Journal Article Epublish 1 citation
PubMed: 39372873 DOI: 10.3389/fonc.2024.1440024
Transoral laser microsurgery for supraglottic carcinomas: results of a prospective multicenter trial (SUPRATOL).
Front Oncol 14:1440024
Authors: Petra Ambrosch, Sylvia Meuret, Andreas Dietz, Asita Fazel, Rainer Fietkau, Ralf Tostmann, Ursula Schroeder, Anne Lammert, Julian Künzel, Martin C Jäckel, Daniel Boeger, Claudia Scherl, Thomas Deitmer, Kerstin Breitenstein, K-Wolfgang Delank, Hermann Hilber, Sarah Vester, Stephan Knipping, Ulrich Harreus, Matthias Scheich, Sylva Bartel, Stefan K Plontke, Sven Koscielny, Johannes A Veit, Jens Greve, Volker Schilling, Maximilian Linxweiler, Sonja Weiß, Georgios Psychogios, Christoph Arens, Claus Wittekindt, Jens Oeken, Maria Grosheva, Christoph Borzikowsky
Affiliations
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Kiel, Kiel, Germany.
- Section of Phoniatrics and Audiology, Clinic of Otorhinolaryngology, University of Leipzig, Leipzig, Germany.
- Clinic of Otorhinolaryngology, University of Leipzig, Leipzig, Germany.
- Department of Radiooncology, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany.
- Clinical Trial Unit UMG, Universitätsmedizin Goettingen, Goettingen, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Luebeck, Luebeck, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, Regensburg, Germany.
- Department of Otorhinolaryngology, Helios-Kliniken Schwerin, Schwerin, Germany.
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany.
- German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC), Bonn, Germany.
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg and Private Medical Practice for Otorhinolaryngology, Regensburg, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Städtisches Klinikum Dessau, Dessau, Germany.
- Department of Otorhinolaryngology, Krankenhaus Bad Tölz, Bad Tölz, Germany.
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Julius-Maximilians-University Hospital Würzburg, Würzburg, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Jena, Jena, Germany.
- Private Medical Practice for Nasal Surgery, Muenchen, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Vivantes Klinikum Neukölln, Germany.
- Department of Otorhinolaryngology, Saarland University, Homburg, Germany.
- Department of Otorhinolaryngology, Klinikum Kassel, Kassel, Germany.
- Clinic of Otorhinolaryngology, University of Ioannina, Ioannina, Greece.
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Dortmund, Dortmund, Germany.
- Department of Otorhinolaryngology, Hospital Chemnitz, Chemnitz, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany.
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany.
Abstract
Background
A limited number of single institutions have published retrospective cohort studies on transoral laser microsurgery for supraglottic laryngectomy (TLM-SGL). These studies have shown that the oncologic outcomes of TLM-SGL are comparable to those of open SGL. However, there is limited information available regarding swallowing rehabilitation and quality of life (QoL).
Patients and methods
SUPRATOL is a prospective, multicenter trial assessing the functional outcomes of TLM-SGL +/- adjuvant radio-(chemo)-therapy. The primary endpoint was aspiration-free swallowing at 12 months, as established using fibreoptic endoscopic evaluation of swallowing (FEES) and defined as a grade < 6 on the penetration-aspiration scale. Secondary endpoints were swallowing- and voice-related QoL, the prevalence of temporary and permanent tracheostomy and percutaneous gastrostomy, local control, laryngectomy-free survival, overall survival, and disease-free survival, as well as the influence of treatment centers on outcomes.
Results
From April 2015 to February 2018, 102 patients were recruited from 26 German Otorhinolaryngology (ORL) hospitals. All patients had TLM-SGL and 96.1% underwent uni- or bilateral, mostly selective neck dissection. To 47.0% of patients, adjuvant radio-(chemo)-therapy (R(C)T) was administered. The median follow-up period was 24.1 months. At 12-month follow-up, completed by 84.3% of patients, 98.2%, 95.5%, and 98.8% were free of aspiration when tested with saliva, liquid, or pulp. Adjuvant R(C)T, pT category, and type of resection had no significant influence on swallowing rehabilitation. A total of 40.2% of patients had been tracheotomized, and in 46.1% of patients, a PEG tube was inserted. At the 24-month follow-up, 5.3% of patients still required a tracheostomy, and 8.0% continued to use a percutaneous endoscopic gastrostomy (PEG) tube. Deterioration of swallowing- and voice-related QoL was observed immediately after treatment, but patients recovered, and baseline values were reached again. The Kaplan-Meier 2-year rates for local control, laryngectomy-free survival, overall survival, and disease-free survival were 88%, 92%, 93%, and 82%, respectively.
Conclusions
Our prospective multicenter trial shows that, at 12 months post-TLM-SGL +/- R(C)T, 95.5%-98.8% of patients achieved aspiration-free swallowing. Morbidity was higher than previously reported. The rates of permanent tracheostomy and gastrostomy tube placement correspond to previous cohort studies. The 2-year oncologic outcomes are within the reported range.
Clinical trial registration
https://drks.de/search/en/trial/DRKS00004641, identifier (DRKS00004641).
MeSH
Tracheostomy, Disease-Free Survival, Laryngectomy, Cohort Studies, Rehabilitation, Lasers, Microsurgery, Therapeutics, Gastrostomy, Deglutition, Voice