Transoral laser microsurgery for supraglottic carcinomas: results of a prospective multicenter trial (SUPRATOL).

Autor:	Ambrosch P; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Kiel, Kiel, Germany., Meuret S; Section of Phoniatrics and Audiology, Clinic of Otorhinolaryngology, University of Leipzig, Leipzig, Germany., Dietz A; Clinic of Otorhinolaryngology, University of Leipzig, Leipzig, Germany., Fazel A; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Kiel, Kiel, Germany., Fietkau R; Department of Radiooncology, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany., Tostmann R; Clinical Trial Unit UMG, Universitätsmedizin Goettingen, Goettingen, Germany., Schroeder U; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), University of Luebeck, Luebeck, Germany., Lammert A; Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany., Künzel J; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, Regensburg, Germany., Jäckel MC; Department of Otorhinolaryngology, Helios-Kliniken Schwerin, Schwerin, Germany., Boeger D; Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany., Scherl C; Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany., Deitmer T; German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC), Bonn, Germany., Breitenstein K; Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany., Delank KW; Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany., Hilber H; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg and Private Medical Practice for Otorhinolaryngology, Regensburg, Germany., Vester S; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, Regensburg, Germany., Knipping S; Department of Otorhinolaryngology, Head and Neck Surgery, Städtisches Klinikum Dessau, Dessau, Germany., Harreus U; Department of Otorhinolaryngology, Krankenhaus Bad Tölz, Bad Tölz, Germany., Scheich M; Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Julius-Maximilians-University Hospital Würzburg, Würzburg, Germany., Bartel S; Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany., Plontke SK; Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany., Koscielny S; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Jena, Jena, Germany., Veit JA; Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.; Private Medical Practice for Nasal Surgery, Muenchen, Germany., Greve J; Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany., Schilling V; Department of Otorhinolaryngology, Head and Neck Surgery, Vivantes Klinikum Neukölln, Germany., Linxweiler M; Department of Otorhinolaryngology, Saarland University, Homburg, Germany., Weiß S; Department of Otorhinolaryngology, Klinikum Kassel, Kassel, Germany., Psychogios G; Clinic of Otorhinolaryngology, University of Ioannina, Ioannina, Greece., Arens C; Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany., Wittekindt C; Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Dortmund, Dortmund, Germany., Oeken J; Department of Otorhinolaryngology, Hospital Chemnitz, Chemnitz, Germany., Grosheva M; Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany., Borzikowsky C; Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2024 Sep 20; Vol. 14, pp. 1440024. Date of Electronic Publication: 2024 Sep 20 (Print Publication: 2024).
DOI:	10.3389/fonc.2024.1440024
Abstrakt:	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). Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. (Copyright © 2024 Ambrosch, Meuret, Dietz, Fazel, Fietkau, Tostmann, Schroeder, Lammert, Künzel, Jäckel, Boeger, Scherl, Deitmer, Breitenstein, Delank, Hilber, Vester, Knipping, Harreus, Scheich, Bartel, Plontke, Koscielny, Veit, Greve, Schilling, Linxweiler, Weiß, Psychogios, Arens, Wittekindt, Oeken, Grosheva and Borzikowsky.)
Databáze:	MEDLINE
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