McGuirt W F, Blalock D, Koufman J A, Feehs R S, Hilliard A J, Greven K, Randall M
Department of Otolaryngology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC.
Arch Otolaryngol Head Neck Surg. 1994 Sep;120(9):951-5. doi: 10.1001/archotol.1994.01880330035007.
To compare voice results following laser resection or radiation therapy for T1a glottic carcinomas.
Objective recordings of acoustical data that were analyzed and calculated by an acoustic analyzer and subjective scores by patients, speech therapists, surgeons, and radiation therapists are compared.
Academic medical center speech laboratory at an institution where patients had been treated. Archival files were searched and patients were solicited by letter to participate in this analysis.
Men treated at least 6 months previously and who were without active laryngeal disease. Criteria were unilateral vocal cord carcinomatous involvement with no subglottic, anterior commissure, or arytenoid extension and tumor invasion clinically judged to be less than half of the cordal depth.
Thirteen patients had received approximately 63 Gy in 28 fractions, five fractions a week, with laterally opposed fields using a linear accelerator. Eleven patients had had resection of less than half of the cordal depth by using a carbon dioxide laser with a 300-microns spot size working at a 400-mm distance; 13- to 15-W power intensity with a one tenth of a second burn in a noncontinuous mode.
No statistically significant differences between the two study groups were found. Patients and physicians subjectively rated (1 indicates normal; 5, aphonic) the quality of voices of patients in the irradiation group (1.5 and 2.0) as slightly better than the quality of voices of patients in the laser group (2.0 and 2.4). Speech pathologists rated the voices of patients in the laser and irradiation group as indistinguishable and mildly abnormal (2.75 and 2.73).
Voice quality in highly selected patients with vocal cord carcinoma treated by laser resection can be as good as that in patients whose cancer was similarly staged after radiation therapy.
比较T1a期声门癌激光切除术后与放射治疗后的嗓音结果。
比较由声学分析仪分析和计算得出的声学数据的客观记录，以及患者、言语治疗师、外科医生和放射治疗师给出的主观评分。
一所对患者进行过治疗的学术医疗中心言语实验室。检索了存档文件，并通过信件邀请患者参与此次分析。
至少在6个月前接受过治疗且无活动性喉部疾病的男性。入选标准为单侧声带癌累及，无声门下、前联合或杓状软骨扩展，且临床判断肿瘤浸润小于声带深度的一半。
13例患者接受了约63 Gy的放疗，分28次，每周5次，采用直线加速器从两侧相对照射。11例患者使用光斑尺寸为300微米的二氧化碳激光，在距离400毫米处，以13至15瓦的功率强度，非连续模式下每次烧灼十分之一秒，切除小于声带深度一半的组织。
两个研究组之间未发现统计学上的显著差异。患者和医生主观评分（1表示正常；5表示失音）显示，放疗组患者嗓音质量（1.5和2.0）略优于激光组患者（2.0和2.4）。言语病理学家认为激光组和放疗组患者的嗓音无明显差异，均为轻度异常（2.75和2.73）。
经严格筛选的声带癌患者，激光切除术后的嗓音质量可与放疗后处于相似分期的患者相当。
