2822 - NCDB Analysis of Survival Outcomes for Locoregionally Advanced Laryngeal Cancer Treated with Definitive Chemoradiation vs. Surgery
Presenter(s)
P. Pius1, P. Pitts2, M. Gordon3, E. Becker4, K. Ding4, and C. Henson5; 1University of Oklahoma Stephenson Cancer Center, Oklahoma CIty, OK, 2OUHSC, Oklahoma City, OK, United States, 3University of Oklahoma Health Science Center, Oklahoma City, OK, 4University of Oklahoma Health Sciences Center, Oklahoma City, OK, 5University of Oklahoma Health Sciences Center, OKLAHOMA CITY, OK
Purpose/Objective(s): The VA Laryngeal Study Group trial demonstrated that induction chemotherapy and radiation therapy (RT) are effective in laryngeal preservation without compromising overall survival (OS) when compared to laryngectomy and postoperative RT. Following this, the RTOG 91-11 trial showed that concurrent chemoradiation (cCRT) improved locoregional control and laryngeal preservation with similar OS when compared to induction chemotherapy and RT. Notably, these trials were conducted in the era of two-dimensional RT. Over the past two decades, advancements in radiation oncology have enabled more precise and conformal treatment approaches, aiming to improve disease outcomes while reducing toxicities. However, the impact of modern RT techniques on survival outcomes for advanced laryngeal cancer remains unclear, warranting analysis in the context of today’s treatments.
Materials/Methods: The NCDB was queried to identify patients diagnosed with advanced laryngeal cancer who received primary surgical management versus cCRT between 2004 to 2021. Eligible patients were selected based on stage III-IVB, squamous cell carcinoma, and received either primary surgery or cCRT. The primary outcome of interest was OS, analyzed using Kaplan-Meier survival curves. Cox proportional hazards models were used to evaluate survival rates and identify prognostic factors. Multivariable analysis was conducted to assess the influence of treatment group, ethnicity, sex, age, facility type, insurance status, income, education level, clinical tumor stage, and clinical nodal stage on OS. Additional endpoint was salvage surgery rate which was defined as percentage of patients who received surgery greater than or equal to 90 days after cCRT.
Results: A total of 32733 patients were identified in the NCDB. 13633 (41.6%) received primary surgical management and 19100 (58.4%) received cCRT. The median OS was 54 months and 55 months for surgery vs cCRT, respectively (p = 0.32). 5-year and 10-year OS was 47.1% and 29.0% for primary surgical management. 5-year and 10-year OS was 47.3% and 24.8% for cCRT. Importantly, OS did not differ significantly between cCRT and surgery (HR 0.97, 95% CI 0.936 – 1.003) in multivariate analysis. Multivariate analysis revealed that factors significantly associated with improved survival included female gender, younger age, higher income, early nodal stage, academic/research facility, private insurance and Asian and Hispanic ethnicity (compared with non-Hispanic, white ethnicity). Finally, salvage surgery rate was 1.42%.
Conclusion: In the modern era of radiation therapy, concurrent chemoradiation remains an effective treatment for locoregionally advanced laryngeal cancer, with favorable survival outcomes compared to historical data. This analysis highlights the importance of patient selection and the potential impact of advanced radiation techniques on survival.