title: Voice outcomes following radiation versus laser microsurgery for T1 glottic carcinoma: systematic review and meta-analysis.
abstract: OBJECTIVE
  Systematic review of literature on patient-reported voice handicap following T1 glottic squamous cell carcinoma treatment using transoral laser microsurgery or radiation therapy.
  
  
  METHODS
  PubMed, Web of Science, and Scopus (1997-2013).
  
  
  METHODS
  These data sources were searched for papers reporting Voice Handicap Index (VHI) after treatment of early glottic carcinoma. Review and reference cross-checking were performed using a priori selection criteria. Study data were abstracted and publication quality categorized independently by 2 authors. Corresponding authors were contacted to maximize data for analysis. Meta-analysis was performed only with studies that included both treatment modalities, to reduce heterogeneity and maximize rigor; random effects modeling was used to pool results.
  
  
  RESULTS
  Eighteen publications were identified that reported VHI data following surgery and radiotherapy for T1 glottic carcinoma. No studies were randomized. When studies that reported multiple T-stages or systematic treatment selection bias were excluded, 8 retrospective cohort studies describing 362 patients were suitable for meta-analysis. Follow-up time (mean, 47 months; range, 1-298 mo) and extent of surgical excision varied across studies. Six studies showed no VHI difference between treatment arms; 2 favored radiotherapy over surgery (1 of which reported transmuscular cordectomy for all surgical patients); and none favored surgery. Meta-analysis showed no significant difference in posttreatment VHI between radiotherapy and surgery (mean difference, -5.52; 95% confidence interval, -11.40, 0.36; heterogeneity I (2) = 61%, P = .01).
  
  
  CONCLUSIONS
  VHI scores were comparable following transoral laser microsurgery and radiation therapy for T1 glottic carcinoma in the current literature, suggesting no clinically significant difference in functional voice outcomes between treatment types.
authors.affiliation: Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Greulich
authors.affiliation: The Voice Clinic of Indiana, Carmel, Indiana, USA The Department of Speech and Hearing Sciences, Indiana University, Bloomington, Indiana, USA.
authors.forename: Noah P
authors.initials: NP
authors.lastname: Parker
authors.affiliation: Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Merati
authors.affiliation: Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA smisono@umn.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Misono
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery*; D005931:Glottis; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D014831:Voice; D014833:Voice Quality
keywords: glottis/radiotherapy; glottis/surgery; humans; laryngeal neoplasms; laser therapy; neoplasm staging; quality of life; voice disorders; voice quality
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