In the Journals

Upfront laryngectomy may improve survival in advanced-stage laryngeal cancer

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November 27, 2014

A single academic center that frequently performed surgical therapy for patients with advanced-stage laryngeal cancer reported a higher rate of 5-year survival among its patients than that reported in a national database, according to results of a retrospective review.

Survival rates for patients with laryngeal cancer have declined over the past 2 decades. During that time, treatment for advanced-stage disease shifted from primary surgical therapy to organ-preservation strategies that include chemotherapy and radiation, according to background information provided by researchers.

Blake Joseph LeBlanc, MD, of the department of otolaryngology — head and neck surgery at Louisiana State University Health-Shreveport, and colleagues identified 165 patients with laryngeal cancer included in the LSU Health Registry between 1998 and 2007. The majority of those patients (n=117) had advanced-stage disease — defined as stage III or stage IV — whereas 48 patients had early-stage disease, defined as stage I or stage II.

The percentage of LSU Health patients with advanced disease during the study period was considerably higher than the national rate (70.9% vs. 46.6%; P<.01).

More than half (n=64; 54.7%) of the patients with advanced disease treated at LSU Health underwent primary surgical therapy, including total laryngectomy or pharyngolaryngectomy, which included removal of the voice box and area at the back of the mouth and throat. That approach was contrary to national trends, as data from the National Cancer Data Base showed the national rate of laryngectomy decreased from 60% in the 1980s to 32% in 2007.

Despite the difference in approach, LeBlanc and colleagues determined 5-year survival for patients with stage IV disease treated at LSU Health during the study period was 55.5% (95% CI, 43.3-66.1), compared with 31.6% (95% CI, 30.5-32.9) nationwide as reported by the National Cancer Data Base.

The 5-year OS rate for all patients treated at LSU Health, regardless of disease stage, was 59.1%. That was comparable to the national rate, even though patients treated at LSU Health were more likely to be uninsured (23.7% vs. 5%; P<.001) and travel 50 miles or more for treatment (60.4% vs. 15.8%; P<.001).

“LSU Health treats a high percentage of patients with advanced-stage laryngeal carcinoma who have lower socioeconomic status, yet still has improved survival rates compared with the National Cancer Data Base over the study time period,” LeBlanc and colleagues wrote. “This contributes to a growing body of literature that suggests that initial surgical therapy for advanced-stage disease may result in increased survival compared with organ preservation.”

Disclosure: The researchers report no relevant financial disclosures.

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