Surgery associated with better survival for patients with advanced laryngeal cancer

Patients with advanced laryngeal cancer appear to have better survival if they are treated with surgery than with nonsurgical chemoradiation.

Approximately 11,000 to 13,000 cases of laryngeal cancer are diagnosed each year, and squamous cell carcinoma accounts for the vast majority of these tumors. Prior to 1991, total surgical removal of the larynx with postoperative radiation was the standard of care for advanced cancer. Since then, chemoradiation has become an increasingly popular treatment because it can preserve the larynx.

The authors, led by Uchechukwu C. Megwalu, MD, MPH, of the Ichan School of Medicine at Mount Sinai, New York, New York, evaluated survival outcomes for surgical vs nonsurgical treatment for advanced laryngeal cancer. The authors used data from the Surveillance, Epidemiology and End Results (SEER) database for their study of 5,394 patients with stage III or IV laryngeal squamous cell carcinoma diagnosed between 1992 and 2009.

They found that patients who had surgery had better 2-year and 5-year disease-specific survival (70% vs 64% and 55% vs 51%, respectively) and 2-year and 5-year overall survival (64% vs 57% and 44% vs 39%, respectively) than patients who did not undergo surgery. The use of nonsurgical treatment increased over time: 32% in the 1992 to 1997 patient group, 45% in the 1998 to 2003 group, and 62% in the 2004 to 2009 group. The gap in survival between the two groups consistently narrowed over subsequent years. Patients who received a diagnosis between 2004 and 2009 had better survival than those with an earlier diagnosis and this may be due to improvements in radiation and chemotherapy strategies.

“Patients need to be made aware of the modest but significant survival disadvantage associated with nonsurgical therapy as part of the shared decision-making process during treatment selection,” stated the authors. The study was published in JAMA Otolaryngology-Head & Neck Surgery (2014; doi:10.1001/.jamaoto.2014.1671).

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