 |
|
Outcome of Salvage Total Laryngectomy Following Organ Preservation Therapy
The Radiation Therapy Oncology Group Trial 91-11
Randal S. Weber, MD;
Brian A. Berkey, MS;
Arlene Forastiere, MD;
Jay Cooper, MD;
Moshe Maor, MD;
Helmuth Goepfert, MD;
William Morrison, MD;
Bonnie Glisson, MD;
Andy Trotti, MD;
John A. Ridge, MD, PhD;
K. S. Clifford Chao, MD;
Glenn Peters, MD;
D. J. Lee, MD;
Andrea Leaf, MD;
John Ensley, MD
Arch Otolaryngol Head Neck Surg. 2003;129:44-49.
Objective To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy.
Design Patients entered into a 3-arm randomized prospective multi-institutional trial for laryngeal preservation who required TL following initial treatment.
Setting The Radiation Therapy Oncology Group 91-11 trial for laryngeal preservation.
Patients 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.
From the Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pa (Dr Weber); Department of RTOG Statistics, Radiation Therapy Oncology Group, Philadelphia (Mr Berkey); Department of Medical Oncology, Johns Hopkins Oncology Center, Baltimore, Md (Drs Forastiere and Lee); Department of Radiation Oncology, New York University, New York (Dr Cooper); Department of Head and Neck Surgery, M. D. Anderson Cancer Center, University of Texas, Houston (Drs Maor, Goepfert, Morrison, and Glisson); Department of Radiation Oncology, Moffit Cancer Center, University of South Florida, Tampa (Dr Trotti); Department of Surgery, Fox Chase Cancer Center, Philadelphia (Dr Ridge); Department of Radiation Oncology, Washington University, St Louis, Mo (Dr Chao); Department of Otolaryngology, University of Alabama, Birmingham (Dr Peters); Department of Hematology, Medical Oncology, Eastern Cooperative Oncology Group, Brooklyn, NY (Dr Leaf); and Department of Medical Oncology, Southwest Oncology Group, Detroit, Mich (Dr Ensley).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Redefining the Role of Induction Chemotherapy in Head and Neck Cancer
Adelstein
JCO 2008;26:3117-3119.
FULL TEXT
Dysphagia treatment post stroke: a systematic review of randomised controlled trials
Foley et al.
Age Ageing 2008;37:258-264.
ABSTRACT
| FULL TEXT
Planned Simultaneous Cervical Skin Reconstruction for Salvage Total Pharyngolaryngectomy
Watanabe et al.
Jpn J Clin Oncol 2008;38:167-171.
ABSTRACT
| FULL TEXT
Salvage Surgery for Recurrent Carcinoma of the Hypopharynx and Reconstruction Using Jejunal Free Tissue Transfer and Pectoralis Major Muscle Pedicled Flap
Dubsky et al.
Arch Otolaryngol Head Neck Surg 2007;133:551-555.
ABSTRACT
| FULL TEXT
Identification of Angiogenesis/Metastases Genes Predicting Chemoradiotherapy Response in Patients With Laryngopharyngeal Carcinoma
Ganly et al.
JCO 2007;25:1369-1376.
ABSTRACT
| FULL TEXT
American Society of Clinical Oncology Clinical Practice Guideline for the Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer
Pfister et al.
JCO 2006;24:3693-3704.
ABSTRACT
| FULL TEXT
Single-Cycle Induction Chemotherapy Selects Patients With Advanced Laryngeal Cancer for Combined Chemoradiation: A New Treatment Paradigm
Urba et al.
JCO 2006;24:593-598.
ABSTRACT
| FULL TEXT
Concurrent Chemoradiotherapy as the Most Appropriate Treatment for Most T3 Laryngeal Carcinomas
Enepekides
Arch Otolaryngol Head Neck Surg 2005;131:815-818.
FULL TEXT
Cost Comparison of Surgery vs Organ Preservation for Laryngeal Cancer
Davis et al.
Arch Otolaryngol Head Neck Surg 2005;131:21-26.
ABSTRACT
| FULL TEXT
Decreased Short- and Long-term Swallowing Problems With Altered Radiotherapy Dosing Used in an Organ-Sparing Protocol for Advanced Pharyngeal Carcinoma
Smith et al.
Arch Otolaryngol Head Neck Surg 2004;130:831-836.
ABSTRACT
| FULL TEXT
Quality of Life for Patients Following Total Laryngectomy vs Chemoradiation for Laryngeal Preservation
Hanna et al.
Arch Otolaryngol Head Neck Surg 2004;130:875-879.
ABSTRACT
| FULL TEXT
The Expanding Role of Systemic Therapy in Head and Neck Cancer
Cohen et al.
JCO 2004;22:1743-1752.
ABSTRACT
| FULL TEXT
|
