The use of surgery to treat early-stage laryngeal cancer is increasing in the U.S., and chemotherapy in combination with radiation therapy is being used more often to treat patients in an advanced stage of the disease, according to a report in the Archives of Otolaryngology -- Head & Neck Surgery (October 2011, Vol. 137:10, pp. 1017-1024).
Cancer of the larynx was diagnosed in nearly 13,000 people in the U.S. in 2010, and 3,660 were projected to die from the disease, according to the study authors. Early-stage laryngeal cancer has traditionally been treated with radiation therapy or surgical resection with comparable successful outcomes.
Amy Y. Chen, MD, and colleagues at Emory University and the American Cancer Society examined trends and four-year survival rates of surgical and nonsurgical 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.
The authors found that surgical resection of early-stage laryngeal cancer increased over the years, with a corresponding decrease in radiation.
Among patients with early-stage cancer, the proportion receiving primary surgery increased from 20% in 1985 to 33% in 2007, whereas the use of RT decreased from 64% to 52%, they reported. The four-year survival rate for patients with early-stage laryngeal cancer treated with surgery was higher than the rate for those treated with RT, 79% versus 71%.
Among patients with advanced-stage cancer, the use of CRT increased from less than 7% to 45%, whereas the use of total laryngectomy (surgical removal of the voice box) decreased from 42% to 32%, they noted.
Advanced-stage patients who had total laryngectomy had a four-year survival rate of 51%. The survival rate for patients treated with CRT was 48%, and the survival rate for those treated with RT was 38%.
Patients who lived in areas with higher socioeconomic status ZIP codes and who had private insurance were more likely to be treated with surgery for early-stage laryngeal cancer, and to receive CRT for advanced-stage cancer. Early-stage patients who were not African-American, and who were treated at academic facilities, were more likely to receive surgery. Younger patients with advanced-stage cancer were more likely to be treated with CRT.
"Not only were clinical factors associated with type of treatment, but select socio-demographic elements were also associated with treatment," the authors concluded. "Further investigation as to the decision-making process of patients with different socio-demographic backgrounds will assist in mitigating the differences in survival for this group of patients."
