Search

Objectives: Among patients with T2N0M0 glottic larynx cancer undergoing definitive radiotherapy, recent retrospective and prospective data have suggested improved outcomes with altered fractionation over conventional fractionation (CFxn). We sought to characterize national fractionation patterns and to compare outcomes among them.Materials and Methods: We queried the National Cancer Database for T2N0M0 squamous cell carcinomas of the glottis diagnosed from 2004-2014 and managed with definitive radiotherapy. Dose-per-fraction and duration of radiotherapy were used to define cohorts undergoing CFxn, hypofractionation (HypoFxn), and hyperfractionation (HyperFxn). Logistic regression was performed to identify predictors of receiving altered fractionation. Cox regression and propensity-score matching (PSM) analyses were used to compare survival between schedules.Results: We abstracted 2 006 CFxn patients, 1 166 HypoFxn patients, and 161 HyperFxn patients. Fractionation patterns changed significantly from 2004 to 2014, with use of HyperFxn decreasing from 6.3% to 1.8% and use of HypoFxn increasing from 23.9% to 54.1% (p<0.001). Receipt of altered fractionation was independently associated with later year of diagnosis and higher facility volume. On Cox regression, both HypoFxn (hazard ratio [HR] for mortality 0.84, 95% confidence interval [95%CI] 0.73-0.97) and HyperFxn (HR 0.74, 95%CI 0.56-0.99) were associated with improved survival over CFxn. The survival advantage of each altered fractionation schedule over CFxn was redemonstrated on comparison of PSM groups.Conclusion: Increasing utilization of HypoFxn for T2N0M0 glottic cancer is driving national practice patterns away from CFxn. Our findings support the use of altered fractionation, particularly HypoFxn, for patients undergoing definitive radiotherapy, although HyperFxn remains understudied in a prospective fashion. [ABSTRACT FROM AUTHOR]

Objective: Limited investigation of factors potentially contributing to treatment choice in early-stage glottic carcinoma (EGC) has been performed with large-scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC., Methods: The NCDB was queried for all cases of T 1-2  N 0  M 0 glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first-line treatment modality: radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume., Results: 34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7]), treatment at non-academic facilities (OR 2.8, [95%CI: 2.6, 3.0]), and shorter travel distances to treatment centers (OR 2.2, [95%CI: 2.0, 2.4]). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non-metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model., Conclusion: Most patients in the NCDB receive first-line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics., Level of Evidence: 4 Laryngoscope, 133:901-907, 2023., (© 2022 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: Multiple population studies have shown racial discrepancies in head and neck cancer treatment and outcomes. We sought to characterize the impact of race on clinical outcomes for patients with early glottic squamous cell carcinoma (SCC) in a tertiary institution which provides equivalent access to care., Methods: We retrospectively reviewed all early glottic (T1-T2) squamous cell carcinoma at a single institution, the Michael E. DeBakey Veterans' Administration Medical Center (MEDVAMC). Data collected included demographic information, primary and adjuvant treatment modalities, time to diagnosis, time to treatment, recurrences, recurrence treatment modality, secondary malignancies, recurrence-free survival (RFS), and overall survival (OS)., Results: One hundred seventeen patients with a primary diagnosis of T1-T2 glottic squamous cell carcinoma were included. Black and white patients demonstrated equivalent rates of recurrence, RFS, and OS. There was no significant difference in treatment delivery by race for all recorded parameters. T1b tumors were associated with an increased risk of recurrence which did not translate into a statistically significant decrease in RFS or OS. Surgical treatment was associated with increased recurrence but similar RFS and OS compared to radiation-based treatment. Secondary malignancies were common; 12% of patients were diagnosed with a second primary lung cancer during the study period., Conclusion: At our institution, race did not impact survival when access to care, treatment selection, and delivery are equivalent for early glottic SCC. Secondary lung cancer is a critical risk factor for mortality in this patient group and requires long-term surveillance and monitoring., Level of Evidence: 4 Laryngoscope, 130:1733-1739, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Recent reported evidence indicates that vocal cord carcinoma is evolving similarly to oropharyngeal cancer with an increasing number of patients without a smoking history having human papillomavirus (HPV) disease. Observations also suggest that an increasing number of patients who present with glottic carcinoma are younger than has been reported in the past. Therefore, an investigation was done to examine the incidence of glottic carcinoma in patients 30 years old (y/o) or younger. Methods: A retrospective review was done with Institutional Review Board approval to evaluate the incidence of patients 30 y/o or younger presenting with glottic carcinoma in 2 symmetric-length time periods over 28 years. These data were comprised from glottic cancer patients evaluated by the senior author (S.M.Z.) at the Massachusetts Eye and Ear Infirmary (July 1990-June 2004) and subsequently at the Massachusetts General Hospital (July 2004-June 2018). HPV testing was done on those patients identified as having a disease process at 30 y/o or younger. Results: Between July 1990 and June 2018, 353 patients were diagnosed with glottic carcinoma. From July 1990 to June 2004, there were 112 patients, with none being 30 y/o or younger. From July 2004 to June 2018, 241 patients were diagnosed with glottic carcinoma; 11 patients (7 females, 4 males) were 30 y/o or younger. Of the 11 patients, 3 (1 female, 2 males) were 10 to 19 y/o, 3 (2 females, 1 male) were 20 to 25 y/o, and 5 (4 females, 1 male) were 26 to 30 y/o. Moreover, 10 of the 11 cases were tested and were positive for high-risk HPV. None of the 11 glottic cancer patients had been previously treated for benign recurrent respiratory papillomatosis although it was initially suspected prior to biopsy due to the morphology of the lesions and the patients' young age. Three of 11 had a history of smoking; all 3 had less than 3 pack-years. One of the 11 glottic cancer patients was treated with serial Cidofovir injections that resulted in dramatic acceleration in the growth of the cancer. Conclusion: Historically, glottic carcinoma is considered to be a tobacco-induced disease associated with a multidecade process of initiation, promotion, transformation, and progression. However, recent published evidence shows that glottic carcinoma can be an HPV-related disease with increasing incidence in nonsmokers. It isn't surprising that alternate malignant pathways may have a different timeline. In this investigation, an increased incidence of HPV-positive glottic cancer in patients 30 y/o or younger was documented in the past 14 years. This finding further supports the concept that glottic carcinoma is an evolving disease, and it demonstrates the increasing importance of discriminating potential glottic carcinomas in young patients from benign low-risk HPV recurrent respiratory papillomatosis. [ABSTRACT FROM AUTHOR]

This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for primary and adjuvant treatment of cancer of the glottic larynx are reviewed here in a systematic fashion according to stage., (© 2017 Wiley Periodicals, Inc.)

Objectives/hypothesis: The goal of the study was to identify geographic trends in the primary treatment of early-stage glottic cancer., Study Design: Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End-Results (SEER) database., Methods: Using the most up-to-date November 2014 submission of the SEER database in addition to SEER-18 data files, a cohort was created of stage I to II squamous cell glottic cancer from 2004 to 2012. The treatment groups (radiation and surgery) were compared with respect to several pretreatment covariates including age, race, gender, state where they received treatment, year of diagnosis, and American Joint Committee on Cancer (AJCC) stage., Results: In analyzing geographic trends, a statistically significant difference in treatment received by region and state was found (P < .0001.). When examining patient demographics, there was no statistically significant difference in treatment by age (P = .5206), AJCC stage (P = .4922), or year of diagnosis (P = .6593). There was a significant difference in racial distribution by treatment (P = .0038), with patients receiving surgery more likely to be black than patients receiving radiation (12% vs. 10%). In analyzing overall survival (OS), there was no significant difference in OS among the four US treatment regions (P = .2508)., Conclusions: Geographic factors impact overall treatment of early-stage glottic cancer. In addition, it was determined that race was a factor that correlated to differences in treatment modality. Finally, overall survival across the United States was determined to be significantly better in patients receiving radiation therapy., Level of Evidence: 4 Laryngoscope, 126:880-884, 2016., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To identify trends in treatment and survival for patients with stage I glottic cancer and glottic carcinoma in situ (CIS)., Methods: The 18-registry SEER data were analyzed for CIS and stage I glottic cancer. Treatment variables and observed and relative survival were assessed separately for stage I and glottic CIS., Results: Among 14 025 cases of stage I glottic cancer identified from 1988 to 2012, radiation was the most common treatment for all eras. An increase in surgical treatment occurred with a decline in combination therapy. There were 3169 cases of glottic CIS, with surgery the most common initial treatment but with radiotherapy increasing across the years. Relative survival was similar for treatment type and era of diagnosis. Among the 3738 patients with glottic CIS, 5.4% went on to develop invasive glottic carcinoma of any stage, with invasive cancer more common in patients treated by surgery alone compared to radiation or surgery with radiation., Conclusions: Despite changes in treatment modalities for CIS and stage I glottic cancer, there have not been significant changes in survival for CIS, with slightly improved survival for treatment with surgery alone. Patients treated with surgery alone had an increased rate of subsequent invasive cancer., (© The Author(s) 2015.)