title: Subjective voice quality, communicative ability and swallowing after definitive radio(chemo)therapy, laryngectomy plus radio(chemo)therapy, or organ conservation surgery plus radio(chemo)therapy for laryngeal and hypopharyngeal cancer.
abstract: This retrospective analysis focusses on the impact of therapy on perceived long-term post-cancer treatment function. A validated questionnaire including items and components for the assessment of communicative ability, quality of voice and swallowing was sent to 129 patients. All patients were treated between 1998 and 2007. A total of 76 patients (58.9%) with carcinoma of the larynx or hypopharynx replied to the questionnaire. Data was evaluated retrospectively. Therapy delivered was definitive radio(chemo)therapy (defchRT/RT) (21/76, 28%), laryngectomy + radio(chemo)therapy (LE + chRT/RT) (28/76, 37%), or larynx conservation surgery + radio(chemo)therapy (LCS + chRT/RT) (27/76, 36%). Radiotherapy was administered using 2D- or 3D-conformal planning. The most common concomitant chemotherapy delivered was cisplatin + 5FU. For statistical analyses of the components, averages were calculated and tested using the Kruskal-Wallis test and the U-test of Mann and Whitney. Differences were assessed by the Monte Carlo method or Fisher's exact test. The single item rates were compared with Fisher's exact test. Mean follow-up was 56.7 months (range, 8-130 months). After defchRT/RT, patients trended towards more substantial-strong hoarseness compared with LCS + chRT/RT (P = 0.2). After LE, patients were dissatisfied with their artificial larynx/electrolarynx and the tone of their voice (P = 0.3, P = 0.07) and communicative ability (P = 0.005, P = 0.008) compared with those treated with defchRT/RT and LCS + chRT/RT, respectively. Dysphagia and additional percutaneous endoscopic gastrostomy (PEG) feeding were more frequent after defchRT/RT in comparison with the other two groups (P < 0.05). Voice quality and communicative ability were slightly worse after defchRT/RT and LE + chRT/RT, but satisfying with all treatment modalities. Further development of the therapy approach is necessary to reduce long-term side effects, with measures of post-treatment function as important endpoints.
authors.affiliation: Department of Radiotherapy, University of Rostock, Südring 75, 18059 Rostock, Germany marcella.szuecs@uni-rostock.de.
authors.forename: Marcella
authors.initials: M
authors.lastname: Szuecs
authors.affiliation: Department of Radiotherapy, University of Leipzig, Stephanstraße 9a, 04103 Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuhnt
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery 'Otto Körner', University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Punke
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery 'Otto Körner', University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Witt
authors.affiliation: Department of Radiation Oncology, Hospital Chemnitz, Bürgerstraße 2, 09113 Chemnitz, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Klautke
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery 'Otto Körner', University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Kramp
authors.affiliation: Department of Radiotherapy, University of Rostock, Südring 75, 18059 Rostock, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Hildebrandt
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000379:methods; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology* / Q000523:psychology; D005260:Female; D006685:Hoarseness / Q000209:etiology* / Q000523:psychology; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000523:psychology / Q000628:therapy*; D007822:Laryngeal Neoplasms / Q000523:psychology / Q000628:therapy*; D007825:Laryngectomy; D007830:Larynx / Q000528:radiation effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods / Q000523:psychology; D017060:Patient Satisfaction; D011832:Radiation Injuries / Q000209:etiology / Q000523:psychology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014833:Voice Quality
keywords: dysphagia; quality of voice; radiation; surgery