T1a 병기 성문암의 방사선 치료 후 음성에 관한 연구

Quantitative Analysis of Voice Quality after Radiation Therapy for Stage T1a Glottic Carcinoma

  • 이준규 (전남대학교병원 이비인후과) ;
  • 정웅기 (전남대학교 의과대학 방사선종양학교실)
  • Lee Joon-Kyoo (Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Chung Woong-Gi (Department of Radiation Oncology, Chonnam National University Medical School, Chonnam National University Hospital)
  • 발행 : 2005.03.01

초록

목적 : 후두암에서 방사선 치료는 음성을 보존할 수 있기 때문에 조기 성문암의 일차적인 치료법으로 사용된다. 이에 T1a 병기 성문암에서 방사선 치료가 환자의 음성에 미치는 영향을 알아보고자 하였다. 대상 및 방법 : 조기 성문암(T1a)으로 진단 받고 방사선 치료를 받은 후 최소 1년이 지난 17명의 남자 환자들을 대상으로 객관적인 음성검사들(음향분석, 공기역학검사, 후두 스트로보스코피)을 이용하여 음성을 평가하였고, 이것을 성별과 연령을 맞춘 정상 대조군과 비교하였다. 음향분석으로는 평균 기본주파수(Fo), jitter, shimmer, 잡음 대 조화음 비율(Noise to Harmonics Ratio)을 측정하였다. 공기역학적 검사로는 최대발성지속시간, 평균호기류율, 음강도, 성문하압, 성문저항, 성문효율, 성문력을 측정하였다. 결과 : 방사선 치료를 받은 환자에서 음향분석의 shimmer만이 통계학적으로 의의 있게 높았다. 그 외 다른 검사나 공기역학검사에서는 두 군 간에 통계학적인 유의성이 없었다. 결론 : 본 연구에서는 단지 shimmer만이 방사선 치료 환자군에서 높았기 때문에 T1a 병기 성문암에서의 방사선치료는 음성의 질에 큰 영향을 미치지 않은 것으로 사료된다.

Purpose : To evaluate the voices of irradiated patients with early glottic carcinoma and to compare these with the voices of healthy volunteers. Materials and Methods : The voice samples (sustained vowel) of seventeen male patients who had been irradiated for T1a glottic squamous carcinoma at least 1 year prior to the study were analyzed with objective voice analyzer (acoustic voice analysis, aerodynamic test, and videostroboscopic analysis) and compared with those of a normal group of twenty age- and sex-matched volunteers. Average fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio were obtained for acoustic voice analysis. Maximal phonation time, mean flow rate, intensity, subglottic pressure, glottal resistance, glottal efficiency, and glottal power were obtained for aerodynamic test. Results : The irradiated group presented higher values of shimmer in acoustic voice analysis. There was no significant difference between two groups in other parameters. Conclusion : In this study all the objective voice parameters except shimmer were no4 significantly different between the irradiated group and the control group. These results suggest that the voice quality is minimally affected by radiation therapy for 71 a glottic carcinoma.

키워드

참고문헌

  1. Ahn YC, Park CI, Kim KH. Radiation therapy of early glottic cancer. J Korean Soc Ther Radiol 1990;8:51-58
  2. Kim JC, Park IK. Radiotherapy results of stage I glottic cancer. J Korean Soc Ther Radiol Oncol 1998;16:245-250
  3. Chung WK, Ahn SJ, Nam TK, Nah BS, Cho JS, Lim SC. Prognostic factors for local control in early glottic cancer treated with radiation therapy. J Korean Soc Ther Radiol Oncol 2000;18:226-232
  4. Morgan DA, Robinson HF, Marsh L, Bradley PJ. Vocal quality 10 years after radiotherapy for early glottic cancer. Clin Radiol 1988;39:295-296 https://doi.org/10.1016/S0009-9260(88)80541-5
  5. Llewellyn-Thomas HA, Sutherland HJ, Hogg SA, et al. Linear analogue self-assessment of voice quality in laryngeal cancer. J Chron Dis 1984;37:917-924 https://doi.org/10.1016/0021-9681(84)90068-7
  6. Sutherland HJ, Llewellyn-Thomas H, Hogg SA, et al. Do patients and physicians agree on the assessment of voice quality in laryngeal cancer? J Otolaryngol 1984;13:325-330
  7. Karim AB, Snow GB, Siek HT, Njo KH. The quality of voice in patients irradiated for laryngeal carcinoma. Cancer 1983;51:47-49 https://doi.org/10.1002/1097-0142(19830101)51:1<47::AID-CNCR2820510112>3.0.CO;2-1
  8. Stoicheff ML. Voice following radiotherapy. Laryngoscope 1975;85:608-618 https://doi.org/10.1288/00005537-197504000-00002
  9. Fletcher GH, Klein R. Dose-time-volume relationship in squamous-cell carcinoma of the larynx. Radiology 1964;182:1032-1042
  10. Perez CA, Mill WB, Ogura JH, Powers WE. Irradiation of early carcinoma of the larynx. Significance of tumor extent. Arch Otolaryngol 1971;93:465-472 https://doi.org/10.1001/archotol.1971.00770060711005
  11. McGuirt WF, Blalock D, Koufman JA, et al. Comparative voice results after laser resection or irradiation of T1 vocal cord carcinoma. Arch Otolaryngol Head Neck Surg 1994;120:951-955 https://doi.org/10.1001/archotol.1994.01880330035007
  12. Miller S, Harrison LB, Solomon B, Sessions RB. Vocal changes in patients undergoing radiation therapy for glottic carcinoma. Laryngoscope 1990;100:603-606 https://doi.org/10.1288/00005537-199006000-00010
  13. Lehman JJ, Bless DM, Brandenburg JH. An objective assessment of voice production after radiation therapy for stage I squamous cell carcinoma of the glottis. Otolaryngol Head Neck Surg 1988;98:121-129 https://doi.org/10.1177/019459988809800205
  14. Hoyt DJ, Lettinga JW, Leopold KA, Fisher SR. The effect of head and neck radiation therapy on voice quality. Laryngoscope 1992;102:477-480 https://doi.org/10.1288/00005537-199205000-00001
  15. Benninger MS, Gillen J, Thieme P, Jacobson B, Dragovich J. Factors associated with recurrence and voice quality following radiation therapy for T1 and T2 glottic carcinomas. Laryngoscope 1994;104:294-298 https://doi.org/10.1288/00005537-199403000-00009
  16. Dworking JP, Aref A. Voice laboratory measures following radiation therapy for T1N0 glottic carcinoma. J Med Speech Language Pathol 1997;5:59-74
  17. Rovirosa A, Martinez-Celdran E, Ortega A, et al. Acoustic analysis after radiotherapy in T1 vocal cord carcinoma: a new approach to the analysis of voice quality. Int J Radiat Oncol Biol Phys 2000;47:73-79 https://doi.org/10.1016/S0360-3016(99)00524-6
  18. Aref A, Dworkin J, Devi S, Denton L, Fontanesi J. Objective evaluation of the quality of voice following radiation therapy for T1 glottic cancer. Radiother Oncol 1997;45:149-153 https://doi.org/10.1016/S0167-8140(97)00154-0
  19. Hocevar-Boltezar I, Zargi M. Voice quality after radiation therapy for early glottic cancer. Arch Otolaryngol Head Neck Surg 2000;126:1097-1100 https://doi.org/10.1001/archotol.126.9.1097
  20. Rovirosa A, Martinez-Celdran E, Ortega A, et al. Acoustic voice analysis and subjective patient impression after radiotherapy in T1 vocal cord carcinoma. In: First World Congress on Head and Neck Oncology (abstract book), Spain; 1998:99
  21. Colton RH, Sagerman RH, Chung CT, Yu YW, Reed GF. Voice change after radiotherapy. Some preliminary results. Radiology 1978;127:821-824 https://doi.org/10.1148/127.3.821
  22. Harrison LB, Solomon B, Miller S, Fass DE, Armstrong J, Sessions RB. Prospective computer-assisted voice analysis for patients with early stage glottic cancer: a preliminary report of the functional result of laryngeal irradiation. Int J Radiat Oncol Biol Phys 1990;19:123-127
  23. Hirano M, Hirade Y, Kawasaki H. Vocal function following carbon dioxide laser surgery for glottic carcinoma. Ann Otol Rhinol Laryngol 1985;94:232-235
  24. Tsunoda K, Soda Y, Tojima H, et al. Stroboscopic observation of the larynx after radiation in patients with T1 glottic carcinoma. Acta Otolaryngol Suppl 1997;527:165-166 https://doi.org/10.3109/00016489709124064
  25. Tamura E, Kitahara S, Ogura M, Kohno N. Voice quality after laser surgery or radiotherapy for T1a glottic carcinoma. Laryngoscope 2003;113:910-914 https://doi.org/10.1097/00005537-200305000-00025
  26. Brandenburg JH. Laser cordectomy versus radiotherapy: an objective cost analysis. Ann Otol Rhinol Laryngol 2001;110:312-318 https://doi.org/10.1177/000348940111000404
  27. Lee HH, Lee KD, Lee HK, Pyo KB, Ahn KM, Lee YS. Treatment results and voice anlysis after laser cordectomy for glottic T1 cancer. Korean J Otolaryngol 2002;45:805-810
  28. Krengli M, Policarpo M, Manfredda I, et al. Voice quality after treatment for T1a glottic carcinoma-radiotherapy versus laser cordectomy. Acta Oncol 2004;43:284-289 https://doi.org/10.1080/02841860410026233
  29. Lee YS, Kim CJ, Kim JC, Kim BK, Kim SY, Nam SY. Comparison of the voice and treatment results after laser cordectomy or radiotherapy on T1a staged glottic cancer. J Korean Soc Logo Phon 2002;13:139-144