Background: Early laryngeal cancer is effectively treated with transoral laser microsurgery (TLM) or radiotherapy, both offering comparable oncological outcomes. The impact on voice and swallowing remains unclear. Objectives: To evaluate voice and swallowing outcomes following treatment with TLM or radiotherapy for early laryngeal cancer in a UK multi-centre prospective study. Methods: A total of 137 patients with T1 or T2 laryngeal cancer were recruited from five UK head & Neck cancer centres. Patients received either TLM or radiotharpy (up to 55Gy). Voice and swallowing function were assessed at baseline, three months, and six months post-treatment using a multidimensional protocol: Voice Handicap Index (VHI-10), Maximum Phonation Time (MPT), GRBAS perceptual voice scale, 100mL timed Water Swallow Test and Normalcy of Diet (NoD). Results VHI scores improved significantly following radiotherapy at three months (MD 8.66, SD 11.46, 95% CI 5.5, 11.8, p<0.001). MPT was also significantly longer in the radiotherapy group (MD 2.47, SD 6.2, 95% CI 0.7-4.2, p=0.007). Perceptual voice ratings showed reduced hoarseness post-radiotherapy at three months (MD 0.71, SD 1.11, 95% CI 0.43,0.98, p<0.001). No significant differences were found between treatments for swallowing function or NoD, which remains stable up to six months. Conclusion Radiotherapy is associated with better short-term voice outcomes compared to TLM. Swallowing function remains largely unaffected by treatment type. This study highlights the need to include functional outcomes in treatment decisions and is the first UK multicentre prospective study to use standardised, multidimensional assessments of early recovery following treatment for early laryngeal cancer.

Dysphagia as a late side-effect of radiotherapy (RT) for head and neck cancer (HNC) may not manifest until many years post-treatment (1). Insidious deterioration in swallowing function can significantly impact emotional and physical health. Patients may need enteral feeding support and experience chest co-morbidities which can be fatal (2). Not all patients will develop late-RAD and there is variation in the literature regarding actual prevalence due to heterogeneity in study populations and designs (3). There is also a lack of consensus regarding the definition of ‘late’ but growing acknowledgement that a latency period occurs, where swallowing function is stable before a progressive decline is seen (4). Discharge from surveillance at five years post-treatment has been standard in published recommendations (5). However, there is increasing recognition that this should be extended to allow for appropriate monitoring for the development of delayed side effects (6).