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Management and Outcome Differences in Supraglottic Cancer Between Ontario, Canada, and the Surveillance, Epidemiology, and End Results Areas of the United States

Patti A. Groome, Brian O’Sullivan, Jonathan C. Irish, Deanna M. Rothwell, Karleen Schulze, Padraig R. Warde, Ken M. Schneider, Robert G. Mackenzie, D. Ian Hodson, J. Alex Hammond, Sunil P.P. Gulavita, Libni J. Eapen, Peter F. Dixon, Randy J. Bissett, William J. Mackillop

From the Radiation Oncology Research Unit, Departments of Oncology and Community Health and Epidemiology, Queen’s University, Kingston; Departments of Radiation Oncology and Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto; and Departments of Radiation Oncology at the Regional Cancer Centres of Cancer Care Ontario, Ontario, Canada.

Address reprint requests to P.A. Groome, PhD, Radiation Oncology Research Unit, Apps Level 4, Kingston General Hospital, Kingston, Ontario K7L 2V7, Canada; email: patti.groome{at}krcc.on.ca.

Purpose: We compared the management and outcome of supraglottic cancer in Ontario, Canada, with that in the Surveillance, Epidemiology, and End Results (SEER) Program areas in the United States.

Methods: Electronic, clinical, and hospital data were linked to cancer registry data and supplemented by chart review where necessary. Stage-stratified analyses compared initial treatment and survival in the SEER areas (n = 1,643) with a random sample from Ontario (n = 265). We also compared laryngectomy rates at 3 years in those patients 65 years and older at diagnosis.

Results: Radical surgery was more commonly used in SEER, with absolute differences increasing with increasing stage: I/II, 17%; III, 36%; and IV, 45%. The 5-year survival rates were 74% in Ontario and 56% in SEER for stage I/II disease (P = .01), 55.7% in Ontario and 46.8% in SEER for stage III disease (P = .40), and 28.5% in Ontario and 29.1% in SEER for stage IV disease (P = .28). Cancer-specific survival results mirrored the overall survival results with the exception of stage IV disease, for which 34.6% of Ontario patients survived their cancer compared with 38.1% in SEER (P = .10). This stage IV difference was more pronounced when we further controlled for possible cause of death errors by restricting the comparison to patients with a single primary cancer (P = .01). Three-year actuarial laryngectomy rates differed. In stage I/II, these rates were 3% in Ontario compared with 35% in SEER (P < 10^-3). In stage III disease, the rates were 30% and 54%, respectively (P = .03), and in stage IV disease they were 33% and 64% (P = .002).

Conclusion: There are large differences in the management of supraglottic cancer between the SEER areas of the United States and Ontario. Long-term larynx retention was higher in Ontario, where radiotherapy is widely regarded as the treatment of choice and surgery is reserved for salvage. In stages I to III, survival was similar in the two regions despite the differences in treatment policy. In stage IV, there may be a small survival advantage in the U.S. SEER areas related to the higher use of primary surgery.

Supported by the National Cancer Institute of Canada with funds from the Canadian Cancer Society. P.A.G. is an Ontario Ministry of Health Career Scientist.

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