Surgery Boosts Laryngeal Cancer Survival Outcomes

Surgery is the optimal choice for improving the survival of advanced laryngeal cancer patients

medwireNews: For patients with advanced laryngeal cancer, surgery offers better disease-specific survival (DSS) and overall survival (OS) than non-surgical strategies, suggests research published in JAMA Otolaryngology - Head & Neck Surgery.

The results of the “real-world” study of 5394 patients treated for stage III or IV laryngeal squamous cell carcinoma between 1992 and 2009 contradict findings from clinical trials of organ preservation protocols that have suggested equivalent efficacy with surgery, say the authors.

“Patients need to be made aware of the modest but significant survival disadvantage associated with non-surgical therapy as part of the shared decision-making process during treatment selection”, emphasise Uchechukwu Megwalu and Andrew Sikora, both from the Icahn School of Medicine at Mount Sinai in New York, USA.

The researchers note that the use of primary non-surgical treatment became increasingly more common over the study, from 32% of patients treated between 1992 and 1997 to 62% of patients treated between 2004 and 2009.

But multivariate analysis revealed that the 2834 patients who received conservative primary chemoradiation had significantly poorer DSS and OS than the 2560 patients who underwent surgery, with hazard ratios (HRs) of 1.33 and 1.32, respectively, after adjusting for year of diagnosis, age, gender, race, marital status, cancer stage and cancer subsite.

Of note, compared with patients treated surgically, DSS was also significantly worse in patients treated conservatively when data were analysed according to later year of diagnosis (HR=0.79 for 2004–2009 vs 1998–2003), having stage III disease (HR=0.59 vs stage IV), increasing age (HR=1.03), female gender (HR=0.80), glottic subsite (HR=0.74) and marital status (HR=0.68 for married vs single).

Similarly, in addition to type of treatment, OS was significantly decreased by later year of diagnosis (HR=0.91), stage III disease (HR=0.66), increasing age (HR=1.03), female gender (HR=0.81), glottic subsite (HR=0.80) and marriage (HR=0.69).

The researchers suggest several potential reasons for the difference in survival outcomes between reports such as the VA Laryngeal Cancer Study and their “real-life” clinical setting. These include the consistency of treatment protocols, the impact of strict inclusion criteria on confounders such as comorbidity and follow-up of patients for salvage surgery leading to better results in clinical trials.

“Other potential factors that may affect survival outcomes include incomplete treatment, interrupted treatment sessions, and delay in initiating treatment”, the authors conclude.

“The need for pretreatment tooth extractions in many patients receiving chemoradiation therapy is a potential source of treatment delay, especially in poorly adherent patients.”

Reference

Megwalu U, Sikora A. Survival outcomes in advanced laryngeal cancer. JAMA Otolaryngol Head Neck Surg 2014; Published online 21 August. doi:10.1001/jamaoto.2014.1671

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