Oropharyngeal cancer patients treated with combined chemotherapy and radiation therapy reported a decrease in their voice and speech quality (VSQ) for up to 1 year after the completion of treatment, according to new research. The study was presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium in Scottsdale, Arizona.
The study further showed that limiting the dose of radiation to the glottic larynx to less than 20 Gy resulted in a decrease in posttreatment VSQ problems, and that patient-reported VSQ indicated more adverse effects from treatment than did independent physician assessment.
The research evaluated the VSQ of 91 patients with stage III/IV oropharyngeal cancer (OPC) at the University of Michigan in Ann Arbor. The patients were treated from 2003 to 2011 on two prospective studies of definitive concurrent chemotherapy and radiation therapy, using advanced intensity-modulated radiation therapy techniques intended to minimize the radiation dose to the pharyngeal constrictors, salivary glands, oral cavity (the inside region of the mouth), glottic larynx, supraglottic larynx, and esophagus.
Patients’ voice and speech problems were evaluated and reported independently by patients and their physicians. Patients completed questionnaires prior to treatment, and 1, 3, 6, 12, 18, and 24 months after chemotherapy and radiation. Factors associated with worsening patient-reported VSQ were assessed and were defined as a decrease in questionnaire scores from the patients’ baseline evaluations.
A maximum decrease in VSQ was reported at 1-month posttreatment, with 68% of patients reporting worsening scores on one questionnaire and 41% reporting lower scores on a second questionnaire. Improvements to the scores were seen thereafter, with patients, on average, reporting scores back to baseline by 12 months posttreatment when scored on the first questionnaire and by 18 months posttreatment when scored on the second. At 12 months after treatment, however, one-third of patients continued to report a decrease in VSQ compared with baseline.
In contrast, physician assessment was much less sensitive to voice and speech problems at posttreatment, with VSQ reported (grade 1 toxicity) by physicians in only 5% of patients at 3 months and 0% at either 1 or 2 years.
On further analysis, voice quality worsening (as reported by patients) was closely related to the radiation dose received by the glottic larynx (the voice box), whereas patient-perceived speech difficulty was related to radiation dose received by both the glottic larynx and oral cavity.
“In contrast to chronic mouth dryness and swallowing difficulties, which have been recognized for years as potential complications in patients receiving radiation therapy for cancers of the head and neck, relatively little attention has been directed to treatment-related changes in voice and speech quality,” said lead author Jeffrey Vainshtein, MD, chief resident in the Department of Radiation Oncology at the University of Michigan.