Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey.
Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey.
Clin Otolaryngol. 2021 Mar;46(2):340-346. doi: 10.1111/coa.13674. Epub 2020 Dec 8.
Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post-treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma.
Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool-10 test (EAT-10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed.
CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20 mL water according to the Penetration and Aspiration Scale (P < .05). The mean EAT-10 Score was found 0 in the CO2 TOLMS group, and 3.20 ± 3.24 in the RT group (P < .05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P > .05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5 mL and 10 mL water, 5 mL and 20 mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P < .05).
It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.
CO2 经口激光微创手术（CO2 TOLMS）和放疗（RT）都是早期声门型喉癌的标准治疗方法。然而，之前的研究主要关注于嗓音结果，而非吞咽结果。本研究旨在比较 CO2 TOLMS 和 RT 治疗 T1 声门型喉癌后对吞咽功能的晚期影响。
纳入 2015 年 5 月至 2019 年 1 月间的 40 例 T1 声门型喉癌患者（20 例 CO2 TOLMS 和 20 例 RT）。询问患者是否有引发吞咽困难的特定食物类型、任何食团控制困难、需要清嗓子、咽喉有异物感、呛咳、咳嗽和口干。还评估了功能性口腔摄入量表（FOIS）、吞咽功能结果量表（FOSS）、饮食评估工具-10 测试（EAT-10）和纤维内镜吞咽功能检查（FEES）结果。
CO2 TOLMS 组患者在使用 10 和 20 ml 水时在渗透和吸入方面的表现明显优于 RT 组，根据渗透和吸入量表（P<0.05）。CO2 TOLMS 组的平均 EAT-10 评分为 0，而 RT 组为 3.20±3.24（P<0.05）（得分越低表示结果越好）。根据咽后残留严重程度的耶鲁量表，两组之间的咽后残留没有统计学上的显著差异（P>0.05）。CO2 TOLMS 组在使用 5 ml 和 10 ml 水、5 ml 和 10 ml 蜂蜜稠度食物以及酸奶时，梨状窦的残留量明显少于 RT 组，根据耶鲁咽后残留严重程度量表（P<0.05）。
建议在长期来看，CO2 TOLMS 在治疗 T1 声门型喉癌的吞咽功能方面更具优势。
