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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). BJS 2019; 106: 1452-1463.

Published: 22nd August 2019

Authors: B. Sunde, F. Klevebro, A. Johar, G. Johnsen, A.‐B. Jacobsen, N. I. Glenjen et al.

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.

Method

In the NeoRes trial, patients were assigned randomly in a 1 : 1 ratio to receive either cisplatin 100 mg/m2 on day 1 and an infusion of 750 mg per m2 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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