Najib Safieddine, Jennifer Knox, Rebecca Wong, Wei Xu, Jennifer Hornby, Shaf Keshavjee, Gail Darling; University of Toronto, Toronto, ON, Canada
Objective: The objective of this study was to determine the effect of neoadjuvant chemoradiotherapy followed by surgery on health related quality of life(HRQOL)in patients with esophageal cancer.Methods: HRQOL was evaluated in a prospective phase II study of neoadjuvant chemoradiotherapy followed by esophagectomy. A cohort of 52 English speaking patients with technically resectable, histologically proven carcinoma of the esophagus, fit for the planned treatment, received induction chemotherapy(Cisplatin 30 mg/m2, Irinotecan 65 mg/m2 weekly in weeks 1&2), followed by concurrent radiation and chemotherapy (40Gy in 20 fractions week 4 to 8 with Cisplatin, Irinotecan in weeks 4&5,7&8), then by a boost to a total of 50 Gy. Esophagectomy with lymphadenectomy was performed 6 weeks after completion of induction. HRQOL assessments using the Functional Assessment of Cancer Therapy- Esophageal (FACT-E) were performed: pretreatment, 7 weeks after initiation of neoadjuvant therapy, preresection (12-14 weeks after neoadjuvant therapy), 1 month, 3 months, 6 months and 1 year following resection.
Results: Of the 52 patients entered in the study, 43 patients completed the treatment. FACT-E scores declined significantly following chemoradiation at week 7(119 vs. 125 baseline)(p 0.03) but returned to baseline prior to surgery(127). Similarly, scores declined significantly after surgery (115 at 1 mon) but returned to baseline by 3 months postop(125). By 6 months post-op there was a statistically significant improvement in scores as compared to baseline(130, p=0.009). FACT-E scores continued to increase significantly over time for patients who were alive with or without disease but were observed to decline in those who ultimately died(p=0.007). In cases with a complete pathological response the increase in FACT-E score was significantly greater than in cases with partial or no response(p=0.05). Also, an increase in QOL was associated with significantly lower risk of death(p=0.03).
Conclusion: Neoadjuvant therapy has a significant impact on HRQOL but this effect is transient with recovery to baseline within 7 weeks after completion of induction. Similarly HRQOL declines following surgery but returns to baseline within 3 months of surgery and continues to increase over time except in patients with progressive disease. Decline in FACT-E scores predicts death. Patients in whom a complete pathological response was seen demonstrate significantly greater increases in FACT-E scores than those with partial or no response.
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