Larynx preservation preferred over total laryngectomy

Patients with locally advanced laryngopharyngeal cancers who receive radical chemoradiation have significantly better voice outcomes during the 12 months following treatment when compared with patients who have undergone a total laryngectomy and surgical voice restoration, according to a study in the February 1 issue of the International Journal for Radiation Oncology-Biology-Physics, the official journal of the American Society for Therapeutic Radiology and Oncology.

The conventional treatment for patients with advanced squamous carcinoma of the larynx has traditionally been a total laryngectomy, which is the removal of the voice box, with or without radiation; however, this treatment has several serious side effects, including natural-voice loss, altered food-swallowing function and a permanent opening in the trachea.

Researchers in this study, conducted jointly by the Royal Marsden Hospital Head and Neck Unit and The Institute of Cancer Research, both in London, sought to determine if larynx preservation through chemoradiation would result in improved voice results and serve as a suitable alternative to total laryngectomy, which, in turn, would remove the need for surgery and all of the related potential side effects and risks.

Twenty-one patients, both male and female, with a median age of 65 years old, who were diagnosed with Stage III or IV laryngopharyngeal cancer, were given induction chemotherapy followed by radical chemoradiation. The researchers then used electroglottography – placing electrodes alongside the larynx – to electronically record and analyze the voice function of the patients before treatment and at one, six and 12 months after treatment. This is the first study of its kind to use electroglottography as an assessment technique.

Patients were asked to read a standard passage and pronounce vowel sounds into a microphone that sat at the same distance from the mouth of each patient. The researchers then used these recordings to measure jitter in the voice, maximum phonation time and words per minute.

Single voice recordings were also taken from 21 patients, with a median age of 65 years old, who received a total laryngectomy and surgical voice restoration, as well as from 21 normal controls of the same median age group.

The researchers found that preservation of the larynx through chemoradiation did not always return voice quality to exactly how it was before the tumor was present, but it did provide for significantly better voice outcomes when compared to removing the larynx through surgery. At 12 months after treatment, the patients receiving chemoradiation had normal maximum phonation time and words per minute, but less than normal jitter.

“This study is important because it offers patients reassurance that if they undergo organ preservation, it is statistically proven that their voice will be better than if they undergo surgery. We can reassure patients that their voice is likely to recover from the immediate effects of chemoradiation,” said Kevin Harrington, M.B.B.S., clinical senior lecturer at The Institute of Cancer Research. “This study should also allay the concerns of surgeons that laryngopharyngeal cancer patients cannot be successfully treated with chemoradiation with good functional outcome.”