Radiotherapy versus surgery for early T1-T2 glottic carcinoma.
OBJECTIVE
To compare surgery and radiotherapy as treatments for early T1-T2 glottic cancer in terms of local and regional control, complications, cost, and voice outcome.


METHODS
Retrospective comparative review of 36 patients with T1 or T2 glottic carcinoma diagnosed between 1992 and 2003 at the McGill University Health Centre. Twelve patients postsurgery (group 1) and 26 patients postradiotherapy (group 2) were compared in terms of local and regional control and complications related to treatment. The costs of surgery and radiotherapy, including all personnel and equipment, were estimated. A cross-sectional study was undertaken of 11 patients with a history of T1 or T2 glottic carcinoma: 5 patients postsurgery, 4 patients postradiotherapy, and 2 patients postradiotherapy and surgery. Vocal fold function and voice quality were assessed by an otolaryngologist using videostroboscopy and a standardized questionnaire (Voice Handicap Index) and by an experienced speech-language pathologist using the Visipitch II computer program (Kay Elemetrics Corp., Lincoln Park, NJ).


RESULTS
Retrospective study: The recurrence rate following primary treatment was 37.5% for group 1 and 22% for group 2. Group 1 patients presented with 25% of local complications (vocal fold scars) and no systemic complications. Patients in group 2 presented with local and systemic complications: 35% for local and 27% for systemic. One patient had mild carotid stenosis, and one patient had mild esophageal stenosis. The cost of treatment with radiotherapy was five times higher than the cost of surgery. Cross-sectional study: Vocal fold function assessed by videostroboscopy was superior in group 2. However, patients in group 1 scored higher on the subjective (Voice Handicap Index questionnaire) and objective (Visipitch parameters) voice assessments.


CONCLUSIONS
Surgery and radiotherapy are both very effective in terms of local and regional control for early glottic carcinoma. However, surgery tends to be more cost-effective, with less complications and possibly a better voice outcome.
Mlynarek
Alex
A
Department of Otolaryngology-Head and Neck Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec.
Kost
Karen
K
Gesser
Ruth
R
D000368:Aged; D002277:Carcinoma / Q000532:radiotherapy* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005931:Glottis; D017048:Health Care Costs; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics; D011878:Radiotherapy / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014833:Voice Quality