title: 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.
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.
  
  
  METHODS
  Prospective, single-arm, phase 2 multi-institutional trial.
  
  
  METHODS
  Southwest Oncology Group trial S9709.
  
  
  METHODS
  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.
  
  
  METHODS
  Transoral supraglottic laryngectomy by carbon dioxide laser followed by planned postoperative radiotherapy.
  
  
  METHODS
  Three-year progression-free 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 (<or=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 postoperative radiotherapy appears feasible in a multi-institutional setting, with reasonable disease control. Although timing was variable, most patients recovered adequate swallowing in the early postoperative period.
authors.affiliation: Southwest Oncology Group, Operations Office, 14980 Omicron Dr, San Antonio, TX 78245-3217, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.forename: James
authors.initials: J
authors.lastname: Moon
authors.forename: R Kim
authors.initials: RK
authors.lastname: Davis
authors.forename: Wael A
authors.initials: WA
authors.lastname: Sakr
authors.forename: Shankar P G
authors.initials: SP
authors.lastname: Giri
authors.forename: Joseph
authors.initials: J
authors.lastname: Valentino
authors.forename: Michael
authors.initials: M
authors.lastname: LeBlanc
authors.forename: John M
authors.initials: JM
authors.lastname: Truelson
authors.forename: George H
authors.initials: GH
authors.lastname: Yoo
authors.forename: John F
authors.initials: JF
authors.lastname: Ensley
authors.forename: David E
authors.initials: DE
authors.lastname: Schuller
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D007825:Laryngectomy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome