Document Type
Article
Publication Date
April 2022
Journal
Thorac Cancer
First Page
1
Last Page
18
URL with Digital Object Identifier
https://doi.org/10.1111/1759-7714.14433
Abstract
Background: We compared the health-related quality of life (HRQOL) in patientsundergoing trimodality therapy for resectable stage I-III esophageal cancer.Methods: A total of 96 patients were randomized to standard neoadjuvant cisplatinand 5-fluorouracil chemotherapy plus radiotherapy (neoadjuvant) followed by surgicalresection or adjuvant cisplatin, 5-fluorouracil, and epirubicin chemotherapy with concurrentextended volume radiotherapy (adjuvant) following surgical resection.Results: There was no significant difference in the functional assessment of cancertherapy-esophageal (FACT-E) total scores between arms at 1 year (p = 0.759) with36% versus 41% (neoadjuvant vs. adjuvant), respectively, showing an increase of ≥15points compared to pre-treatment (p = 0.638). The HRQOL was significantly inferiorat 2 months in the neoadjuvant arm for FACT-E, European Organization for Researchand Treatment of Cancer quality of life questionnaire (EORTC QLQ-OG25), andEuroQol 5-D-3 L in the dysphagia, reflux, pain, taste, and coughing domains(p andlt; 0.05). Half of patients were able to complete the prescribed neoadjuvant arm chemotherapywithout modification compared to only 14% in the adjuvant arm(p andlt; 0.001). Chemotherapy related adverse events of grade ≥2 occurred significantlymore frequently in the neoadjuvant arm (100% vs. 69%, p andlt; 0.001). Surgery relatedadverse events of grade ≥2 were similar in both arms (72% vs. 86%, p = 0.107). Therewere no 30-day mortalities and 2% vs. 10% 90-day mortalities (p = 0.204). There wereno significant differences in either overall survival (OS) (5-year: 35% vs. 32%,p = 0.409) or disease-free survival (DFS) (5-year: 31% vs. 30%, p = 0.710).Conclusion: Trimodality therapy is challenging for patients with resectable esophagealcancer regardless of whether it is given before or after surgery. Newer and less toxicprotocols are needed.
Notes
Open access