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本研究は,的確な情報提示と介入を行うことを目指し,早期声門癌患者に対する(化学)放射線治療((C)RT)の音声機能への中長期的な影響について検討を行った.
対象は2006年以降にT1-T2N0M0の早期声門癌に対し,(C)RTを受けた患者34例(T1:17例,T2:17例).検討項目は,Voice Handicap Index(VHI),GRBAS尺度,音響分析,最長発声持続時間(MPT),喉頭所見とした.
3〜24か月,25〜48か月,49か月以降と時期別に分けて比較したところ,25〜48か月でVHI,MPT,声門閉鎖の評価がよい傾向を示し,声帯前方の癒着は長期経過中の音声に対する増悪因子であった.病期別は,GRBAS尺度の努力性(S)がT1群に比べT2群で有意に障害の程度が強かった(p=0.001).主観的評価と客観的評価を比較すると乖離がみられた症例が1/3程度存在した.以上より,原発巣の進展範囲や喉頭所見に留意し,主観・客観の両側面から慎重に評価することが重要であり,患者の満足度向上のためのST介入の余地があると考えられた.
While (chemo-)radiotherapy ((C)RTx) is one of the established therapeutic options for head and neck cancer, well-refined management of unavoidable adverse reactions is indispensable to provide better medical care. The purpose of this study was to assess the post-therapeutic vocal function of the patients who underwent (C)RTx to treat their glottic cancer. Thirty-four patients with early glottic cancer (T1, n=17;T2, n=17) took part in this study. GRBAS scale, acoustic analyses, maximum phonation time (MPT), and laryngeal endoscopic findings were used as objective vocal parameters, while voice handicap index (VHI) was utilized for subjective vocal assessment. Vocal evaluations started 3 months after (C)RTx, and the post-therapeutic period was divided at 24 months and 48 months. VHI, MPT, and glottis closure showed the best scores in the 25-48 months group. Laryngeal web formation was considered as a factor that potentially impairs patients' vocal quality 49 months or more after surgery. Vocal quality of the T2 group was significantly more strained (p=0.001) compared with the T1 group. Around 1/3 of the patients showed divergence of the scores in the subjective and objective vocal assessment. Speech-language-hearing therapists should pay attention to endoscopic findings and oncological information of the patients to achieve satisfactory vocal function.
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