Surgery is increasingly being used to treat patients with early-stage laryngeal cancer 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.
Researchers from Emory University and the American Cancer Society analyzed data on 131,694 laryngeal cancer cases diagnosed from 1985 to 2007, identified from the National Cancer Database. The proportion of patients with early-stage disease receiving primary surgery increased from 20% in 1985 to 33% in 2007, while the use of radiation therapy decreased from 64% to 52%. The 4-year survival rate was higher for patients with early-stage laryngeal cancer treated with surgery than for those treated with radiation therapy (79% vs 71%), the investigators reported.
Not a Trivial Decision
Among patients with advanced-stage cancer, the use of chemoradiation increased from less than 7% to 45%, the researchers found, whereas total laryngectomy decreased from 42% to 32%. The 4-year survival rates were 51% for patients treated with total laryngectomy and 48% for those treated with chemoradiation.
“For the patient, choosing between [chemoradiation] and laryngectomy is not a trivial decision,” the authors noted. “Laryngectomy may result in a total loss of voice and sometimes impairment of swallowing function, leading to a decreased quality of life. However, treating advanced laryngeal cancer with [chemoradiation] can result in complications such as renal failure and bone marrow suppression. Later complications, such as persistent dysphagia, gastrostomy tube dependency, pharyngoesophageal stenosis, chronic lung aspiration, and permanent tracheotomy tracheotomy dependence, can occur.” The authors added that some patients receiving chemoradiation may still require a laryngectomy because of a dysfunctional larynx or persistent disease. ■
Chen A, et al: Arch Otolaryngol Head Neck Surg 137:1017-1024, 2011.
