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Neck Cancer

Surgery - Laser Surgery. The Role of Function. Petra Ambrosch and Wolfgang Steiner University of Kiel and University of Göttingen. STATEMENTS ON. Head and. Neck Cancer. Frankfurt am Main, Germany. “Quality” of Voice in Early Glottic Cancer. TUMOR RELATED FACTORS

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Neck Cancer

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  1. Surgery - Laser Surgery The Role of Function Petra Ambrosch and Wolfgang Steiner University of Kiel and University of Göttingen STATEMENTS ON Head and Neck Cancer Frankfurt am Main, Germany

  2. “Quality” of Voice in Early Glottic Cancer • TUMOR RELATED FACTORS • Volume/Bulk of tumor- Extent of submucosal infiltration- Extent of vocalis infiltration- Direct infiltration of arytenoid OBSERVER RELATED FACTORS Subjective measures- Patient reports- Questionnaires- Untrained observers- Treating physicians- Neutral observers- Family / friends- Speech / voice therapists Objective measures PATIENT RELATED FACTORS - Smoking - Occupation - Medical comorbidity- Socioeconomic issues- Expectations of outcome- Motivation- Compliance with speech therapy

  3. 10 Studies comparing RT with Endoscopic Laser Resection for Post-treatment Voice Author Sample Voice quality Size Brandenburg 2002 L=30; R=44 comparable Stoeckli et al. 2001 L=40; R=16 comparable Delsupehe et al. 1999 L=30; R=12 no difference Rosier et al. 1998 L=31; R=31 RT slightly better, difference not significant Rydell et al. 1995 L=20; R=18 RT significantly better McGuirt et al. 1994 L=11; R=13 comparable Cragle and Brandenburg 1993 L=14; R=20 similar Epstein et al. 1990 L=17; R=60 RT significantly better Schuller et al. 1990 L= 5; R= 8 similar Hirano et al. 1985 L=17; R=14 comparable

  4. Post-Treatment Voice 10 studies comparing radiotherapy with endoscopic laser resection for post-treatment voice 7 of 10 studies reported comparable voice quality 3 of 10 studies reported better voice after radiotherapy 5 of 6 objective studies by speech pathologists showed no difference in voice quality

  5. pT2b (n=97) and pT3 (n=70) Glottic Carcinoma Functional Results Swallowing All patients achieved undisturbed oral intake Voice Speech intelligibility (telephone test) >90%

  6. pT1 and pT2 Supraglottic Carcinomas (n=83) Functional Results 82 patients achieved undisturbed oral intake 1 patient depends on a gastrostomy tube no laryngectomy for functional reasons

  7. pT3 and pT4 Supraglottic Carcinomas (n=121) Functional Results 114 (94.2%) patients achieved undisturbed oral intake 4 (3.3%) patients depend on a gastrostomy tube 3 (2.5%) laryngectomies for functional reasons

  8. Swallowing after Transoral Laser Microsurgery • Over 500 patients between 1994 – 2004 • Heterogeneity in tumor stages and in reporting functional outcomes • Time to “normal” swallowing reported at a mean of 6-10 days • “Satisfactory” swallowing in > 90% patients • Majority have some degree of early post-op aspiration • Aspiration leading to pneumonia reported in 2 – 6% • Less than 2% need a permanent enteral feeding tube for inability to swallow • TL for functional reasons becomes necessary in 0% -1% patients

  9. Piriform Sinus Carcinomas (n=129) Functional Results 126 (97.7%) patients achieved undisturbed oral intake 3 (2.3%) patients depend on a gastrostomy tube

  10. Functional Outcomes of Laser Microsurgery Author Year N Larynx preservation no function preservation Steiner, Ambrosch 2001 129 3 (1%) Rudert 2002 29 0 Vilaseca et al. 2004 28 3 (10%)

  11. Swallowing Function after Endoscopic Laser Resection • Access to tumor does not require disruption of laryngeal framework • Normal elevation of the larynx • Surgery does not alter relative position of glottis to BOT • (in supraglottic resections) or esophagus (in piriform sinus resections) • Pharyngeal musculature and innervation preserved • Sensory innervation from SLN preservedRe-epithelialized mucosa probably regains sensation from regenerating nerve endings of SLN

  12. Göttingen Kiel

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