COMPARATIVE VOICE RESULTS AFTER LASER RESECTION OR IRRADIATION OF T1 VOCAL CORD CARCINOMA

Objective: To compare voice results following laser resection or radia tion therapy for T1a glottic carcinomas. Design: Objective recordings of acoustical data that were analyzed and calculated by an acoustic an alyzer and subjective scores by patients, speech therapists, surgeons, and radiation therapists are compared. Setting: Academic medical cent er speech laboratory at an institution where patients had been treated . Archival files were searched and patients were solicited by letter t o participate in this analysis. Patients: Men treated at least 6 month s previously and who were without active laryngeal disease. Criteria w ere unilateral vocal cord carcinomatous involvement with no subglottic , anterior commissure, or arytenoid extension and tumor invasion clini cally judged to be less than half of the cordal depth. Interventions: Thirteen patients had received approximately 63 Gy in 28 fractions, fi ve fractions a week, with laterally opposed fields using a linear acce lerator. Eleven patients had had resection of less than half of the co rdal depth by using a carbon dioxide laser with a 300-mu m spot size w orking at a 400-mm distance; 13- to 15-W power intensity with a one te nth of a second burn in a noncontinuous mode. Results: No statisticall y significant differences between the two study groups were found. Pat ients and physicians subjectively rated (1 indicates normal; 5, aphoni c) the quality of voices of patients in the irradiation group (1.5 and 2.0) as slightly better than the quality of voices of patients in the laser group (2.0 and 2.4). Speech pathologists rated the voices of pa tients in the laser and irradiation group as indistinguishable and mil dly abnormal (2.75 and 2.73). Conclusion: Voice quality in highly sele cted patients with vocal cord carcinoma treated by laser resection can be as good as that in patients whose cancer was similarly staged afte r radiation therapy.