Kennedy J T, Paddle P M, Cook B J, Chapman P, Iseli T A
Department of Otolaryngology, Head and Neck Surgery, St Vincent's Hospital, Victoria, Australia.
J Laryngol Otol. 2007 Dec;121(12):1184-8. doi: 10.1017/S0022215107007554. Epub 2007 Apr 20.
Early glottic cancer may be treated with primary radiotherapy or transoral laser microsurgery with comparable survival. The choice of therapy therefore depends on patient preference after discussion of risks, benefits and alternatives.
All previously untreated patients undergoing transoral laser microsurgery for T1 or T2 glottic cancer at St Vincent's Hospital between July 1997 and December 2004 had their staging and demographics recorded. Surgery was categorised according to the European Laryngological Society. A voice recording was made pre-operatively then at 12 weeks post-operatively and scored by two independent speech therapists on the Oates Russell Voice Profile - a scale of zero (normal) to five (severe dysphonia). Follow up was for a minimum of two years.
Fifty-three patients with a mean age of 56 were included. The observed survival was T1 89.4 per cent and T2 85.3 per cent after a mean follow up of 47 months. Nineteen patients staged T1 underwent cordectomy. A second procedure was required in 22.2 per cent, however, none required a laryngectomy. Thirty-four patients staged T2 underwent hemilaryngectomy. A second procedure was required in 41.2 per cent including 8.8 per cent requiring salvage laryngectomy. One patient died with unresectable nodal disease. The mean Oates Russell Voice Profile for T1 disease was 2.37 and for T2 2.68 (range 1 to 4) indicating a mild (2) to moderate (3) degree of voice impairment.
Survival outcomes following transoral laser microsurgery are comparable to treatment with radiotherapy. Voice impairment is usually mild to moderate following transoral laser microsurgery for early glottic cancer but overall may be greater than in radiotherapy patients. The repeatability of transoral laser microsurgery may result in a lower laryngectomy rate compared with published series using radiotherapy.
早期声门癌可采用根治性放疗或经口激光显微手术治疗，生存率相当。因此，治疗方法的选择取决于在讨论风险、益处和替代方案后患者的偏好。
1997年7月至2004年12月期间，在圣文森特医院接受经口激光显微手术治疗T1或T2声门癌的所有既往未治疗患者，记录其分期和人口统计学资料。手术根据欧洲喉科学会进行分类。术前及术后12周进行语音记录，由两名独立的言语治疗师根据奥茨·拉塞尔嗓音量表进行评分，该量表从0（正常）到5（严重发音障碍）。随访至少两年。
纳入53例平均年龄为56岁的患者。平均随访47个月后，T1期患者的观察生存率为89.4%，T2期为85.3%。19例T1期患者接受了声带切除术。22.2%的患者需要进行二次手术，但无一例需要行喉切除术。34例T2期患者接受了半喉切除术。41.2%的患者需要进行二次手术，其中8.8%的患者需要挽救性喉切除术。1例患者死于无法切除的淋巴结疾病。T1期疾病的奥茨·拉塞尔嗓音量表平均评分为2.37，T2期为2.68（范围为1至4），表明存在轻度（2）至中度（3）程度的嗓音障碍。
经口激光显微手术的生存结果与放疗相当。早期声门癌经口激光显微手术后的嗓音障碍通常为轻度至中度，但总体上可能比放疗患者更严重。与已发表的放疗系列相比，经口激光显微手术的可重复性可能导致喉切除率较低。
