Impact of Radiotherapy on Laryngeal Cancer Survival: A Population-based Study of 13,808 U.S. Patients

ArticleinCancer 118(5):1276-87 · October 2011with43 Reads
DOI: 10.1002/cncr.26357 · Source: PubMed
Radiotherapy with its advantage of organ preservation has been used to treat laryngeal cancer (LC) for several decades. However, the impact of radiation on overall survival (OS) in a large population-based study has not been evaluated to date. The authors analyzed all patients who had localized and/or regional glottic and supraglottic cancer in the Surveillance, Epidemiology, and End Results Program by comparing treatment trends and OS for the periods 1988 to 1993, 1994 to 1999, and 2000 to 2006. Kaplan-Meier and logistic regression analyses were conducted to evaluate OS and the influence of patient demographics on treatment received. Among 13,808 patients with LC, radiotherapy use increased over the 3 periods for localized glottic cancer (LGC) (94%, 97%, and 98% during 1988-1993, 1994-1999, and 2000-2006, respectively; P < .001); for regional glottic cancer (RGC) (53%, 66%, and 75%, respectively; P < .001), for localized supraglottic cancer (LSGC) (61%, 83%, and 94%, respectively), and for regional supraglottic cancer (RSGC) (43%, 55%, and 78%, respectively; P < .001). No significant decrease in 5-year OS was observed during the 3 periods (LGC: 73%, 76%, and 78%, respectively; RGC: 57%, 51%, and 56%, respectively; LSGC: 33%, 35%, and 39%, respectively; and RSGC: 36%, 36%, and 43%, respectively). Blacks were significantly less likely to receive radiotherapy than whites (odds ratio: LGC, 0.42; RGC, 0.76; RSGC, 0.68; all P < .05). Those in the lowest tertile of median household income, compared with highest tertile, received radiotherapy less frequently (odds ratio: LGC, 0.42; RGC, 0.57; RSGC, 0.57; all P < .001). The current results indicated that the increased use of radiation with its advantage of speech preservation had no adverse impact on the survival of patients with LC. Black race and low income status had significant, inverse relations with the receipt of radiotherapy.
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  • [Show abstract] [Hide abstract] ABSTRACT: To identify potential racial disparities in the use of larynx preservation. Retrospective database review. Academic medical center. The Surveillance Epidemiology and End Results (SEER) database was used to identify white, black, Hispanic, and Asian patients with stage III and IV laryngeal cancers that were diagnosed during 1991 through 2008. Patients with T4 disease or distant metastasis were intentionally excluded. Univariate and multivariate logistic regression analysis, with odds ratios and 95% confidence intervals, was used to investigate the relationship between race/ethnicity and the use of larynx preservation with radiation therapy as initial therapy. Among the 5385 cases of laryngeal cancers that met the selection criteria, the racial distribution was white (72.7%), black (16.8%), Hispanic (7.4%), and Asian (3.1%). On univariate analysis, blacks (odds ratio [OR], 0.72; 95% CI, 0.59-0.88) were significantly less likely to undergo larynx preservation. This racial disparity persisted on multivariate analysis for blacks (OR, 0.78; 95% CI, 0.63-0.96) and was still observed among patients treated more recently between 2001 and 2008 (OR, 0.74; 95% CI, 0.56-0.96). Pronounced racial disparities exist in the use of larynx preservation therapy for locally advanced laryngeal cancer. While acknowledging the potential biases of socioeconomic factors, further research to better elucidate the underlying reasons for these findings may be warranted.
    Article · Jul 2012
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    Full-text · Article · Dec 2013
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