Radiation therapy remains the most commonly employed treatment for smaller vocal cord cancers. Without question, irradiation offers high cure rates with preservation of vocal function.
Since the advent of the CO2 surgical laser, the indications for laser surgery for vocal cord cancer have expanded, and some surgeons prefer use of the laser for primary excision of early forms of this cancer. These proponents suggest that laser resection offers several advantages over irradiation and that the cure rates and voice results are comparable. The reported advantages are:
- The ability to “surgically explore” the lesion to reveal the true extent of disease.
- The ability to treat the cancer at one time with outpatient surgery (versus the six weeks required for standard radiation therapy).
- Having a specimen that can be analyzed to ensure that the entire tumor was removed (with radiation, the tumor is never removed—it is shrunken.
- Fewer side effects of surgery versus radiation therapy.
- The relatively low-cost. Cost analysis studies show that laser surgery may be as little as 1/10th the cost of radiation therapy.
- Irradiation is retained as a future therapeutic option if surgery is done first. Radiation can typically only be used once. If it fails, open surgical resection (often with removal of the entire voice box) may need to be used to ensure proper removal of the radiated cancer.
A recent study compared the vocal results of patients treated by laser resection with a comparable radiation-therapy treated group. Although voice results with surgery were worse with larger tumors, the overall voice results were comparable or superior for the surgical group.
Choosing between endoscopic laser surgery and radiation therapy is not a simple matter. Surgeons more experienced with endoscopic techniques are more likely to properly select patients for surgery, but the patients themselves also must participate in their treatment selection.
