Longitudinal analysis of Voice Handicap Index in early glottic cancer patients treated with transoral laser microsurgery: age, gender, stage and time dependence

Lane, Ciaran; Rigby, Matthew H.; Hart, Robert D.; Trites, J; Levi, Eric; Taylor, S. Mark

doi:10.1017/s0022215119000392

Cited by 9 publications

(9 citation statements)

References 28 publications

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“…However, during the 1st year of follow‐up, patients treated with both radiotherapy modalities showed a steeper and clinically significant improvement compared to a more stable and clinically insignificant improvement over time with TLM. The nonlinear stable trajectory for TLM has been described previously by Lane et al 40 It is in accordance with the belief that full remodeling of the glottic tissue takes 12 to 24 months. However, because the first follow‐up measurement is taken at 2 to 4 months, short deteriorations after surgery may go undetected.…”

Section: Discussionsupporting

confidence: 85%

Longitudinal Patient‐Reported Voice Quality in Early‐Stage Glottic Cancer

Dorr

Sewnaik

Andrinopoulou

et al. 2023

Otolaryngol.--head neck surg.

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Objective. Patient-reported voice quality is an important outcome during counseling in early-stage glottic cancer. However, there is a paucity of adequate longitudinal studies concerning voice outcomes. This study aimed to investigate longitudinal trajectories for patient-reported voice quality and associated risk factors for treatment modalities such as transoral CO 2 laser microsurgery, single vocal cord irradiation, and local radiotherapy.Study Design. A longitudinal observational cohort study. Setting. Tertiary cancer center.Methods. Patients treated for Tcis-T1b, N0M0 glottic cancer were included in this study (N = 294). The Voice Handicap Index was obtained at baseline and during follow-up (N = 1944). Mixed-effects models were used for investigating the different trajectories for patient-reported voice quality.Results. The mean follow-up duration was 43.4 (SD 21.5) months. Patients received transoral CO 2 laser microsurgery (57.8%), single vocal cord irradiation (24.5%), or local radiotherapy (17.5%). A steeper improvement during the first year after treatment for single vocal cord irradiation (−15.7) and local radiotherapy (−12.4) was seen, compared with a more stable trajectory for laser surgery (−6.1). All treatment modalities showed equivalent outcomes during long-term follow-up. Associated risk factors for different longitudinal trajectories were age, tumor stage, and comorbidity. Conclusion.Longitudinal patient-reported voice quality after treatment for early-stage glottic cancer is heterogeneous and nonlinear. Most improvement is seen during the first year of follow-up and differs between treatment modalities. No clinically significant differences in longterm trajectories were found. Insight into longitudinal trajectories can enhance individual patient counseling and provide the foundation for an individualized dynamic prediction model.

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Section: Discussionsupporting

confidence: 85%

Longitudinal Patient‐Reported Voice Quality in Early‐Stage Glottic Cancer

Dorr

Sewnaik

Andrinopoulou

et al. 2023

Otolaryngol.--head neck surg.

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“…The attenuation of post-interventional dysphonia in early glottic cancer should be viewed in this context, taking into account the importance of identifying voice outcomes as a function of time on patients'quality of life. Indeed, patients and physicians should realize the non-linear course of postinterventional improvement in voice handicap, 8 and acknowledge the optimal time of voice function return, which does seem to be extending up to two years posttreatment, according to the results of the present study.…”

Section: Discussionmentioning

confidence: 60%

“…While the improvement of postoperative VHI-10 scores in patients with EGC treated with TLM is well established and seems, in fact, to be extending well into the 2 nd postoperative year, 8 meta-analyses have indicated that the perceptive and acoustic vocal quality of their radiotherapy-only counterparts may be even better. 1 9 However, by applying element analysis of the VHI-10, the present study identified that when these radical single-treatment modalities are combined, the postinterventional intelligibility of the patients' speech in noisy environments may pose as the primary parameter of voice handicap in the 2 nd postintervention year ( p = 0.000).…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Concept of Non- and Minimally Invasive Interventions in Early Glottic Cancer – Part II: Single Therapy Should be Favored over the Combination of Transoral Laser Microsurgery and Radiotherapy, Regarding the Postinterventional Voice Quality

Vlastarakos

Georgantis

Nikolopoulos

et al. 2021

Int Arch Otorhinolaryngol

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Introduction Early glottic cancer (EGC) is associated with a high cure rate. Hence, patients and physicians also focus on the impact of the proposed treatment on the speaking function of the preserved larynx. Objectives The present study assessed the impact of single-modality treatment (transoral laser microsurgery [TLM], or radiotherapy) or combination therapy for EGC on postinterventional voicing and explored factors which might explain the related perceptions. Methods A total of 108 patients filled in the voice handicap index 10 questionnaire, 1 and 2 years postinterventionally. Non-parametric tests were used for the respective statistical analyses. Results Sixty-four patients were treated with TLM, 15 with radiotherapy, and 29 with both modalities. Transoral microsurgery and radiotherapy were associated with postinterventional dysphonia, which attenuated between the first and second postintervention year (p = 0.000). No association between sociodemographic parameters and the attenuation of postinterventional dysphonia was identified for either treatment modality. Transoral microsurgery and radiotherapy resulted in comparable postinterventional voicing, in the first (p = 0.940) and second (p = 0.196) postintervention years. The addition of TLM to radiotherapy resulted in worse voice quality in the second, compared with the first postintervention year (p = 0.000), demonstrating a detrimental effect on speech intelligibility in noise (p = 0.000). Conclusion Single therapy should be favored over the combination of TLM and radiotherapy for EGC in terms of retaining better postinterventional voice quality. Postinterventional dysphonia should be taken into account, during preinterventional counseling, as it may exert leverage on the quality of patients' lives. Patients and physicians should acknowledge the optimal time of voice function return, which seems to be extending up to two years posttreatment.

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“…Lane et al . found that VHI-10 scores show maximal improvement 5.5 months after TLM [ 26 ]. Other authors argue that voice assessments should be performed at least 6–12 months post-TLM to allow post-operative edema to resolve [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, most patients in our cohort had a type IV or V cordectomy, which is associated with worse subjective voice outcomes post-operatively. Additionally, advanced age correlates with worse voice outcomes [ 26 ]. Although the average age in our cohort was 70.2 years; we found no difference in VHI-10 or MPT in patients under the age of 70 years in either group.…”

Section: Discussionmentioning

confidence: 99%

Injection laryngoplasty during transoral laser microsurgery for early glottic cancer: A randomized controlled trial

Afif

Rigby

Mackay

et al. 2022

Journal of Otolaryngology - Head & Neck Surgery

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Background Transoral laser microsurgery is widely used for treating T1/T2 glottic cancers. Hyaluronic acid (HA) is commonly used in vocal cord augmentation. We investigated the impact of intra-operative injection laryngoplasty on voice outcomes in early glottic cancer. Methods Twenty patients were randomized to the treatment group receiving HA injection to the vocal cord contralateral to the lesion; or the control group, receiving no injection. Patients had a Voice Handicap Index-10 (VHI-10) questionnaire and a Maximum Phonation Time (MPT) measurement preoperatively and at 3, 12 and 24 months post-operatively. Mean change in VHI-10 and MPT, compared to baseline and between time points, were compared. Survival estimates were calculated. Results Mean VHI-10 scores improved over time amongst all patients. There were no changes in mean VHI-10 from pre-operative values to 3, 12 or 24 months post-operatively. There were no significant differences when comparing various timepoints between groups. There were no significant changes in MPT amongst the groups, or the time-points compared. Two-year overall survival was 91.7%; disease free survival was 80.9%; no difference in recurrence free survival was seen between the groups. Conclusion Subjective voice scores improved over time in both groups; there were no improvements in VHI-10 or MPT scores in the injection group, over control, at any time points. We saw no significant impact for intra-operative HA injection laryngoplasty on subjective or objective voice outcomes following surgery for early glottic cancers. Graphical abstract

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Longitudinal analysis of Voice Handicap Index in early glottic cancer patients treated with transoral laser microsurgery: age, gender, stage and time dependence

Cited by 9 publications

References 28 publications

Longitudinal Patient‐Reported Voice Quality in Early‐Stage Glottic Cancer

Longitudinal Patient‐Reported Voice Quality in Early‐Stage Glottic Cancer

Revisiting the Concept of Non- and Minimally Invasive Interventions in Early Glottic Cancer – Part II: Single Therapy Should be Favored over the Combination of Transoral Laser Microsurgery and Radiotherapy, Regarding the Postinterventional Voice Quality

Injection laryngoplasty during transoral laser microsurgery for early glottic cancer: A randomized controlled trial

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