Transoral XXXX 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.

@entity1 @entity5 @entity957 @entity189 @entity544
OBJECTIVE: To evaluate feasibility, functional outcome, and disease control of endoscopic surgery and irradiation in @entity1 with @entity957 of the supraglottic larynx. DESIGN: Prospective, single-arm, phase 2 multi-institutional trial. SETTING: Southwest Oncology Group trial S9709. @entity1 : Thirty-four @entity1 diagnosed as having stage I, stage II, or selected stage III (T1-2N1M0) supraglottic @entity189 enrolled from September 15, 1997, to December 1, 2001. INTERVENTIONS: Transoral supraglottic laryngectomy by @entity544 laser followed by planned postoperative radiotherapy. MAIN OUTCOME MEASURES: Three-year progression-free survival, proportion of @entity1 requiring tracheostomy as a result of surgery, and time to adequate oral intake. RESULTS: All 34 @entity1 underwent surgery without major protocol deviation. Thirty-two @entity1 (94%) completed planned postoperative radiotherapy without major deviation. At the time of analysis, only 1 @entity1 (3%) had documented local disease recurrence at the primary disease site and required salvage total laryngectomy, and 2 @entity1 (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. @entity1 who required tracheostomy before endoscopic resection due to either obstructive @entity5 bulk or unfavorable anatomy that precluded safe intubation (4 @entity1 [12%]) were all decannulated in the early postoperative period (<or=1 week). Of the 34 @entity1 , 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 @entity1 (21%) achieving delayed recovery (2.7-9.8 months). Three @entity1 (9%) remained dependent on a feeding tube at last documented follow-up. CONCLUSIONS: Transoral endoscopic @entity544 laser excision of supraglottic @entity5 combined with postoperative radiotherapy appears feasible in a multi-institutional setting, with reasonable disease control. Although timing was variable, most @entity1 recovered adequate swallowing in the early postoperative period.
