Voice and Swallowing Outcomes After Early Laryngeal Cancer: A UK Based Multi-Centre Study

Early laryngeal cancer is effectively treated with transoral laser microsurgery (TLM) or radiotherapy, both offering comparable oncological outcomes. The impact on voice and swallowing remains unclear.

To evaluate voice and swallowing outcomes following treatment with TLM or radiotherapy for early laryngeal cancer in a UK multi-centre prospective study.

A total of 137 patients with T1 or T2 laryngeal cancer were recruited from five UK head and neck cancer centres. Patients received either TLM or radiotherapy (up to 55 Gy). Voice and swallowing function were assessed at baseline, 3 months and 6 months post-treatment using a multidimensional protocol: Voice Handicap Index (VHI-10), maximum phonation time (MPT), GRBAS perceptual voice scale, 100 mL timed water swallow test and Normalcy of Diet (NoD).

VHI scores improved significantly following radiotherapy at 3 months (MD 8.66, SD 11.46, 95% CI 5.5, 11.8, p < 0.001). MPT was also significantly longer in the radiotherapy group (MD 2.47, SD 6.2, 95% CI 0.7-4.2, p = 0.007). Perceptual voice ratings showed reduced hoarseness post-radiotherapy at 3 months (MD 0.71, SD 1.11, 95% CI 0.43, 0.98, p < 0.001). No significant differences were found between treatments for swallowing function or NoD, which remains stable up to 6 months.

Radiotherapy is associated with better short-term voice outcomes compared to TLM. Swallowing function remains largely unaffected by treatment type. This study highlights the need to include functional outcomes in treatment decisions and is the first UK multicentre prospective study to use standardised, multidimensional assessments of early recovery following treatment for early laryngeal cancer.