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More surgery in early-stage laryngeal cancer treatment; more chemoradiation for advanced-stage

CHICAGO The use of surgery to treat early-stage laryngeal cancer (cancer of the voice box) is increasing in the United States, and chemotherapy in combination with radiation therapy is being used increasingly to treat patients in an advanced stage of the disease, according to a report in the October issue of Archives of Otolaryngology Head & Neck Surgery, one of the JAMA/Archives journals.

Cancer of the larynx, or voice box, 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 background information in the article. Early-stage laryngeal cancer has traditionally been treated with radiation therapy or surgical resection (removal of part of the larynx) with comparable successful outcomes.

Amy Y. Chen, M.D., M.P.H., 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.

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 percent in 1985 to 33 percent in 2007), whereas the use of RT decreased from 64 percent to 52 percent," they report. "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 percent vs. 71 percent)."

"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 [surgical removal of the voice box] decreased from 42 percent to 32 percent," they continue.

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.

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 sociodemographic elements were also associated with treatment," the authors conclude. "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."

Contact: Kathi Baker
JAMA and Archives Journals

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