Evaluation of Voice After Definitive Radiotherapy in Patients of Early Stage Squamous Cell Carcinoma of Larynx (Glottis)
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ORIGINAL ARTICLE
Evaluation of Voice After Definitive Radiotherapy in Patients of Early Stage Squamous Cell Carcinoma of Larynx (Glottis): A Prospective Observational Study Awadhesh Kumar Mishra1
•
Vivek Raj Sinha2 • Virender Suhag3 • Ajith Nilakantan4
Received: 23 August 2020 / Accepted: 28 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Post treatment voice quality is an important consideration in choosing the management option for laryngeal cancer. We assessed voice quality after radiotherapy in patients of early squamous cell carcinoma of glottis comprehensively using Videolaryngostroboscopy (VLS), Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scores and Voice Handicap Index (VHI)10. Fifty four consenting patients of early squamous cell carcinoma of glottis (Tis, T1 and T2) awaiting definitive radiotherapy were recruited consecutively. Voice was evaluated by VLS, GRBAS scores and VHI-10 before radiotherapy as well as 3 months and 12 months after radiotherapy. There were 52 males and 2 females in the study. Hoarseness of voice was the commonest presenting symptom. Mean duration of symptoms was 2.45 months (± 0.80), ranging from 1 to 4 months. 35 (64.82%) were T1 while 19 (35.18%) were T2 lesions. They received 60–70 Gy of radiotherapy in 28–35 fractions. There was only one recurrence on follow up for 12 months. On VLS
& Awadhesh Kumar Mishra [email protected] Vivek Raj Sinha [email protected] Virender Suhag [email protected] Ajith Nilakantan [email protected] 1
Department of ENT-Head Neck Surgery, Base Hospital Delhi Cantt, New Delhi, India
2
Venkateshwar Hospital, Dwarka, New Delhi, India
3
Command Hopital (SC), Pune 411040, India
4
Military Hospital, Pathankot, India
at 12 months post-RT the periodicity, phase symmetry, mucosal waves and amplitude were normal in 74.07%, 70.37%, 56.67% and 78.7% cases respectively. Complete glottic closure was obtained in 72.22%. The voice was ‘acceptable’ (Grade 1 or 2 on VLS parameters) in more than 90% cases. Mean total GRBAS score was 3.39 (± 2.67). Mean total VHI-10 was 6.7 (± 1.75). All indices were significantly better than pre RT levels. Good quality of voice can be expected after radiotherapy for early glottic cancer in majority of patients. Keywords Laryngeal Glottis Voice quality Radiotherapy Hoarseness Stroboscopy
Introduction An impairment of voice not only interferes with daily life activities, but can also be emotionally devastating to the patient. Voice disorders, thus, have functional, emotional and psychosocial effect on an individual’s daily life. The impact of a disease process or its management on voice should not be underestimated [1, 2]. Laryngeal carcinoma is one of the most common carcinoma among Head and Neck malignancies and also the most important cause of change in voice quality. In India, the prevalence of laryngeal cancer is 3–6% of all cancers in men [3]. Histo-pathologically, glottic carcinomas are Squamous Cell Carcinomas in majority of cases. Smoking and alcoho
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