Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in a homogenous patient population.
OBJECTIVE
To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma.


METHODS
Patients, affected by laryngeal glottic carcinoma, treated by laser CO2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software.


RESULTS
A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001).


CONCLUSIONS
This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined.
Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Nicola
N
Dinapoli
Claudio
C
Parrilla
Jacopo
J
Galli
Rosa
R
Autorino
Francesco
F
Miccichè
Francesco
F
Bussu
Mario
M
Balducci
Lucia
L
D'Alatri
Raffaella
R
Marchese
Mario
M
Rigante
Giuseppe
G
Di Lella
Luca
L
Liberati
Giovanni
G
Almadori
Gaetano
G
Paludetti
Vincenzo
V
Valentini
D000368:Aged; D003299:Cooperative Behavior; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D007830:Larynx / Q000528:radiation effects*; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010348:Patient Care Team; D057240:Patient Preference; D011183:Postoperative Complications / Q000209:etiology*; D011832:Radiation Injuries / Q000209:etiology*; D012189:Retrospective Studies; D014833:Voice Quality / Q000528:radiation effects*