Transoral carbon dioxide laser supraglottic laryngectomy and irradiation in stage I, II, and III squamous cell carcinoma of the supraglottic larynx: Report of southwest oncology group phase 2 trial S9709

Amit Agrawal, James Moon, R. Kim Davis, Wael A. Sakr, Shankar P.G. Giri, Joseph Valentino, Michael LeBlanc, John M. Truelson, George H. Yoo, John F. Ensley, David E. Schuller

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Objective: To evaluate feasibility, functional outcome, and disease control of endoscopic surgery and irradiation in patients with squamous cell carcinoma of the supraglottic larynx. Design: Prospective, single-arm, phase 2 multi-institutional trial. Setting: Southwest Oncology Group trial S9709. Patients: Thirty-four patients diagnosed as having stage I, stage II, or selected stage III (T1-2N1M0) supraglottic laryngeal carcinoma enrolled from September 15, 1997, to December 1, 2001. Interventions: Transoral supraglottic laryngectomy by carbon dioxide laser followed by planned postoperative radiotherapy. Main Outcome Measures: Three-year progressionfree survival, proportion of patients requiring tracheostomy as a result of surgery, and time to adequate oral intake. Results: All 34 patients underwent surgery without major protocol deviation. Thirty-two patients (94%) completed planned postoperative radiotherapy without major deviation. At the time of analysis, only 1 patient (3%) had documented local disease recurrence at the primary disease site and required salvage total laryngectomy, and 2 patients (6%) had documented regional recurrence and required salvage neck dissection. Estimated 3-year progression-free survival and overall survival were 79% and 88%, respectively. No subjects required tracheostomy as a direct consequence of endoscopic resection. Patients who required tracheostomy before endoscopic resection due to either obstructive tumor bulk or unfavorable anatomy that precluded safe intubation (4 patients [12%]) were all decannulated in the early postoperative period (<1 week). Of the 34 patients, 24 (71%) recovered adequate oral intake (no longer requiring supplemental intravenous fluids or tube feeding) in the early postoperative period (before hospital discharge) (median time, 2 days; range, 1-7 days), with an additional 7 patients (21%) achieving delayed recovery (2.7-9.8 months). Three patients (9%) remained dependent on a feeding tube at last documented follow-up. Conclusions: Transoral endoscopic carbon dioxide laser excision of supraglottic tumors combined with post-operative radiotherapy appears feasible in a multiinstitutional setting, with reasonable disease control. Although timing was variable, most patients recovered adequate swallowing in the early postoperative period.

Original languageEnglish
Pages (from-to)1044-1050
Number of pages7
JournalArchives of Otolaryngology—Head and Neck Surgery
Volume133
Issue number10
DOIs
StatePublished - Oct 2007

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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