancer and a group of 197 patients with benign voice disorders. Furthermore, VHI scores were collected from 123 subjects randomly chosen from the normal population. VHI reliability was high with high internal consistency and test-retest stability. VHI scores of glottic cancer patients were similar to those of patients with voice problems due to benign lesions. Both groups of patients were clearly deviant from the normal population. Within the normal population, 16% appeared to have not-normal voices. Based on ROC curves a cut-oV score of 15 points was deWned to identify patients with voice problems in daily life. A clinical relevant diVerence score of 10 points was deWned to be used for individual patients and of 15 points to be used in study designs with groups. Patients with voice problems after treatment for early glottic cancer encounter the same amount of problems in daily life as the other voiceimpaired patients. The VHI proved to be an adequate tool for baseline and eVectiveness measurement of voice.

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An Objective Assessment of Voice Production after Radiation Therapy for Stage I Squamous Cell Carcinoma of the Glottis

Cited by 96 publications

References 15 publications

Histologic Characterization of Human Scarred Vocal Folds

Histologic Characterization of Human Scarred Vocal Folds

The treatment of early laryngeal cancers (T1–T2 N0): surgery or irradiation?

Voice in early glottic cancer compared to benign voice pathology

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