Health-related quality of life and voice following radiotherapy for laryngeal cancer--a comparison between glottic and supraglottic tumours.

BACKGROUND: To provide further information about short-term effects on voice quality and health-related quality of life (HRQL) following radiotherapy for laryngeal cancer, comparing glottic and supraglottic tumours. MATERIAL AND METHODS: Sixty-seven male patients who received radiotherapy for glottic and supraglottic tumours were included. Voice recordings were performed and patient reported outcome questionnaires filled in before radiotherapy and one-month post-completion. Acoustic and temporal measures were produced from the recordings and compared to an age-matched, vocally healthy control group (n = 23). RESULTS: Deterioration of HRQL post-radiotherapy was noted for both the glottic and supraglottic cohort. Pre- radiotherapy the glottic cohort demonstrated acoustic and temporal measures that were statistically different from healthy controls, with improvements post-radiotherapy where several measures showed no statistically significant differences compared to healthy controls. The supraglottic cohort revealed voice measures comparable to the healthy controls but demonstrated statistically significant impairments in HRQL compared to the glottic cohort following radiotherapy. CONCLUSION: Patients with supraglottic tumours may experience more eating and swallowing related problems prior to radiotherapy compared to glottic tumours and demonstrate a more significant reduction in HRQL following treatment. However, in terms of voice measurements, subjective measures correlate poorly with objective acoustic parameters, thereby emphasising the importance of patient-reported outcomes as part of treatment evaluation.

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

PURPOSE: 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. MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSION: Our study did not show any significant difference on the primary endpoints of Voice Handicap Index and Grade, Roughness, Breathness, Asthenia, and Strain scores. LEVEL OF EVIDENCE: III. CLINICAL TRIAL REGISTRATION: The VOQUAL study was registered on the ClinicalTrials.gov platform under the number NCT04447456, in July 2020.

Single vocal cord irradiation for early-stage glottic cancer: Excellent local control and favorable toxicity profile.

OBJECTIVE: To validate the earlier reported promising oncologic outcomes and favorable toxicity profile following single vocal cord irradiation (SVCI) in an expanded cohort of patients with early-stage glottic cancer treated at our institute with longer follow-up time. MATERIALS AND METHODS: Between February 2011 and January 2020, 111 consecutive patients with early-stage glottic cancer were treated with SVCI to the whole involved vocal cord (58.08 Gy, given in 16 fractions of 3.63 Gy). Setup verification was done using cone-beam CT, prior to each fraction. The endpoints were local control (LC), overall survival (OS), grade ≥ 3 toxicity and voice quality assessment using voice-handicap index (VHI) questionnaires. RESULTS: Median follow-up was 41 months (range; 8-84). Two patients developed in-field local failure (LF). The 3- and 5-year LC rates were 99.1% and 97.1%, respectively. As both patients with LF were successfully salvaged with total laryngectomy, the 5-year ultimate LC-rates was 99%. The 5-years OS was 80.6%. All patients finished treatment without any interruption. No patients developed acute grade ≥ 3 toxicity. Late grade 3 toxicity was reported in 7 patients (6.5%) out of 108 patients evaluable for late toxicity; 2 because of severe hoarseness and 5 because of laryngeal radionecrosis (4.5%). The 5-years laryngectomy-free survival was 98.1%. The VHI-scores improved over time, only 22% of patients had VHI > 30 at 3-years post-radiotherapy, compared to 38% at baseline. CONCLUSIONS: Local control rate and laryngectomy-free survival of SVCI are excellent with favorable toxicity profile and good VHI-score. These results validate our early results.

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.

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.

Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in a homogenous patient population.

BACKGROUND AND PURPOSE: To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. PATIENTS AND METHODS: Patients, affected by laryngeal glottic carcinoma, treated by laser CO2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. RESULTS: A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). CONCLUSION: This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined.

[Effectiveness of concomitant therapy with S-1, nedaplatin, and radiation for laryngeal cancer].

Laryngeal cancer occurs more frequently in head and neck cancers, so there are a number of reports regarding the treatment results,wherein the therapeutic strategy and results are stable to some extent. However, due to the spread of chemoradiotherapy, there are differences in the larynx preservation rates for T2 and T3 cases, depending on the facility. Our department has been administering chemoradiotherapy for advanced cancer based on the perspective of conserving the organ and the function. We herein report our examination of 20 laryngeal cancer cases receiving concomitant therapy with S-1, Nedaplatin, and radiation (hereinafter, referred to as SN therapy) in our department from April 2005 to December 2008. The resulting complete response (CR) rate for the SN therapy was 82.4%, excluding T4 cases. Due to their refusal of surgery, 2 of 3 cases in which the SN therapy had been administered for T4 cases receiving SN therapy showed CR, wherein the CR rate in all cases after the SN therapy was 80. 0%. The larynx preservation rate after the SN therapy was 94.1%.

The Effect of Supraclavicular Radiotherapy on Acoustic Voice Quality Index (AVQI), Spectral Amplitude and Perturbation Values.

OBJECTIVE: The Acoustic Voice Quality Index (AVQI), spectral amplitude, and voice perturbation parameters are objective assessment methods that are used in clinical settings and for research purposes. The aim of this study was to demonstrate the effect of supraclavicular RT on the physiology and function of the vocal fold. METHODS: A total of 29 female patients were included in the study. The voices of the patients, who were diagnosed with breast cancer and underwent supraclavicular RT, were recorded before and after the treatment (1 and 6 months). AVQI, spectral amplitude (H1-H2, H1-A1, H1-A2, H1-A3) and acoustic analyses of the voice perturbation parameters were performed. RESULTS: AVQI was significantly higher in the first month (P < 0.05). Of the voice perturbation parameters, shimmer was found to be significantly high in the first month (P < 0.05). However, not all spectral amplitude values showed a significant change (P > 0.05). CONCLUSION: In this study, AVQI and shimmer values were found to be higher following the application of supraclavicular RT. These results showed that nonlaryngeal RT might cause changes in the acoustic values of the voice in the early stage.

Factors affecting the quality of voice in the early glottic cancer treated with radiotherapy.

AIMS: To prospectively analyze the objective voice quality before and after radiotherapy (RT) for early glottic cancer and to evaluate the role of different factors that may affect it. METHODS: Patients with T1-T2N0M0 glottic cancer underwent voice quality assessment before treatment and after radical RT. Post-RT voice quality was compared to the voice at diagnosis and the voice of healthy individuals used as controls. A comprehensive set of voice parameters were measured. The effects of age, smoking history, T stage, anterior commissure (AC) involvement, radiation dose, fractionation and volumes on pre-treatment and post-treatment voice quality were analyzed. RESULTS: The voice quality data of 50 patients were analyzed. Following treatment, there was a significant improvement in the majority of measured parameters. However, perturbation and HNR remained inferior compared to controls. A history of smoking, AC involvement and larger RT volumes resulted in poorer voice parameters following RT. There was no significant impact of age alone. T2 tumors had an inferior voice quality before treatment, but did not remain inferior following RT. Hypofractionated RT did not show any negative impact. CONCLUSIONS: There is a considerable improvement of voice quality following RT. Several factors may have specific effects on pre-treatment and post-treatment voice.

Vocal changes following radiotherapy to the head and neck for non-laryngeal tumors.

To investigate vocal changes in patients following the neck irradiation for non-laryngeal tumors sparing the glottic region. Fifteen patients were enrolled for the study. Phonatory effort and voice evaluation were reported. Perceptual evaluation and acoustic analysis were performed. Men/women ratio was 6/9. The mean age was 54 years with a range from 24 to 84. The most common primary site of tumor was the nasopharynx and tongue. The mean phonatory effort was significantly greater in the irradiated group versus controls (0.54 vs. 0.08 with a P value 0.01). Fifteen percent reported their voice as being poor and almost 85% as being fair. All the parameters of the GRABS perceptual evaluation were significantly worse in the irradiated group. There were no statistically significant differences between all the acoustic variables in both groups except for an decrease in the Habitual pitch in the irradiated patients. Radiation therapy to head and neck region can affect voice even if the radiation beams spare the vocal folds.

Selective (intra-arterial), rapid infusion chemo-radiotherapy to preserve the larynx in advanced laryngeal carcinoma: preliminary results.

OBJECTIVES: We had previously treated patients with advanced stage laryngeal cancer by laryngectomy with or without post-operative radiotherapy. In order to improve such patients' quality of life, we sought to preserve the larynx by selective (intra-arterial), rapid infusion chemotherapy combined with radiotherapy. METHODS: Chemotherapy was administered intra-arterially in the angiography suite via transfemoral catheterisation of the superior thyroid artery. Patients received up to four once-weekly infusions of cisplatin (75 mg/patient) with simultaneous intravenous administration of sodium thiosulphate, a neutralising agent. Patients also received external radiation simultaneously at a dose of 1.8 or 2.0 Gy per fraction, once daily for five days a week for 7 weeks. RESULTS: Intra-arterial infusion chemo-radiotherapy was performed in eight patients with advanced laryngeal carcinoma (four glottic, three supraglottic and one subglottic type carcinoma). A complete response was achieved at the primary site and at lymph node metastases in all eight patients. Overall toxic side effects were modest. No catheter-related thrombo-embolic complications were observed during any of the chemotherapy sessions. CONCLUSIONS: Selective (intra-arterial), rapid infusion chemo-radiotherapy may enable laryngeal preservation in patients with advanced laryngeal carcinoma.

Outcomes of Treating Early Glottic Neoplasms With a Potassium Titanyl Phosphate Laser.

OBJECTIVES:: The aim of this study was to assess the outcome of treating glottic dysplasia and early squamous cell carcinoma (SCC) with potassium titanyl phosphate (KTP) photoangiolytic laser ablation. METHODS:: Patient demographics, comorbidities, and tumor characteristics were recorded. Perceptual, patient-reported, and objective voice outcomes were assessed. Use of treatment modalities in addition to the KTP laser, development of locoregional or metastatic SCC, and overall survival were recorded. RESULTS:: There were 23 patients with glottic dysplasia and 18 patients with glottic SCC. Mean age at treatment was 69 years. Most patients (95%) were male. Posttreatment fundamental frequency fell from 132 ± 35 to 116 ± 24 Hz ( P = .03). Overall, 61% of patients achieved a normal voice. There was a learning-curve, and most treatment failures occurred in the first half of the series. Five-year KTP-only disease-control rates were 87.1% and 53.5% for dysplasia and malignancy, respectively. Five-year overall survival was 56%, with no laryngectomies or deaths due to SCC. CONCLUSIONS:: Ablating dysplasia and early glottic cancer using a KTP laser is a viable treatment option. It has a learning curve and a failure rate but, in this series, no ultimate loss of oncologic control. Its introduction into clinical practice should be managed carefully in the context of multidisciplinary cancer care. LEVEL OF EVIDENCE:: 4.

Prospective, longitudinal electroglottographic study of voice recovery following accelerated hypofractionated radiotherapy for T1/T2 larynx cancer.

BACKGROUND AND PURPOSE: To measure voice outcomes following accelerated hypofractionated radiotherapy for larynx cancer. MATERIALS AND METHODS: Twenty-five patients with T1/T2 glottic cancer underwent serial electroglottographic and acoustic analysis (sustained vowel/i/ and connected speech) before radiotherapy and 1, 6 and 12 months post-treatment. Twenty-five normal subjects served as a reference control population. RESULTS: Pre-treatment measures were significantly worse for larynx cancer patients. Median jitter (0.23% vs 0.97%, p=0.001) and shimmer (0.62dB vs 0.98dB, p=0.05) and differences in data ranges reflected greater frequency and amplitude perturbation in the larynx cancer patients. Pre-treatment Mean Phonation Time (MPT) was significantly reduced (21s vs 14.8s, p=0.002) in larynx cancer patients. There was a trend towards improvement of jitter, shimmer and normalized noise energy at 12 months post-treatment. MPT improved but remained significantly worse than for normal subjects (21s vs 16.4s, p=0.013). Average fundamental frequency resembled normal subjects, including improvement of the measured range (91.4-244.6Hz in controls vs 100-201Hz in post-treatment larynx cancer patients). CONCLUSIONS: This non-invasive technique effectively measures post-treatment vocal function in larynx cancer patients. This study demonstrated improvement of many key parameters that influence voice function over 12 months after radiotherapy.

Radiotherapeutic management of laryngeal carcinoma.

Authors discuss laryngeal lesions, metastases, and relevant anatomy. Outcome of surgical and radiotherapy in terms of voice preservation is discussed. Radiation techniques and outcomes for laryngeal cancer are presented along with discussion of interdisciplinary treatment. Authors review studies and quality of life outcomes of surviving laryngeal cancer patients.

Effects of laryngeal cancer on voice and swallowing.

Specific deficits that may be encountered as well as interventional strategies and evidence-based practice are discussed. When discussing the voice, it is important to consider that for many people the voice is not just a tool for communication, but also an identifying feature that allows expression of personality. Eating and swallowing are vital to life sustenance and also allow for a myriad of social interactions. Laryngeal cancer can have a dramatic impact on this delicately balanced system leading to disturbances of voice and swallowing.

Voice of postradiotherapy nasopharyngeal carcinoma patients: evidence of vocal tract effect.

This study was aimed at identifying acoustic and physiological measures useful for monitoring voice changes in postnasopharyngeal patients with nonlaryngeal malignancies, and providing evidences of vocal tract effect on voice through comparisons between individuals with and without intact vocal tract. Simultaneous acoustic-electroglottographic signals recorded during phonation of vowels /i/ and /a/ sustained at habitual, high, and low pitch levels were compared among 10 postradiotherapy patients with nasopharyngeal carcinoma (NPC), 10 voice patients (VPs) with intact vocal tract, and 10 healthy individuals with normal voice (NORM). Results from a series of discriminant analyses revealed that the NPC group generally exhibited lower signal-to-noise (SNR) and open quotient (OQ) and higher Formant 1 frequency (F(1)) and speed quotient (SQ) than the NORM group. Unlike both VP and NORM groups, the NPC group failed to show a pitch effect on all voice measures, including OQ, SQ, percent jitter, percent shimmer, and SNR, suggesting an effect of radiotherapy and/or vocal tract on laryngeal behaviors. For the vowel /i/, on the other hand, only the NPC and NORM groups showed a pattern of pitch-dependent F(1) raising, a reflection of increased pharyngeal narrowing. These findings suggested that the pitch effect on laryngeal behaviors differed not only between individuals with intact vocal tract and those without but also between those with structural and dynamic changes of vocal tract.

Acoustic voice analysis in different phonetic contexts after larynx radiotherapy for T1 vocal cord carcinoma.

INTRODUCTION: Radiotherapy for early vocal cord carcinoma affects quality of voice. Nevertheless, most patients refer to having a high satisfaction level with their voice. The few acoustic studies on quality of voice have been performed only in prolonged vowel production, which is not a usual speech situation. The present study has been done with the aim of establishing which phonetic situations reflect a greater alteration in voice production related to irradiation. MATERIAL AND METHODS: Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 non-irradiated subjects were included in a study of acoustic voice analysis. This analysis was performed one year after radiotherapy. Patients and control group voices were tape recorded in extended vowel production, oral reading of a standard paragraph, spontaneous speech and in a song. Acoustic analysis was performed by a Kay Elemetric's Computerized Speech Lab (model CSL #4300). Fundamental frequency, jitter, shimmer and harmonics-to-noise ratio were obtained in both groups. Statistical test: Lin concordance coefficient and Pearson's correlation coefficient, Student's t-test and ROC curves. RESULTS: Concordance and correlation studies did not allow selection of any subgroup in acoustic parameters and different acoustic situations. Acoustic parameters had higher median values in irradiated patients. Student's t-test showed significant differences for fundamental frequency in sustained vowel production and spontaneous speech; for jitter there was statistical significance in all the acoustic situations and for shimmer in oral reading and song. Jitter showed a cut-off of 2.02% with a sensitivity of 89% and specificity of 97% in classifying irradiated and non-irradiated groups. The ROC curve for jitter correctly classified 94% of subjects into irradiated or non-irradiated groups. CONCLUSIONS: The present study showed that jitter obtained from spontaneous speech was the most relevant parameter in discriminating voice in irradiated patients by acoustic analysis. Jitter in spontaneous speech is in need of more analysis in bigger series and in more advanced stages of larynx cancer as its relevance has been demonstrated.

State of the art: Rehabilitation of speech and swallowing after total laryngectomy.

Despite the development and expansion of non-surgical organ preservation therapy, total laryngectomy continues to be the optimal therapy for far-advanced local disease and the only curative option for radiotherapy failures not amenable to partial laryngeal procedures. Laryngectomy, however, remains a life-altering operation with profound effects on swallowing and speech. In the nearly 150 years since the first total laryngectomy was performed, few ablative aspects have changed, but reconstructive techniques have undergone radical evolution. This review will trace the origins of laryngeal rehabilitation for voice and swallowing, the current state of the art with attention to pre-treatment considerations and post-operative management, current surgical management techniques, and the future of functional laryngeal reconstruction.

A Multidimensional Study of Vocal Function Following Radiation Therapy for Laryngeal Cancers.

BACKGROUND: Radiation therapy (XRT) has proven to be an effective curative modality in the treatment of laryngeal cancers. However, XRT also has deleterious effects on vocal function. AIM: To demonstrate the multidimensional nature of deficits in vocal function as a result of radiation therapy for laryngeal cancer. STUDY DESIGN: Cohort study. METHODOLOGY: Vocal function parameters were chosen from the 5 domains of voice assessment to complete a multidimensional assessment battery. Adults irradiated (XRT group) for laryngeal cancers were compared to a control group of individuals with no history of head and neck cancers or radiation therapy. The control group was matched in age, sex, and pack years of smoking. RESULTS: Eighteen participants were recruited for the study. The XRT group demonstrated significantly worse clinical values as compared to the control group across select parameters in the each of the 5 domains of voice assessment. DISCUSSION: Radiation therapy for laryngeal cancers results in multidimensional deficits in vocal function. Notably, these deficits persist long term. In the present study sample, multidimensional deficits were persistent 2 to 7 years following completion of XRT. The observed multidimensional persistent vocal difficulties highlight the importance of vocal rehabilitation in the irradiated larynx cancer population.

The Effectiveness of Low-Level Light Therapy in Attenuating Vocal Fatigue.

OBJECTIVES: Low-level light therapy (LLLT) is effective in reducing inflammation, promoting wound healing, and preventing tissue damage, but has not yet been studied in the treatment of voice disorders. The objective of this study was to investigate the possible effectiveness of LLLT in attenuating symptoms of vocal fatigue created by a vocal loading task as measured by acoustic, aerodynamic, and self-reported vocal effort. METHODS: In a randomized, prospective study, 16 vocally healthy adults divided into four groups underwent a 1-hour vocal loading procedure, followed by infrared wavelength LLLT (828 nm), red wavelength LLLT (628 nm), heat, or no heat-light (control) treatment targeting the laryngeal region of the ventral neck surface. Phonation threshold pressure (PTP), relative fundamental frequency (RFF), and the inability to produce soft voice (IPSV) self-perceptual rating scale were recorded (1) at baseline, (2) immediately after vocal loading, (3) after treatment, and (4) 1 hour after treatment. RESULTS: Vocal loading significantly increased PTP and IPSV and decreased onset and offset RFFs, consistent with a shift toward vocal dysfunction. Red light significantly normalized the combination of PTP, IPSV, and RFF measures compared to other conditions. CONCLUSIONS: RFF is sensitive to a vocal loading task in conjunction with PTP and IPSV, and red LLLT may have a normalizing effect on objective and subjective measures of vocal fatigue. The results of this study lay the groundwork and rationale for future research to optimize LLLT wavelength combinations and overall dose.

Voice Range Profile and Health-related Quality of Life Measurements Following Voice Rehabilitation After Radiotherapy; a Randomized Controlled Study.

PURPOSE: The aim of the present study was to investigate the effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer. METHOD: A total of 42 patients with laryngeal cancer who are treated with radiotherapy with curative intent participated in a randomized controlled study. The collected data were voice range profiles (VPRs) and patient-reported outcome (PRO) instruments for measurement of self-perceived communication function (Swedish Self-Evaluation for Communication Experiences after Laryngeal cancer (S-SECEL)) and health related quality of life (HRQL) (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck module). Data were collected 1 month (pre voice rehabilitation), 6 months, and 12 months postradiotherapy. Of the patients, 19 received voice rehabilitation, whereas 23 constituted a control group. RESULTS: There were several statistically significant improvements in the study group concerning the HRQL and self-perceived communication function. The largest improvements occurred between occasions 1 (prevoice rehabilitation) and 2 (6-month postradiotherapy) and then remained constant. VRP area demonstrated a statistically significant difference when comparing changes over time, where the study group improved more than the control group. CONCLUSION: HRQL and self-perceived communication function showed improvement in the study group and trends of impairment in the control group. This result might suggest that it would be beneficial for the patients as well as in a health economic perspecitve, to receive voice rehabilitatiom to make a faster improvement of the HRQL and self-perceived communication function.