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

Amit Agrawal, James Moon, R. Kim Davis, Wael A. Sakr, Shankar P G Giri, Joseph Valentino, Michael LeBlanc, John M. Truelson, George H. Yoo, John F. Ensley, David E. Schuller

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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. Design: Prospective, single-arm, phase 2 multi-institutional trial. Setting: Southwest Oncology Group trial S9709. Patients: 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. Interventions: Transoral supraglottic laryngectomy by carbon dioxide laser followed by planned postoperative radiotherapy. Main Outcome Measures: Three-year progressionfree 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 (<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 post-operative radiotherapy appears feasible in a multiinstitutional setting, with reasonable disease control. Although timing was variable, most patients recovered adequate swallowing in the early postoperative period.

Original languageEnglish (US)
Pages (from-to)1044-1050
Number of pages7
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume133
Issue number10
DOIs
StatePublished - Oct 2007

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Laryngectomy
Gas Lasers
Larynx
Squamous Cell Carcinoma
Tracheostomy
Postoperative Period
Radiotherapy
Enteral Nutrition
Recurrence
Neck Dissection
Survival
Parenteral Nutrition
Deglutition
Intubation
Disease-Free Survival

ASJC Scopus subject areas

  • Otorhinolaryngology

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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. / Agrawal, Amit; Moon, James; Davis, R. Kim; Sakr, Wael A.; Giri, Shankar P G; Valentino, Joseph; LeBlanc, Michael; Truelson, John M.; Yoo, George H.; Ensley, John F.; Schuller, David E.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 133, No. 10, 10.2007, p. 1044-1050.

Research output: Contribution to journalArticle

Agrawal, Amit ; Moon, James ; Davis, R. Kim ; Sakr, Wael A. ; Giri, Shankar P G ; Valentino, Joseph ; LeBlanc, Michael ; Truelson, John M. ; Yoo, George H. ; Ensley, John F. ; Schuller, David E. / 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. In: Archives of Otolaryngology - Head and Neck Surgery. 2007 ; Vol. 133, No. 10. pp. 1044-1050.
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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. Design: Prospective, single-arm, phase 2 multi-institutional trial. Setting: Southwest Oncology Group trial S9709. Patients: 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. Interventions: Transoral supraglottic laryngectomy by carbon dioxide laser followed by planned postoperative radiotherapy. Main Outcome Measures: Three-year progressionfree 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 (<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 post-operative radiotherapy appears feasible in a multiinstitutional setting, with reasonable disease control. Although timing was variable, most patients recovered adequate swallowing in the early postoperative period.",
author = "Amit Agrawal and James Moon and Davis, {R. Kim} and Sakr, {Wael A.} and Giri, {Shankar P G} and Joseph Valentino and Michael LeBlanc and Truelson, {John M.} and Yoo, {George H.} and Ensley, {John F.} and Schuller, {David E.}",
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T2 - Report of southwest oncology group phase 2 trial S9709

AU - Agrawal, Amit

AU - Moon, James

AU - Davis, R. Kim

AU - Sakr, Wael A.

AU - Giri, Shankar P G

AU - Valentino, Joseph

AU - LeBlanc, Michael

AU - Truelson, John M.

AU - Yoo, George H.

AU - Ensley, John F.

AU - Schuller, David E.

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N2 - 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 I, stage II, or selected stage III (T1-2N1M0) 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 progressionfree 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 (<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 post-operative radiotherapy appears feasible in a multiinstitutional setting, with reasonable disease control. Although timing was variable, most patients recovered adequate swallowing in the early postoperative period.

AB - 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 I, stage II, or selected stage III (T1-2N1M0) 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 progressionfree 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 (<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 post-operative radiotherapy appears feasible in a multiinstitutional setting, with reasonable disease control. Although timing was variable, most patients recovered adequate swallowing in the early postoperative period.

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