This led some researchers to relate that total laryngectomy was no longer useful in the initial treatment of laryngeal cancer…. However, this raises the question as to whether organ preservation approaches provide equivalent survival when offered outside of a controlled study. – -Henry T. Hoffman, MD
Explore this issue:July 2006
It’s perplexing to many of us as to why some infants present with mild inconsequential expiratory stridor that gets better over time, others have swallowing difficulty and are considered to have moderate disease, and then there are those that are severe and have cardiopulmonary complications like hypoxia, chronic cyanosis, and significant stridor. – -Dana M. Thompson, MD
The SEER Data Set shows an improvement overall for cancer survival in the United States across those years, despite the concurrent decline in survival for laryngeal cancer. Dr. Hoffman and his colleagues reviewed the NCDB to confirm these findings and to examine a variety of hypotheses as to why the decrease in survival has occurred, including the possibility that the decrease was actually an artifact of the database.
Our review of the NCDB identified over 158,000 cases accrued over a 15-year period, and this review did support the SEER data findings identifying a decline in survival for laryngeal cancer from the mid 80s to the mid 90s, Dr. Hoffman said. This decline in survival more markedly affected supraglottic cancers but also affected glottic cancers as well.
Why the Decline?
Among the hypotheses they considered as potential contributing factors in the decreased survival rates were an increase in the proportion of advanced stage cancers during those years; a change in the racial profile of patients with laryngeal cancer; and the proportion of smokers in the United States over that same time period. Upon examination, however, these were all determined to be non-contributing factors.
This leads to the concept that the changing patterns of treatment may be the cause for the diminished survival, Dr. Hoffman said. And the most marked change in patterns of treatment has been the increased use of nonsurgical treatment with irradiation and chemotherapy, while the use of surgery alone has decreased, including the use of endoscopic surgical management.
Further analysis of data both within the NCDB and through systematic review of individual patient charts through a separate national survey mechanism is currently under design to further evaluate these associations.
Novel Theory of Laryngomalacia Etiology
Although laryngomalacia is the most common cause of infant stridor and the most common laryngeal anomaly, there are many things physicians and researchers still don’t know about this disease.