FLEX October 2023

258

International Journal of Radiation Oncology Biology Physics

Aaltonen et al.

60 patients with squamous cell carcinoma limited to 1 vocal cord (T1a)

28 assigned to radiation therapy

32 assigned to laser surgery

Excluded: 2 withdrew consent 1 was female

Excluded: 1 withdrew consent

25 treated

31 treated

The CONSORT (Consolidated Standards of Reporting Trials) flow diagram.

Fig. 1.

voice (score 3), and only 5 (19%) had no voice breathiness (score 0). These numbers contrast with the radiation ther apy group, in which 6 (30%) of the 20 evaluable patients had a mildly or moderately breathy voice 2 years after ra diation therapy, none had an extremely breathy voice, and 14 (70%) had no voice breathiness. Patients with tumor in the anterior part of the vocal cord had a more breathy voice when treated with TLS than did those treated with radiation therapy; in the TLS group the scores were 1.55 at baseline and 1.63 2 years after treatment, and in the radiation ther apy group the scores were 1.38 and 0.66, respectively ( P Z .039). No significant difference emerged when cancer was located in the posterior part of the vocal cord.

significantly from the baseline quality during follow-up in each group (in the TLS group, the VAS score decreased from 59.0 to 43.1, P Z .040; in the radiation therapy group, from 53.1 to 35.4, P Z .026). Patients assigned to radiation therapy reported less impact of hoarseness on their daily living activities than did patients assigned to TLS ( P Z .007).

Videolaryngostroboscopic findings

In comparison with the radiation therapy group, patients assigned to TLS had less sufficient glottal function at vid eolaryngostroboscopy performed 2 years after study entry. They had higher scores for irregular glottal closure ( P Z .025), oval closure ( P Z .005), and incomplete glottal closure ( P Z .018).

Self-rated quality of voice and impact of hoarseness on activities of daily living

When the patients themselves rated hoarseness, voice quality was judged as similar between the groups ( P Z .144) (Table 3). The self-reported quality of voice improved

Concordance of findings

Interrater consistency was good when voice grade, rough ness, or breathiness was assessed (Cronbach a 0.88, 0.88, and 0.84, respectively) but weak for voice asthenia and strain ( < 0.70 for each). Intrarater consistency was excellent or good when voice grade, breathiness, and asthenia were rated (ranges, 0.90-0.95, 0.85-0.89, and 0.87-0.96), mod erate for roughness (0.70-0.79), and weak for strain ( < 0.70). In general, expert-rated voice quality assessments, self rated voice quality, and the stroboscopic findings showed good concordance. High scores for expert-rated breathiness were strongly associated with the degree of self-reported handicap in daily living (at 6-month assessment, r Z 0.568, P Z .001; at 24-month assessment, r Z 0.623, P < .001) and self-rated hoarseness (at 6 months, r Z 0.503, P Z .003; at 24 months, r Z 0.482, P Z .005). Voice breathiness

Characteristics of patients and tumors

Table 1

Radiation therapy group (n Z 25)

Laser surgery group (n Z 31)

Characteristic

Median age, y (range)

69.0 (46-83)

61.0 (46-75)

Tumor histology (n, %) Squamous cell carcinoma 31 (100)

25 (100)

Clinical stage (n, %) T1a

31 (100)

25 (100)

Tumor site on the vocal cord (n, %) Anterior

6 (19) 9 (29) 7 (22) 9 (29)

7 (28) 6 (24) 4 (16) 8 (32)

Anterior-middle

Middle or posterior

Entire cord