• 1/5/2008
  • Marietta
  • staff
  • www.cancerpage.com

Compared with combined chemo/radiotherapy, total laryngectomy improves survival in patients with stage IV laryngeal cancer, according to a report in the Archives of Otolaryngology–Head and Neck Surgery for December.

The results also show that black patients and those with Medicare or Medicaid insurance have inferior outcomes, which may be the result of limited access to care.

Dr. Amy Y. Chen from Emory University and Dr. Michael Halpern from the American Cancer Society, both in Atlanta, assessed factors predictive of survival in advanced laryngeal cancer by analyzing data from 7019 patients drawn from a national registry involving Commission on Cancer-approved treatment facilities.

In the overall analysis, survival was highest for patients treated with total laryngectomy than for those given chemo/radiotherapy or radiotherapy alone (p < 0.001). Compared with total laryngectomy, the hazard ratios for death were 1.6 with radiotherapy and 1.3 with chemo/radiotherapy.

Further analysis showed that total laryngectomy and chemo/radiotherapy provided comparable and better survival outcomes than radiotherapy alone for patients with stage III disease. For patients with stage IV disease, however, total laryngectomy was clearly superior to the other two treatments (p < 0.001).

Women were 12% more likely to survive during follow-up than were men (p = 0.002). Compared with whites, blacks were 14% more likely to die (p = 0.004). Relative to private insurance, Medicaid insurance was associated with a 57% increased mortality risk, while with Medicare mortality was increased by 30% to 35% depending on age.

Dr. Chen and Dr. Halpern note that the finding that total laryngectomy provides better survival than radiotherapy alone is consistent with previous research. By contrast, the finding in the overall analysis that total laryngectomy also achieves higher survival rates than chemo/radiotherapy runs counter to prior reports, which have generally shown equivalent results.

This “may reflect differences in patient mix between those enrolled in previous clinical trials (reporting equivalent survival following total laryngectomy and chemo/radiotherapy) and the broader population of patients with laryngeal cancer treated at Commission on Cancer facilities across the US,” the authors suggest.

Source:
Arch Otolaryngol Head Neck Surg 2007;133:1270-1276.