Impact of neoadjuvant chemoradiotherapy on health-related quality of life in long-term survivors of esophageal or junctional cancer: results from the randomized CROSS trial

Noordman, Bo Jan; Verdam, Mathilde G. E.; Lagarde, Sjoerd M.; Shapiro, Joël; Hulshof, Maarten C.C.M.; Henegouwen, Mark I. van Berge; Wijnhoven, Bas P. L.; Nieuwenhuijzen, Grard A. P.; Bonenkamp, Johannes J.; Cuesta, Miguel A.; Plukker, John; Bilgen, Ernst Jan Spillenaar; Steyerberg, Ewout W.; Gaast, Ate van der; Sprangers, M. A. G.; Lanschot, J. Jan B. van

doi:10.1093/annonc/mdx726

Cited by 67 publications

(74 citation statements)

References 21 publications

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“…HRQoL data from the CROSS trial, which compared surgery alone with nCRT followed by surgery, were reported recently. There was no difference in HRQoL between the treatment groups, even in the long term. Possible explanations for the discrepancy between these findings and those of the present study could be that subtle effects of the neoadjuvant treatment itself may have been masked by the massive effects of surgery on HRQoL in both studies.…”

Section: Discussioncontrasting

confidence: 99%

“…Furthermore, the methodology of the studies differed slightly. The present study focused on direct comparison of the two treatments as opposed to longitudinal comparisons with baseline in the CROSS study. Longitudinal comparisons with baseline have the advantage of better statistical power than the direct arm‐to‐arm comparisons at 5 years' follow‐up.…”

Section: Discussionmentioning

confidence: 99%

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

Sunde

Klevebro

Johar

et al. 2019

British Journal of Surgery

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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.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Sunde

Klevebro

Johar

et al. 2019

British Journal of Surgery

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“…This phenomenon has been described to a lesser extent in patients with prostate cancer 16,33 . The high postoperative morbidity and mortality rates associated with oesophagectomy, and the lasting impact of such surgery on patients' HRQoL likely underlie the substantial loss of life expectancy that patients are willing to trade off 3,11,12 . For clinicians, who tend to focus on long-term survival outcomes, it is important to realize that patients and physicians may differ in their trade-offs between different treatment options 15 -17,25,34,35 . The present findings may help patients and clinicians choose between active surveillance and oesophagectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Relevant attributes that might influence the choice of oesophagectomy versus active surveillance after nCRT and the attribute levels were chosen based on information in the literature, and consensus discussion with two upper gastrointestinal surgeons and five patients who underwent nCRT followed by surgical resection. Attributes were 5‐year overall survival, short‐term HRQoL (3 months after treatment), long‐term HRQoL (more than 1 year after treatment), the risk that oesophagectomy is still necessary, and the average number of surveillance examinations per year involving endoscopy and PET–CT necessary for 5 years of follow‐up after treatment ( Table ).…”

Section: Methodsmentioning

confidence: 99%

Patients' preferences for treatment after neoadjuvant chemoradiotherapy for oesophageal cancer

Noordman

Bekker‐Grob

Coene

et al. 2018

British Journal of Surgery

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“…However, the ARTIST (Adjuvant Chemoradiation Therapy in Stomach Cancer) trial [23] found that additional postoperative radiotherapy had the same bene t as chemotherapy alone in preventing recurrence of gastric cancer. Therefore, while focusing on randomized clinical trials [24,25], we also need to develop and optimize treatment strategies that accord with the medical conditions of the local area.We found that stage III AEG mainly metastasizes to distant sites, predominantly through hematogenous transmission. We recommend increasing the number of follow-up visits within 2 years after surgery, especially in the second year.…”

Section: Site Of Tumor Recurrencementioning

confidence: 99%

Patterns of recurrence in adenocarcinoma of the esophagogastric junction: a retrospective study

Hui

Zhang

Jin

et al. 2020

Preprint

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Background: The prognosis of adenocarcinoma of the esophagogastric junction (AEG) is poor. Understanding the postoperative recurrence pattern of AEG is helpful to verify the effectiveness of treatment and optimize subsequent treatment, so as to improve prognosis.Methods: This single centre,retrospective study included patients with stage III AEG who underwent surgical treatment between January 2009 and December 2016. According to the different postoperative treatment arm, patients were divided into surgery and surgery plus chemotherapy groups. Recurrence-free survival was used as the outcome to compare the recurrence site and pattern between the groups. Results: In total, enrolled 306 patients, 123 in the surgery group and 183 in the surgery plus chemotherapy group.During follow-up (median 17.1 months) of 24 months after surgery, 62.0% of patients had tumor recurrence. The overall recurrence rates in the surgery and surgery plus chemotherapy group were 86.9% and 77.0%, respectively. The recurrence patterns of both groups were mainly distant metastasis. Postoperative chemotherapy reduced the incidence of hematogenous dissemination from 51.2% to 42.0%. Multivariate Cox analysis showed that pN stage increased the risk of recurrence,while surgery plus chemotherapy reduced the risk. Conclusions: Patients with AEG have a risk of hematogenous dissemination after surgery. Postoperative treatment arm and pN stage were independent risk factors in patients with AEG.Surgery plus chemotherapy can improve RFS and reduce distant metastasis, but they do not have a beneficial role in controlling local recurrence.

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Impact of neoadjuvant chemoradiotherapy on health-related quality of life in long-term survivors of esophageal or junctional cancer: results from the randomized CROSS trial

Abstract: Netherlands Trial Register NTR487.

Cited by 67 publications

References 21 publications

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

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

Patients' preferences for treatment after neoadjuvant chemoradiotherapy for oesophageal cancer

Patterns of recurrence in adenocarcinoma of the esophagogastric junction: a retrospective study

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