Long‐term swallowing outcomes of radiotherapy and transoral laser microsurgery for T1 glottic cancer treatment

Abstract

Introduction Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post‐treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma. Methods Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool‐10 test (EAT‐10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed. Results CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20 mL water according to the Penetration and Aspiration Scale (P < .05). The mean EAT‐10 Score was found 0 in the CO2 TOLMS group, and 3.20 ± 3.24 in the RT group (P < .05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P > .05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5 mL and 10 mL water, 5 mL and 20 mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P < .05). Conclusion It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.

Management of clinically node‐negative glottic squamous cell carcinoma patients according to risk‐scoring model for occult lymph node metastases

“…The preferred treatment options for patients with early stage GSCC include transoral endoscopic surgery and radical radiation therapy. Existing literature has compared the two approaches, 2 , 18 , 19 but there is little evidence definitively favoring one treatment, making both of the two approaches acceptable options. Regardless of the primary treatment option, prophylactic intervention of the clinically negative neck in patients with early stage GSCC is usually not recommended.…”

“…2,18,19 but there is little evidence definitively favoring one treatment, making both of the two approaches acceptable options. Regardless of the Low/moderate vs. high 1.858 (1.056-3.269) 1.951 (1.086-3.505) Maximum tumor diameter (MTD) .000 .032 >2.0 cm vs. ≤2.0 cm 4.839 (2.139-10.943) 2.649 (1.085-6.469) Tumor invasive depth .000 .005 ≥1.0 cm vs. <1.0 cm 6.568 (2.565-16.818) 4.267 (1.558-11.689)…”

Márgenes histopatológicos positivos: ¿se relacionan siempre con recidiva tumoral en carcinoma glótico temprano?

“…En cuanto a la función deglutoria, la mayoría de los estudios se han realizado en cáncer de laringe en estadios avanzados. Un estudio reciente de Ozturk et al en pacientes con carcinoma glótico temprano estadio T1 describe mejores desenlaces con MTL vs. radioterapia (38). Se cree que estos hallazgos se deben a que la MTL logra una mejor preservación de la sensibilidad laríngea (37).…”

Patterns of Care for T1 Glottic Squamous Cell Carcinomas from 2004–2020

“…Most studies evaluating these two options conclude that either surgery or RT as single-modality treatments offer comparatively successful results for these patients based on local control, distant metastasis rates, second primary tumor rates, disease-free survival, laryngectomy-free survival, overall survival, GRBAS (grade, roughness, breathiness, asthenia, and strain) scores, Cepstral Spectral Index of Dysphonia scores, and subjective patient-reported voice outcomes. 5,[7][8][9][10][11][12][13][14][15][16][17] Some studies claim surgery as better for certain outcomes, [18][19][20][21][22][23] while others support RT as the preferential treatment. 24,25 As a result, current treatment decisions for patients with T1 glottic cancer are highly variable and often influenced by details such as physician/department experience and patient preference.…”