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Is a change in patient-reported dysphagia after induction chemotherapy in locally advanced esophageal cancer a predictive factor for pathological response to neoadjuvant chemoradiation?

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Abstract

Goals of work

In patients with locally advanced esophageal cancer, only those responding to the treatment ultimately benefit from preoperative chemoradiation. We investigated whether changes in subjective dysphagia or eating restrictions after two cycles of induction chemotherapy can predict histopathological tumor response observed after chemoradiation. In addition, we examined general long-term quality of life (QoL) and, in particular, eating restrictions after esophagectomy.

Materials and methods

Patients with resectable, locally advanced squamous cell- or adenocarcinoma of the esophagus were treated with two cycles of chemotherapy followed by chemoradiation and surgery. They were asked to complete the EORTC oesophageal-specific QoL module (EORTC QLQ-OES24), and linear analogue self-assessment QoL indicators, before and during neoadjuvant therapy and quarterly until 1 year postoperatively. A median change of at least eight points was considered as clinically meaningful.

Main results

Clinically meaningful improvements in the median scores for dysphagia and eating restrictions were found during induction chemotherapy. These improvements were not associated with a histopathological response observed after chemoradiation, but enhanced treatment compliance. Postoperatively, dysphagia scores remained low at 1 year, while eating restrictions persisted more frequently in patients with extended transthoracic resection compared to those with limited transhiatal resection.

Conclusions

The improvement of dysphagia and eating restrictions after induction chemotherapy did not predict tumor response observed after chemoradiation. One year after esophagectomy, dysphagia was a minor problem, and global QoL was rather good. Eating restrictions persisted depending on the surgical technique used.

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Acknowledgements

We would like to thank Sandra Thierstein, trial coordinator of the SAKK Berne, for her tremendous administrative support for this trial, Pierluigi Ballabeni and Christian von Briel for assistance in designing this trial, Yvonne Wechsler for the development of the QoL substudy, and Jürg Bernhard and Daniela Gerber of the SAKK and Beat Thürlimann, St. Gallen, Switzerland, for editing the manuscript.

The Swiss Group for Clinical Cancer Research (SAKK) was the sponsor of the trial, and it was financially supported by the State Secretariat for Education and Research (SER) of Switzerland and Sanofi-Aventis Switzerland.

Conflict of interest

None of the authors has to declare any potential conflicts of interests.

Author information

Authors and Affiliations

  1. Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Effingerstr. 40, 3008, Bern, Switzerland

    Karin Ribi & Jan C. Schuller

  2. Kantonspital St. Gallen, Rorschacherstr. 95, 9006, St. Gallen, Switzerland

    Dieter Koeberle & Thomas Ruhstaller

  3. Stadtspital Triemli, Birmensdorferstr. 497, 8063, Zürich, Switzerland

    Hanspeter Honegger & Norbert Lombriser

  4. Hôpitaux Universitaires de Genève, 24 rue Micheli-du-Crest, 1211, Genève 14, Switzerland

    Arnaud Roth

  5. Universitätsspital Basel, Hebelstrasse 32, 4031, Basel, Switzerland

    Viviane Hess

  6. Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland

    Peter Moosmann

  7. Kantonsspital Chur, Loesstr. 170, 7000, Chur, Switzerland

    Roger von Moos

  8. Universitätsspital Bern/Inselspital, 3010, Bern, Switzerland

    Markus Borner

  9. Universitätsspital Zürich, Rämistr. 100, CH-8091, Zurich, Switzerland

    Bernhard Pestalozzi

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  1. Karin Ribi
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  2. Dieter Koeberle
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  12. Thomas Ruhstaller
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Correspondence to Karin Ribi.

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Ribi, K., Koeberle, D., Schuller, J.C. et al. Is a change in patient-reported dysphagia after induction chemotherapy in locally advanced esophageal cancer a predictive factor for pathological response to neoadjuvant chemoradiation?. Support Care Cancer 17, 1109–1116 (2009). https://doi.org/10.1007/s00520-008-0570-6

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  • DOI: https://doi.org/10.1007/s00520-008-0570-6

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