title: Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy.
abstract: OBJECTIVE
  Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial.
  
  
  METHODS
  Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO2 laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living.
  
  
  RESULTS
  Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization.
  
  
  CONCLUSIONS
  Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland. Electronic address: leena-maija.aaltonen@hus.fi.
authors.forename: Leena-Maija
authors.initials: LM
authors.lastname: Aaltonen
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: Noora
authors.initials: N
authors.lastname: Rautiainen
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Sellman
authors.affiliation: Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland.
authors.forename: Kauko
authors.initials: K
authors.lastname: Saarilahti
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Mäkitie
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Rihkanen
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, and University of Tampere, Tampere, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Laranne
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, and University of Tampere, Tampere, Finland.
authors.forename: Leenamaija
authors.initials: L
authors.lastname: Kleemola
authors.affiliation: Department of Oncology, Tampere University Hospital, and University of Tampere, Tampere, Finland.
authors.forename: Tuija
authors.initials: T
authors.lastname: Wigren
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku, Finland.
authors.forename: Eeva
authors.initials: E
authors.lastname: Sala
authors.affiliation: Department of Oncology, Turku University Hospital, and University of Turku, Turku, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Lindholm
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku, Finland.
authors.forename: Reidar
authors.initials: R
authors.lastname: Grenman
authors.affiliation: Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Joensuu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005387:Finland; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D014827:Vocal Cords / Q000528:radiation effects*; D014832:Voice Disorders / Q000209:etiology* / Q000503:physiopathology; D014833:Voice Quality / Q000528:radiation effects*