Advanced laryngeal cancer patients benefit more from surgery than chemoradiation
22 Aug 2014
Patients with advanced laryngeal cancer appear to have better survival if treated with surgery, compared to non-surgical chemotherapy and radiation therapy.
Squamous cell carcinoma accounts for the vast majority of laryngeal cancer. Prior to 1991, total surgical removal of the larynx with radiation after the operation was the standard of care for advanced cancer. Since then, chemoradiation has become increasingly popular treatment because it can preserve the larynx.
Comparing outcomes of surgical and non-surgical treatments
The authors 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 diagnosed with stage 3 or 4 laryngeal squamous cell carcinoma between 1992 and 2009.
Patients who had surgery had better survival outcomes compared to patients who did not under surgery. In particular:
- 2-year and 5-year disease-specific survival: 70% vs. 64%
- 5-year disease-specific survival: 55% vs. 51%
- 2-year overall survival: 64% vs. 57%
- 5-year overall survival: 44% vs. 39%,
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 were diagnosed between 2004 and 2009 had better survival than those diagnosed earlier and this may be due to improvements in radiation and chemotherapy strategies.
Study authors: important information for decision-making
"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."