Health-related quality of life in a randomized trial of neoadjuvant chemotherapy or chemoradiotherapy plus surgery in patients with oesophageal cancer (NeoRes trial)

Abstract

Background: There are few data comparing health-related quality of life (HRQoL) after neoadjuvant chemotherapy alone (nCT) compared with neoadjuvant chemoradiotherapy (nCRT) in patients with oesophageal cancer.Methods: In the NeoRes trial, patients were assigned randomly in a 1 : 1 ratio to receive either cisplatin 100 mg/m 2 on day 1 and an infusion of 750 mg per m 2 5-fluorouracil over 24 h on days 1-5 in three 21-day cycles (nCT) or the same chemotherapy regimen, but with the addition of 40 Gy radiotherapy (nCRT). HRQoL data were collected at baseline, after neoadjuvant therapy and at 1, 3 and 5 years after surgery. The European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire QLQ-C30 and disease-specific modules were used.Results: Of 181 patients randomized, 165 were included in the analysis of HRQoL. In a direct comparison between the allocated treatments, odynophagia after completion of neoadjuvant therapy but before surgery (P = 0⋅047) and troublesome coughing at 3 years' follow-up (P = 0⋅011) were more pronounced in the nCRT arm. In the longitudinal analyses within each treatment arm, a large deterioration in HRQoL was noted at 1 year. Some recovery was seen in both arms over time but, after 3 and 5 years, patients in the nCRT arm reported more symptoms compared with baseline than patients in the nCT arm.Conclusion: HRQoL after multimodal treatment for cancer of the oesophagus or gastro-oesophageal junction was impaired and more pronounced in patients who underwent nCRT, with only partial recovery over time.

Development and Validation of a Radiomics Nomogram Model for Predicting Postoperative Recurrence in Patients With Esophageal Squamous Cell Cancer Who Achieved pCR After Neoadjuvant Chemoradiotherapy Followed by Surgery

“…Despite multidisciplinary advances in EC treatment, surgery is still the curative strategy of choice. However, neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) followed by surgery has been shown to achieve a better outcome for patients with EC compared with surgery alone ( 5 , 6 ), and is related to improvements in overall survival and disease-free survival. Notably, 15–30% of all patients with EC treated with nCRT followed by surgery achieve a pathological complete response (pCR) ( 7 – 9 ) and ~45% of patients with ESCC achieve pCR ( 7 , 10 , 11 ), where pCR is defined as no histological evidence of the tumor in the surgical specimen.…”

Predictors of changes in skeletal muscle mass after esophagectomy in elderly patients with esophageal cancer

“…Patients treated with NAC were signi cantly associated with a lower preoperative SMI and BMI (Table 3) and had a signi cantly lower preoperative SMI compared with patients who did not receive NAC (Figure 3). NAC reduced skeletal muscle mass by approximately 3% because of side effects, such as fatigue, loss of appetite, and decreased exercise tolerance accompanied by thrombocytopenia [31][32][33][34][35]. It has also been revealed that patients with a low preoperative SMI have less marked loss of SMI after esophagectomy [9].…”

Patient-reported outcome (PRO) results from the AGITG DOCTOR trial: a randomised phase 2 trial of tailored neoadjuvant therapy for resectable oesophageal adenocarcinoma

“…However, direct comparisons of these two approaches do not show a consistent benefit for one over the other [ 10 ] and complication rates may be higher following nCRT [ 9 ]. There are few published reports with patient-reported outcome (PRO) data from randomized neoadjuvant therapy trials, representing a gap in our understanding of the impact of neoadjuvant therapy [ 11 ]. Recent trials have focused on identifying suitable candidates for neoadjuvant therapy regimens, involving chemotherapy or CRT.…”