Quality of life (QOL) in esophageal cancer patients treated with tri-modality therapy: Is the CROSS protocol better?

Abstract

132 Background: To investigate the impact of trimodality therapy on QOL in esophageal cancer patients and compare the CROSS regimen to neoadjuvant cisplatin/5FU. Methods: In a non-randomized, prospective cohort study, patients undergoing neoadjuvant chemoradiation (CRT) and esophagectomy between June 2012 and Nov 2015, with esophageal adenocarcinoma or squamous cell cancer, T1-4N0-3 (AJCC 7thEd.), completed the EORTC-QLQ-C30 at baseline, end of RT, 6 months, and then annually. A 10-point difference in QOL scores was considered clinically significant. Results: Of 35 patients, 13 received cisplatin/5FU concurrent with 45-50 Gy/25fr; 22 received carboplatin/paclitaxel with 41.4 Gy/23fr (CROSS). Median follow up was 16 months (range 2-49). Questionnaire compliance ranged from 75-100%. Median differences (MD) for physical, role, cognitive, social, & global function, and fatigue, nausea/vomiting (N/V), pain, appetite, & constipation were clinically worse at the end of RT. Statistical worsening was found at the end of RT for global (MD -17, p = 0.001), physical (-17, p = 0.001), role (-33, p = 0.001), & social function (-17, p = 0.003), and for fatigue (28, p = 0.001), N/V (17, p = 0.003), pain (17, p = 0.01), dyspnea (0, p = 0.015), sleep disorder (0, p = 0.049) & appetite (33.3, p = 0.001). Clinical worsening persisted on several domains at 6 months. All scores at 1 year improved at least to baseline, except role functioning (-17, p = 1.0) and appetite (33, p = 0.5) which were clinically, but not statistically worse. No significant difference in QOL was found between cisplatin/5FU and CROSS groups at baseline or end of RT. At 6 months median scores were statistically significantly better for pain, fatigue, role, social, and global functioning in the CROSS group. Global QOL at 1 year remained significantly better in the CROSS group. Higher baseline global QOL was associated with improved OS (p = 0.04) and DFS (p = 0.02). Conclusions: QOL worsened across several domains until 6 months post-RT. Most scores returned to baseline or improved at 1 year except for role functioning and appetite. A larger cohort or controlled trial is needed to confirm our findings of a better long term QOL with the CROSS regimen.