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Laryngology/Broncho-Esophagology

Trends in Treatment Choice for Early Glottic Cancer

Monday, October 2, 2023
5:54 PM - 6:00 PM East Coast USA Time
Location: 106BC

    Presenting Author(s)

  • Emily Y. Huang, BS

    Medical Student
    Johns Hopkins School of Medicine
    Baltimore, MD, United States

    • Co-Author(s)

  • SS

    Sarek Shen, MD

    Department of Otolaryngology – Head & Neck Surgery, Johns Hopkins, USA

  • Henry H. Joo, BS

    Medical Student
    Johns Hopkins School of Medicine
    Baltimore, Maryland, United States

  • MN

    Matthew R. Naunheim, MD, MBA

    Assistant Professor
    Massachusetts Eye and Ear Infirmary/Harvard Medical School
    Boston, MA, United States

  • VT

    Ved Tanavde, MD

    Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, USA

    • Senior Author(s)

  • Lee M. Akst, MD

    Director, Johns Hopkins Voice Center
    Johns Hopkins University
    Lutherville, MD, United States

Disclosure(s):
Emily Y. Huang, BS: No relevant relationships to disclose.
Lee M. Akst, MD: No relevant relationships to disclose.
Introduction: Systemic investigation into treatment for early stage glottic cancer (EGC) has demonstrated similar functional and oncologic outcomes between transoral laser microsurgery (TLMS) and external beam radiotherapy (XRT). Although recent studies have identified sociodemographic factors associated with treatment choice, there is little data on longitudinal evolution of EGC management modality. In this study, we aim to identify recent trends in treatment decisions and patient demographics using the National Cancer Database (NCDB).

Methods: This is a retrospective longitudinal study on all cases of T1-2N0M0 glottic carcinoma queried from the NCDB between 2004-2017. We used Mann-Kendall tests to identify trends in the ratio of TLMS to XRT (TLMS/XRT) performed per year. We also compared differences in TLMS:XRT trends based on location, insurance status, and income. Descriptive statistics for patients in the two treatment modality groups were calculated.

Results: A total of 30,189 EGC patients were analyzed: 2030 (6.7%) received TLMS; 28,159 (93.3%) underwent XRT. The overall ratio of TLMS/XRT increased over time, showing a positive monotonic trend (TLMS/XRT: 0.05 in 2004, 0.09 in 2017; p< 0.001). With regard to insurance, TLMS/XRT grew most rapidly in the group with private insurance, such that the growth in TLMS/XRT between the group with private insurance and the group with no insurance was significant (p=0.004). The TLMS/XRT gap also widened over time between patients in the highest income quartile and those in the lowest income quartile (p=0.002). Similarly, the difference in TLMS/XRT over time for patients with treatment facility in the Northeast compared to the South (p < 0.001) has increased.

Conclusions: While the majority of patients receive XRT as the initial treatment for EGC, proportion of TLMS has been slowly increasing over time. Patient insurance status, income, and geography seem to be correlated with increasing use of TLMS.