Trends in Treatment Choice for Early Glottic Cancer

Background/Objective: Systemic investigation into treatment for early-stage glottic cancer (EGC) has demonstrated similar functional and oncologic outcomes between transoral laser microsurgery (TLM) and external beam radiotherapy (XRT). In this study, we aim to identify longitudinal trends in treatment decisions and patient demographics. Methods: This is a retrospective longitudinal study on all cases of T1-2N0M0 glottic carcinoma queried from the NCDB between 2004 and 2017. The ratio of TLM to XRT (TLM/XRT) performed per year was calculated and further stratified by insurance status, education, income, and treatment facility location. Univariable and multivariable linear regressions were used to assess the trend of TLM/XRT over time and evaluate the effect of demographic characteristics on the TLM/XRT ratio. Results: A total of 38,428 EGC patients were analyzed: 2169 (5.6%) received TLM; 36,259 (94.4%) underwent XRT. The overall ratio of TLM/XRT increased over time from 0.04 in 2004 to 0.08 in 2017. Significant increases were observed in the higher-income quartiles (Q4: p < 0.001, Q3: p = 0.02, Q2 < 0.001) and among patients with private (p < 0.02) or public (p = 0.003) insurance. TLM/XRT rose significantly over time in the highest (Q4), third (Q3), and lowest (Q1) education quartiles but not in the second (Q2). Regionally, increases were observed in the Northeast (p < 0.001) and West (p = 0.008), with no significant change in the South or Midwest. By T stage, only T1 tumors showed a significant increase in TLM/XRT over time (p < 0.001). Conclusions: While the majority of patients receive XRT as the initial treatment for EGC, the proportion of TLM has been slowly increasing over time. Patient insurance status, education, income, facility geography, and T stage are correlated with increasing use of TLM.