Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11.
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.
Weber
Randal S
RS
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
Berkey
Brian A
BA
Forastiere
Arlene
A
Cooper
Jay
J
Maor
Moshe
M
Goepfert
Helmuth
H
Morrison
William
W
Glisson
Bonnie
B
Trotti
Andy
A
Ridge
John A
JA
Chao
K S Clifford
KS
Peters
Glenn
G
Lee
D J
DJ
Leaf
Andrea
A
Ensley
John
J
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