早期喉癌放疗后的嗓音结局：一项系统综述。

文献信息

中文摘要

目的： 喉癌是头颈部最常见的恶性肿瘤之一，常伴发声困难。虽然发声困难是早期喉癌（ESLC）放疗（RT）后常见的后遗症，但既往研究主要关注治疗后的慢性结局。我们假设，通过多维嗓音评估所证实的急性期和亚急性期发声困难也会存在于部分此类患者中。本系统综述旨在总结ESLC患者RT后嗓音功能的特征，以认识RT后急性期、亚急性期和慢性期嗓音结局的表现。
方法： 使用三个电子数据库进行文献检索：PubMed、Embase和CINAHL。三个数据库均采用相似策略，以突出“喉部肿瘤”、“放疗”和“嗓音障碍”概念，并遵循系统综述和荟萃分析优先报告条目（PRISMA）声明标准。所评价的研究根据与放疗的时间关系分为急性期、亚急性期和慢性期亚组，并据此进行分析。
结果： 48篇文章（包含1,747例患者的数据）符合纳入标准，报告了接受RT的ESLC患者的嗓音结局结果。正如假设，发声困难不仅存在于慢性期，也存在于急性期和亚急性期，且见于所有嗓音评估领域（除自我评估外）的部分患者中。
结论： 在所有RT后阶段，一部分患者表现出早期发声困难，这凸显了早期嗓音监测的价值，以便在迟发性放射性发声困难发生前获得干预。该证据提示需要在该人群中开展常规嗓音筛查，并在有指征时及时转诊至言语语言病理学家进行多维嗓音评估和干预。

英文摘要

PURPOSE: Laryngeal cancer is one of the most common malignancies of the head and neck with dysphonia. While dysphonia is a frequent sequela post-radiation therapy (RT) for early-stage laryngeal cancer (ESLC), prior work has largely focused on chronic posttreatment outcomes. We hypothesize that acute and subacute dysphonia, as evidenced by a multidimensional voice assessment, will also be present in a subgroup of these patients. The aim of this systematic review was to summarize characteristics of vocal function post-RT for persons with ESLC in order to recognize how voice outcomes present across acute, subacute, and chronic phases of post-RT.
METHOD: A literature search was conducted using three electronic databases: PubMed, Embase, and CINAHL. A similar strategy was used in all three databases to highlight the concepts of "laryngeal neoplasm," "radiotherapy," and "voice disorders" guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. Studies evaluated were subgrouped based on temporal relationships from radiotherapy-acute, subacute, and chronic-and analyzed accordingly.
RESULTS: Forty-eight articles, comprising data from 1,747 patients, met inclusion criteria that reported voice outcomes results in patients with ESLC disease that underwent RT. As hypothesized, dysphonia was present not only in the chronic phase but also acutely and subacutely in a subgroup of patients across all domains of voice evaluations, except self-assessment.
CONCLUSIONS: Across all post-RT phases, a subset of patients demonstrates early dysphonia, highlighting the value of early voice surveillance to promote access to intervention prior to late-onset radiation-induced dysphonia. This evidence suggests a need for routine voice screenings in this population and, when indicated, timely referral to a speech-language pathologist for a multidimensional voice evaluation and intervention.
SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.34735284.