Predictors of Postoperative Radiation Following Laser Resection in Early‐Stage Glottic Cancer

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Guideline recommendations for the treatment of early-stage glottic cancer are limited to single-modality therapy with surgery or radiation alone. We sought to investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) following laser excision for patients with T1-T2N0 glottic squamous cell carcinoma (SCC). </jats:p></jats:sec><jats:sec><jats:title>Study Design</jats:title><jats:p> Retrospective observational study of the National Cancer Database. </jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p> National Cancer Database review from 2004 to 2014. </jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p> A total of 1338 patients with primary cT1-T2N0M0 glottic SCC undergoing primary laser excision were included. Hospitals were divided into quartiles based on yearly volume of laryngeal laser cases performed. Multivariate logistic regression was performed to identify independent predictors of PORT. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The overall rate of PORT was 30.0%. Predictors of PORT included treatment at lower-volume hospitals (adjusted odds ratio [aOR] for quartiles 2-4, 1.32-4.84), positive margins (aOR, 3.83 [95% CI, 2.54-5.78]), and T2 tumors (aOR, 3.58 [95% CI, 2.24-5.74]). PORT utilization demonstrated a strong inverse correlation with hospital volume. Among top-quartile hospitals, the rate of PORT was 11.2%, while rates of PORT at second-, third-, and fourth-quartile institutions were 19.2%, 32.2%, and 37.4%, respectively. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Predictors of PORT in multivariable analysis included treatment at lower-volume facilities, positive margins, and T2 disease. This study highlights the importance of treating early-stage glottic carcinoma at high-volume institutions. In addition, there is a need to reevaluate the use of PORT and reduce the rate of dual-modality therapy for patients with early-stage glottic SCC. </jats:p></jats:sec>

T1 glottic laryngeal cancer: the role of routine follow-up visits in detecting local recurrence

“…Cases treated at non-academic centers and those with lower caseloads had a higher likelihood of positive margins [ 21 ]. Silverman et al showed that postoperative radiotherapy of T1-T2 LSCC was significantly more common in low-volume centers [ 22 ]. In our study, positive margin status in T1a was associated with a higher risk of local recurrence.…”

The impact of undergoing surgical margin evaluation during endoscopic surgery for early‐stage laryngeal squamous cell carcinoma

“…Treatment decisions for re-operative procedures and adjuvant therapy draw from the results of margin evaluation among other pathologic factors. 1,[20][21][22] Patients who do not undergo margin evaluation may either not receive adequate treatment for their extent of disease, or conversely, may receive additional treatment that is unwarranted and associated with additional morbidity and complications. Furthermore, the present study found that surgical margins were more often evaluated after more radical endoscopic surgeries (86.9% for subtotal laryngectomies versus 51.8% for local excisions versus 33.1% for local destruction).…”

“…This contrasts with patients who did not or could not have margins evaluated, who may receive adjuvant radiation due to the uncertainty of surgical margin status despite current guidelines recommending single‐modality therapy. Treatment decisions for re‐operative procedures and adjuvant therapy draw from the results of margin evaluation among other pathologic factors 1,20–22 . Patients who do not undergo margin evaluation may either not receive adequate treatment for their extent of disease, or conversely, may receive additional treatment that is unwarranted and associated with additional morbidity and complications.…”