VoiceS: voice quality after transoral CO2 laser surgery versus single vocal cord irradiation for unilateral stage 0 and I glottic larynx cancer-a randomized phase III trial

Philipp Reinhardt, Roland Giger, Eberhard Seifert, Mohamed Shelan, Elena Riggenbach, Dario Terribilini, Andreas Joosten, Daniel H Schanne, Daniel M Aebersold, Peter Manser, Matthias S Dettmer, Christian Simon, Esat M Ozsahin, Raphaël Moeckli, Andreas Limacher, Francesca Caparrotti, Deepa Nair, Jean Bourhis, Martina A Broglie, Abrahim Al-Mamgani, Olgun Elicin, Philipp Reinhardt, Roland Giger, Eberhard Seifert, Mohamed Shelan, Elena Riggenbach, Dario Terribilini, Andreas Joosten, Daniel H Schanne, Daniel M Aebersold, Peter Manser, Matthias S Dettmer, Christian Simon, Esat M Ozsahin, Raphaël Moeckli, Andreas Limacher, Francesca Caparrotti, Deepa Nair, Jean Bourhis, Martina A Broglie, Abrahim Al-Mamgani, Olgun Elicin

Abstract

Background: Surgery and radiotherapy are well-established standards of care for unilateral stage 0 and I early-stage glottic cancer (ESGC). Based on comparative studies and meta-analyses, functional and oncological outcomes after both treatment modalities are similar. Historically, radiotherapy (RT) has been performed by irradiation of the whole larynx. However, only the involved vocal cord is being treated with recently introduced hypofractionated concepts that result in 8 to 10-fold smaller target volumes. Retrospective data argues for an improvement in voice quality with non-inferior local control. Based on these findings, single vocal cord irradiation (SVCI) has been implemented as a routine approach in some institutions for ESGC in recent years. However, prospective data directly comparing SVCI with surgery is lacking. The aim of VoiceS is to fill this gap.

Methods: In this prospective randomized multi-center open-label phase III study with a superiority design, 34 patients with histopathologically confirmed, untreated, unilateral stage 0-I ESGC (unilateral cTis or cT1a) will be randomized to SVCI or transoral CO2-laser microsurgical cordectomy (TLM). Average difference in voice quality, measured by using the voice handicap index (VHI) will be modeled over four time points (6, 12, 18, and 24 months). Primary endpoint of this study will be the patient-reported subjective voice quality between 6 to 24 months after randomization. Secondary endpoints will include perceptual impression of the voice via roughness - breathiness - hoarseness (RBH) assessment at the above-mentioned time points. Additionally, quantitative characteristics of voice, loco-regional tumor control at 2 and 5 years, and treatment toxicity at 2 and 5 years based on CTCAE v.5.0 will be reported.

Discussion: To our knowledge, VoiceS is the first randomized phase III trial comparing SVCI with TLM. Results of this study may lead to improved decision-making in the treatment of ESGC.

Trial registration: ClinicalTrials.gov NCT04057209. Registered on 15 August 2019. Cantonal Ethics Committee KEK-BE 2019-01506.

Keywords: Glottic cancer; Larynx; Radiotherapy; Randomized controlled trial; Transoral CO2-laser surgery; Vocal cord irradiation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
VoiceS study design
Fig. 2
Fig. 2
Endoscopic view during a type II cordectomy of the left side
Fig. 3
Fig. 3
Formalin-fixed cordectomy specimen
Fig. 4
Fig. 4
Example treatment plan with IMRT (five static fields)
Fig. 5
Fig. 5
Example treatment plan with VMAT

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