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

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 1, stage 11, or selected stage III (T1-2N1MO) 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 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 encloscopic resection due to either obstructive tumor bulk or unfavorable anatomy that precluded safe intubation (4 patients [12%]) were all decarmulated 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: Transcral 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.