Voice rehabilitation after total laryngectomy and postoperative radiation therapy.
OBJECTIVE
The purpose of this study was to evaluate voice rehabilitation after laryngectomy and postoperative irradiation for patients with squamous cell carcinoma of the larynx and hypopharynx.


METHODS
Between December 1983 and December 1998, 173 patients underwent a total laryngectomy and postoperative irradiation and had follow-up from 3 to 188 months (median, 38 months). Three patients were lost to follow-up at 63, 39, and 4 months after treatment. All other living patients had follow-up for 2 years or longer. Twelve (7%) patients had incomplete data pertaining to voice rehabilitation.


RESULTS
Data pertaining to voice rehabilitation were available at 2 to 3 years and longer and 5 years and longer after treatment for 118 and 69 patients, respectively. The methods of voice rehabilitation at 2 to 3 years and longer and 5 years and longer were as follows: tracheoesophageal, 27% and 19%; artificial larynx, 50% and 57%; esophageal, 1% and 3%; nonvocal, 17% and 14%; and no data, 5% and 7%, respectively.


CONCLUSIONS
The most common form of voice rehabilitation after total laryngectomy and postoperative radiation therapy is the artificial larynx. Although the tracheoesophageal puncture is a technique frequently promoted by clinicians as a superior method, a relatively small subset of patients are successfully rehabilitated long-term. However, of those who undergo a tracheoesophageal puncture, approximately half will use this method of voice rehabilitation long term.
Mendenhall
William M
WM
Department of Radiation Oncology, Health Science Center, University of Florida College of Medicine, PO Box 100385, Gainesville, FL 32610-0385, USA. mendewil@shands.ufl.edu
Morris
Christopher G
CG
Stringer
Scott P
SP
Amdur
Robert J
RJ
Hinerman
Russell W
RW
Villaret
Douglas B
DB
Robbins
K Thomas
KT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D007825:Laryngectomy / Q000534:rehabilitation*; D007830:Larynx / Q000503:physiopathology / Q000528:radiation effects; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011677:Punctures; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D014132:Trachea / Q000601:surgery; D014834:Voice Training