Abstract：
OBJECTIVE: Transoral laser microsurgery (TLMS) and radiotherapy (XRT) are mainstays of treatment for early glottic carcinoma (EGC). Here, we investigated case-dependent provider treatment preferences and identify factors which impact decision-making in EGC.
METHODS: This cross-sectional survey of laryngologists, head-and-neck surgeons, and radiation oncologists presented five diagrammatic cases of progressively advanced EGC (T1/2, N0). Respondents indicated preference for TLMS or XRT and ranked factors which influenced their recommendation for each case. Analysis utilized descriptive statistics, Fischer\'s exact tests, and Kruskal-Wallis tests for nonparametric data.
RESULTS: A total of 141 complete responses (69.5% laryngologists) were received. Most respondents practiced in academic settings (93.5%) and within multidisciplinary teams (94.0%). Anterior commissure involvement was the most important a priori tumor factor for case-independent treatment recommendation (Likert Scale: 4.22/5), followed by Laterality (Likert Scale: 4.02/5). Across all specialties, TLMS was recommended for unilateral T1a lesions. Laryngologists continued recommending TLMS in T2 lesions (41.0%) more than head-and-neck surgeons (5.0%) and radiation oncologists (0.0%). Across all cases, survival and voice outcomes were the most important clinical factors impacting treatment decisions. Radiation oncologists weighed voice more heavily than laryngologists in more complex presentations of EGC (rank: 1.6 vs. 2.7, Kruskall-Wallis: p < 0.05).
CONCLUSIONS: In more complex clinical presentations of EGC, preference for TLMS compared to XRT differed across specialists, despite similar rankings of factors driving these treatment recommendations. This may be driven by differing experiences and viewpoints on case-dependent voice outcomes following TLMS versus XRT, suggesting a need for increased understanding of how tumor location and depth impact voice outcomes.
METHODS: 5 Laryngoscope, 134:3686-3694, 2024.
METHODS: This cross-sectional survey of laryngologists, head-and-neck surgeons, and radiation oncologists presented five diagrammatic cases of progressively advanced EGC (T1/2, N0). Respondents indicated preference for TLMS or XRT and ranked factors which influenced their recommendation for each case. Analysis utilized descriptive statistics, Fischer\'s exact tests, and Kruskal-Wallis tests for nonparametric data.
RESULTS: A total of 141 complete responses (69.5% laryngologists) were received. Most respondents practiced in academic settings (93.5%) and within multidisciplinary teams (94.0%). Anterior commissure involvement was the most important a priori tumor factor for case-independent treatment recommendation (Likert Scale: 4.22/5), followed by Laterality (Likert Scale: 4.02/5). Across all specialties, TLMS was recommended for unilateral T1a lesions. Laryngologists continued recommending TLMS in T2 lesions (41.0%) more than head-and-neck surgeons (5.0%) and radiation oncologists (0.0%). Across all cases, survival and voice outcomes were the most important clinical factors impacting treatment decisions. Radiation oncologists weighed voice more heavily than laryngologists in more complex presentations of EGC (rank: 1.6 vs. 2.7, Kruskall-Wallis: p < 0.05).
CONCLUSIONS: In more complex clinical presentations of EGC, preference for TLMS compared to XRT differed across specialists, despite similar rankings of factors driving these treatment recommendations. This may be driven by differing experiences and viewpoints on case-dependent voice outcomes following TLMS versus XRT, suggesting a need for increased understanding of how tumor location and depth impact voice outcomes.
METHODS: 5 Laryngoscope, 134:3686-3694, 2024.
摘要：
目的：经口激光显微手术（TLMS）和放射治疗（XRT）是早期声门型喉癌（EGC）的主要治疗手段。这里,我们调查了病例依赖提供者的治疗偏好,并确定了影响EGC决策的因素.
方法：这项对喉科医师的横断面调查，头颈外科医生,放射肿瘤学家介绍了5例逐渐进展的EGC（T1/2，N0）。受访者表示对TLMS或XRT的偏好以及影响他们对每种情况的推荐的排名因素。分析利用描述性统计数据，Fischer的精确测试,和Kruskal-Wallis检验非参数数据。
结果：共收到141个完全应答（69.5%喉科医师）。大多数受访者在学术环境（93.5％）和多学科团队（94.0％）中实践。前连合受累是独立于病例的治疗建议的最重要的先验肿瘤因素（Likert量表：4.22/5），其次是侧向（李克特量表：4.02/5）。在所有专业中，单侧T1a病变推荐TLMS。喉科医师继续在T2病变中推荐TLMS（41.0％），高于头颈部外科医生（5.0％）和放射肿瘤学家（0.0％）。在所有案件中，生存率和嗓音结局是影响治疗决策的最重要临床因素.在更复杂的EGC演示中，放射肿瘤学家比喉科医生更重视声音（排名：1.6vs.2.7，Kruskall-Wallis：p<0.05）。
结论：在更复杂的EGC临床表现中，与XRT相比，TLMS的偏好在专家之间有所不同，尽管驱动这些治疗建议的因素排名相似。这可能是由TLMS与XRT之后对病例相关语音结果的不同经验和观点驱动的，提示需要增加对肿瘤位置和深度如何影响语音结果的理解。
方法：V喉镜，2024.
方法：这项对喉科医师的横断面调查，头颈外科医生,放射肿瘤学家介绍了5例逐渐进展的EGC（T1/2，N0）。受访者表示对TLMS或XRT的偏好以及影响他们对每种情况的推荐的排名因素。分析利用描述性统计数据，Fischer的精确测试,和Kruskal-Wallis检验非参数数据。
结果：共收到141个完全应答（69.5%喉科医师）。大多数受访者在学术环境（93.5％）和多学科团队（94.0％）中实践。前连合受累是独立于病例的治疗建议的最重要的先验肿瘤因素（Likert量表：4.22/5），其次是侧向（李克特量表：4.02/5）。在所有专业中，单侧T1a病变推荐TLMS。喉科医师继续在T2病变中推荐TLMS（41.0％），高于头颈部外科医生（5.0％）和放射肿瘤学家（0.0％）。在所有案件中，生存率和嗓音结局是影响治疗决策的最重要临床因素.在更复杂的EGC演示中，放射肿瘤学家比喉科医生更重视声音（排名：1.6vs.2.7，Kruskall-Wallis：p<0.05）。
结论：在更复杂的EGC临床表现中，与XRT相比，TLMS的偏好在专家之间有所不同，尽管驱动这些治疗建议的因素排名相似。这可能是由TLMS与XRT之后对病例相关语音结果的不同经验和观点驱动的，提示需要增加对肿瘤位置和深度如何影响语音结果的理解。
方法：V喉镜，2024.
