LASER CORDECTOMY OR RADIOTHERAPY - CURE RATES, COMMUNICATION, AND COST

Health care costs have risen dramatically in recent years. Cost-contai nment strategies have become necessary to ensure that adequate medical care is accessible to all who need it. These strategies include choos ing the least costly of several treatment modalities with equal effica cy. Radiotherapy has been considered by some as the treatment of choic e for early glottic tumors. Rationale for this is based on two major a ssumptions: that cure rates are equal for radiotherapy and surgery, an d that voice preservation and quality is superior with radiotherapy. I mplicit in these assumptions is the idea that cost of therapy should n ot be a factor in selecting an alternative. This study presents a lite rature review of cure rates for laser cordectomy and radiotherapy for T1 glottic cancers. An objective voice analysis was performed on 14 pa tients with T1 glottic cancers treated with laser cordectomy and the r esults were compared to a group of 20 patients treated with radiothera py for similar early tumors. Finally, the average total cost of each m odality was calculated and compared. Our findings indicate that: (1) c ure rates are equivalent; (2) voice quality after laser cordectomy is as good as that noted after radiotherapy; and (3) total cost of therap y is much less for laser cordectomy than for radiotherapy. We advocate loser cordectomy rather than radiotherapy for most early glottic tumo rs.