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Changes in treatment of advanced laryngeal cancer 1985-2001
Amy Y Chen1, Nicole Schrag, Yongping Hao
1Department of Otolaryngology, Emory University School of Medicine, and Department of Health Services Research, American Cancer Society, Atlanta, Georgia 30329, USA. amy.chen@emoryhealthcare.org
Objective:
In 1991, a randomized study was published and demonstrated that use of nonsurgical therapy (chemoradiation) provided similar survival to total laryngectomy (the gold standard) for patients with advanced-stage laryngeal cancer. The purpose of this study was to assess how treatment of advanced laryngeal cancer was influenced by such developments in non-surgical therapy.
Study Design:
Patterns of care study using National Cancer Database (1985-2001).
Results:
The percentage of advanced-stage patients treated with chemoradiation increased from 8.3% to 20.8% while the proportion treated with radiation alone decreased from 38.9% to 23.0%. Use of chemoradiation increased at a significantly faster rate after the 1991 publication at both community cancer centers and teaching research facilities. The use of total laryngectomy decreased slightly during this period.
Conclusions:
The use of chemoradiation increased after the 1991 publication. It was impossible to determine from the NCDB whether additional patients who could benefit from chemo-RT were not offered or did not complete this treatment option. We recommend that treatment recommendations discussed at tumor boards be recorded in cancer registries.
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