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Two-Thirds of Patients With Locally Advanced Laryngeal Cancer Not Receiving Recommended Treatment

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Key Points

  • Patients who underwent a laryngectomy lived nearly 2 years longer on average than those on chemotherapy and radiation therapy.
  • In a study of 969 patients with laryngeal cancer, a total of 616 patients (64%) received larynx-preservation chemoradiation, and 353 (36%) received total laryngectomy.
  • Possible reasons for not following the standard of care are providers misunderstanding the guidelines or patients opting for chemoradiation due to concerns about quality of life.

Despite findings of previous studies and published guidelines, nearly two-thirds of patients with T4a laryngeal cancer are not receiving a total laryngectomy—the recommended form of treatment—and, as a result, have significantly worse survival rates vs those treated with a total laryngectomy. These findings were published by Grover et al in the International Journal of Radiation Oncology • Biology • Physics. Patients who underwent a laryngectomy, on average, lived nearly 2 years longer than those on chemotherapy and radiation therapy.

Study Findings

“Larynx preservation via chemoradiation is an excellent, organ-preserving option to total laryngectomy for many patients with less advanced larynx cancers,” said Alexander Lin, MD, Assistant Professor and Chief of Head and Neck Service in the Department of Radiation Oncology at the Perelman School of Medicine at the University of Pennsylvania. “But it’s inferior for patients with the most locally advanced larynx cancers. These patients should be treated with a total laryngectomy—and our study shows that most of them are not.”

In stage T4a laryngeal cancer, the tumor grows through the thyroid cartilage and/or into tissues beyond the larynx, such as the thyroid gland, trachea, esophagus, tongue muscles, or neck muscles.

The study identified 969 patients from 2003 to 2006 who received curative-intent treatment for T4a laryngeal cancer from the National Cancer Database. A total of 616 patients (64%) received larynx-preservation chemoradiation, and 353 (36%) received total laryngectomy. Median overall survival for total laryngectomy patients was 61 months vs 39 months for patients receiving chemoradiation.

The survival of patients with stage T4a laryngeal cancer who are untreated is typically less than 1 year. The symptoms associated with untreated disease include severe pain and inability to eat, drink, and swallow. Death can frequently occur due to asphyxiation of the airway from the untreated tumor.

“We were surprised to find that nearly two-thirds of patients with stage T4a larynx cancer are not being treated with a total laryngectomy,” said Surbhi Grover, MD, MPH, Assistant Professor of Radiation Oncology. “But we were not surprised to find that overall survival was significantly better with total laryngectomy compared to larynx preservation, given the results of previous studies, which served as the basis for the best-practice guidelines now in place.”

Reasons for Discrepancy

It is unclear why the well-established guidelines for treatment of T4a laryngeal cancer were not followed in the cases examined by the research team.

Possible reasons include providers misunderstanding or misapplying the guidelines or patients refusing total laryngectomy against medical advice and opting for chemoradiation due to concerns about quality of life and loss of normal voice function.

“Patients and providers need to be aware of and educated on the proper indications for both larynx preservation and total laryngectomy, so that the best medical treatment options can be discussed and offered for each patient,” Dr. Lin said. “There may be select cases where patients with this serious form of cancer can be successfully treated with chemoradiation, but those cases will be far fewer in number than the figure we uncovered in our study.”

He continued, “We also need to educate patients on the various methods of voice rehabilitation after total laryngectomy, in order to destigmatize the procedure, and the possible effects on quality of life that such surgery may have.”

Dr. Lin is the corresponding author for the International Journal of Radiation Oncology • Biology • Physics.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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