Study: Treatment strategies for laryngeal cancer shifting

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The use of surgery to treat early-stage laryngeal cancer is increasing in the U.S., and chemotherapy in combination with radiotherapy is being used increasingly to treat patients in an advanced stage of the disease, according to a report published in the October issue of the Archives of Otoloaryngology – Head & Neck Surgery.

Amy Y. Chen, MD, MPH, and colleagues at Emory University and the American Cancer Society, Atlanta, conducted a study to examine trends and four-year survival rates of surgical and non-surgical treatment for laryngeal cancer. They analyzed data on 131,694 laryngeal cancer cases diagnosed from 1985 to 2007, identified from the National Cancer Database. The primary treatment information included radiation therapy (RT), chemoradiation (CRT, chemotherapy in combination with radiation therapy) and curative intent surgery.

Early-stage laryngeal cancer has traditionally been treated with radiation therapy or surgical resection with comparable successful outcomes, but the authors found that surgical resection of early-stage laryngeal cancer increased over the years, with a corresponding decrease in radiation.

From 1985 to 2007, the proportion of patients with early-stage cancer receiving primary surgery increased from 20 percent to 33 percent. Over that same period, the use of RT decreased from 64 percent to 52 percent. Four-year survival rates for those treated with surgery was 79 percent, compared with 71 percent for those treated with RT.

The increase in CRT use in patients with an advanced stage of cancer was more pronounced.

"Among patients with advanced-stage cancer, the use of CRT increased from less than 7 percent to 45 percent, whereas the use of total laryngectomy decreased from 42 percent to 32 percent," wrote the authors.

Advanced-stage patients who had total laryngectomy had a four-year survival rate of 51 percent. The survival rate for patients treated with CRT was 48 percent, and for those treated with RT the survival rate was 38 percent.

Aside from the clinical factors associated with the different types of treatment, the researchers also noticed certain sociodemographic elements affected treatment selection.

“Patients with early-stage cancer who resided in areas with higher socioeconomic status zip codes, had private insurance, who were not African American and who were treated at academic facilities were more likely to receive surgery,” wrote the authors. “Further investigation as to the decision-making process of patients with different sociodemographic backgrounds will assist in mitigating the differences in survival for this group of patients."