title: Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11.
abstract: OBJECTIVE
  To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy.
  
  
  METHODS
  Patients entered into a 3-arm randomized prospective multi-institutional trial for laryngeal preservation who required TL following initial treatment.
  
  
  METHODS
  The Radiation Therapy Oncology Group 91-11 trial for laryngeal preservation.
  
  
  METHODS
  From 1992 to 2000, 517 evaluable patients were randomized to receive chemotherapy followed by radiation therapy (arm 1), concomitant chemotherapy and radiation therapy (arm 2), or radiation therapy alone (arm 3).
  
  
  RESULTS
  Overall, TL was required in 129 patients. The incidence was 28%, 16%, and 31% in arms 1, 2, and 3, respectively (P =.002). Of these, 7 patients (5%) required TL for aspiration or necrosis. Following TL, the incidence of major and minor complications ranged from 52% to 59% and did not differ significantly among the 3 arms. Pharyngocutaneous fistula was lowest in arm 3 (15%) and highest in arm 2 (30%) (P>.05). There was 1 perioperative death. Local-regional control following salvage TL was 74% for arms 1 and 2 and 90% for arm 3. At 24 months, the overall survival was 69% (arm 1), 71% (arm 2), and 76% (arm 3) (P>.73).
  
  
  CONCLUSIONS
  Laryngectomy following organ preservation treatment is associated with acceptable morbidity. Perioperative mortality is low but up to one third of patients will develop a pharyngocutaneous fistula. Local-regional control is excellent for this group of patients. Survival following salvage TL was not influenced by the initial organ preservation treatment.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 3400 Spruce St, 5 Ravdin, Philadelphia, PA 19104, USA. randal.weber@uphs.upenn.edu
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Brian A
authors.initials: BA
authors.lastname: Berkey
authors.forename: Arlene
authors.initials: A
authors.lastname: Forastiere
authors.forename: Jay
authors.initials: J
authors.lastname: Cooper
authors.forename: Moshe
authors.initials: M
authors.lastname: Maor
authors.forename: Helmuth
authors.initials: H
authors.lastname: Goepfert
authors.forename: William
authors.initials: W
authors.lastname: Morrison
authors.forename: Bonnie
authors.initials: B
authors.lastname: Glisson
authors.forename: Andy
authors.initials: A
authors.lastname: Trotti
authors.forename: John A
authors.initials: JA
authors.lastname: Ridge
authors.forename: K S Clifford
authors.initials: KS
authors.lastname: Chao
authors.forename: Glenn
authors.initials: G
authors.lastname: Peters
authors.forename: D J
authors.initials: DJ
authors.lastname: Lee
authors.forename: Andrea
authors.initials: A
authors.lastname: Leaf
authors.forename: John
authors.initials: J
authors.lastname: Ensley
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016879:Salvage Therapy