Abstract
The vocal fold is of utmost importance among the functional components of vocalization. It is, therefore, important in the care of early glottic cancer patients not only to improve treatment results but also to preserve vocal function. Endoscopic laser surgery and Radiotherapy (including chemo radiotherapy) are all accepted treatments for early (stage I and II) glottic cancer. Until 2006 in Kyushu University Hospital, department of otolaryngology, the first choice of treatment for early glottic cancer had been radiotherapy (TAR therapy, TS-1 and vitamin A with radiotherapy), but selected cases of early glottic cancer have undergone endoscopic CO2 laser narrow margin phonomicrosurgery since 2007. This report investigated the results of CO2 laser surgery alone and CO2 laser surgery combined with radiotherapy or chemoradiorherapy (TAR, TS-1 and vitamin A with radiotherapy) while considering voice qualities. A retrospective study was conducted of 136 cases of Stage I (T1a, n=60, T1b, n=31) and stage II (T2N0, n=45) glottic carcinoma (UICC TNM 2002). The follow-up period was from 24 months to 138 months, average 61 months. Of the T1aN0 cases, 24 cases received endoscopic laser surgery alone (Subepithelial cordectomy, type I cordectomy), 19 underwent endoscopic laser surgery followed by radiotherapy, and 17 cases received radiotherapy (60-70 Gy, including TAR therapy). Of the T1bN0 cases, two cases received endoscopic laser surgery alone (type I cordectomy), 12 had endoscopic laser surgery followed by radiotherapy, and 16 received radiotherapy (60-70 Gy, including TAR therapy). Of the T2N0 cases, 3 underwent endoscopic laser surgery alone (Type I or type II, Subligamental cordectomy), 15 cases received endoscopic laser surgery followed by radiotherapy, and 27 had radiotherapy (60-70 Gy, including TAR therapy). Among the 60 T1aN0 cases, 5-year survival rate and voice preservation rate were 100% and 95%, respectively. Local recurrence occurred in nine of these patients (15%), all of whom were successfully re-treated by salvage surgery. In T1b cases, the 5-year survival rate and voice preservation rate were 97% and 93%, respectively. Local recurrence occurred in two of these patients (7%), and one of them was successfully re-treated by salvage surgery. Among the 45 T2N0 patients, the 5-year survival rate and voice preservation rate were 100% and 93%, respectively. All of whom were successfully re-treated by salvage surgery.
The post treatment voice qualities (pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise to harmonic ration (NHR)), were judged to be improved over pretreatment observations. There were no differences between laser surgery and radiotherapy for voice qualities in T1a cases.
