Voice quality after surgery or radiotherapy for glottic T1 squamous cell carcinoma: Results of the VOQUAL study

Many series have compared voice quality after radiotherapy or surgery for cT1 glottic carcinoma. Different meta-analyses identify better results for radiotherapy while others do not identify any difference, some finally find a superiority of surgery. The purpose of this study was to compare the voice quality in the long term of patients who underwent transoral surgery versus exclusive irradiation for the treatment of cT1 glottic carcinoma. The VOQUAL study was a pilot comparative multicenter cross-sectional study. The primary endpoint was the Voice Handicap Index comparison between two groups (radiotherapy or surgery). The voice assessment also consisted in the heteroevaluation of voice quality by the Grade, Roughness, Breathness, Asthenia, and Strain rating scale reported by Hirano. The study included 41 adult patients with cT1 carcinoma of the vocal cord treated by cordectomy or exclusive radiation in two oncologic centers. The median Voice Handicap Index value was 20 [8; 32.5] in the surgery group and 10 [4; 18.5] in the radiotherapy group. There was no statistically significant difference between the median values and the various components F, P and E of the questionnaire (P=0.1585). The median value of the numeric dysphonia Grade, Roughness, Breathness, Asthenia, and Strain scale was 2 [0; 5] in the surgery group and 2 [0.25; 3.75] in the radiotherapy group. There was no statistically significant difference between these values (P=0.78). Our study did not show any significant difference on the primary endpoints of Voice Handicap Index and Grade, Roughness, Breathness, Asthenia, and Strain scores. III. Clinical trial registration: The VOQUAL study was registered on the ClinicalTrials.gov platform under the number NCT04447456, in July 2020. De nombreuses séries ont comparé la qualité de la voix après une radiothérapie ou une chirurgie pour un carcinome glottique classé cT1. Différentes méta-analyses ont identifié de meilleurs résultats pour la radiothérapie tandis que d’autres n’ont identifié aucune différence, certaines enfin ont trouvé une supériorité de la chirurgie. L’étude VOQUAL est une étude pilote comparative multicentrique transversale. Le critère d’évaluation principal était la comparaison du Voice Handicap Index entre deux groupes (radiothérapie contre chirurgie). L’évaluation de la voix consistait également en une hétéroévaluation de la qualité de la voix selon l’échelle de notation Grade, Roughness, Breathness, Asthenia, and Strain (GRBAS)