An analysis in the Dutch Chemoradiotherapy for Esophageal Cancer Followed by Surgery Study (CROSS) reported by Noordman et al in the Journal of Clinical Oncology showed no adverse effect of neoadjuvant chemoradiotherapy vs surgery alone on postsurgery health-related quality of life in patients with esophageal or esophagogastric junction cancer.
The CROSS study showed significant improvement in overall survival with neoadjuvant chemoradiotherapy (carboplatin plus paclitaxel with concurrent 41.4-Gy radiotherapy) vs surgery alone. In the current analysis, health-related quality of life was assessed by the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire–Core 30 (QLQ-C30) and –Oesophageal Cancer Module (QLQ-OES24) questionnaires prior to treatment and at 3, 6, 9, and 12 months after surgery; the neoadjuvant therapy group also received preoperative questionnaires. QLQ-C30 physical functioning and QLQ-OES24 eating problems were predefined primary endpoints. Secondary endpoints were QLQ-C30 global quality of life and fatigue and QLQ-OES24 emotional problems.
Changes in Health-Related Quality of Life
Among 363 patients included in the analysis, no statistically significant differences between groups were observed in any measures in the postoperative period. In the neoadjuvant therapy group, significant declines in physical functioning, eating problems, global quality of life, fatigue, and emotional problems were observed 1 week after neoadjuvant therapy (all P ≤ .001). All endpoints significantly worsened at 3 months vs baseline in both groups (all P < .001), with continuous gradual improvement thereafter. Whereas eating problems, global quality of life, and emotional problems returned to baseline values by the end of follow-up, significant impairment in physical functioning and fatigue persisted at 1 year after surgery in both groups (both P < .001).
The investigators concluded: “Although [health-related quality of life] declined during [neoadjuvant chemoradiotherapy], no effect of [neoadjuvant chemoradiotherapy] was apparent on postoperative [health-related quality of life] compared with surgery alone. In addition to the improvement in survival, these findings support the view that [neoadjuvant chemoradiotherapy] according to the Chemoradiotherapy for Esophageal Cancer Followed by Surgery Study regimen can be regarded as a standard of care.”
The study was supported by the Dutch Cancer Foundation.
Bo Jan Noordman, MD, of the Department of Surgery, Erasmus MC–University Medical Center, is the corresponding author of the Journal of Clinical Oncology article.
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