The quality of life in neoadjuvant versus adjuvant therapy of esophageal cancer treatment trial (QUINTETT): Randomized parallel clinical superiority trial.

Autor: Malthaner RA; Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Yu E; Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Sanatani M; Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Lewis D; Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Warner A; Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Dar AR; Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Yaremko BP; Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Bierer J; Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Palma DA; Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Fortin D; Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Inculet RI; Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Fréchette E; Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Raphael J; Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Gaede S; Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Kuruvilla S; Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Younus J; Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Vincent MD; Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Rodrigues GB; Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Jazyk: angličtina
Zdroj: Thoracic cancer [Thorac Cancer] 2022 Jul; Vol. 13 (13), pp. 1898-1915. Date of Electronic Publication: 2022 May 24.
DOI: 10.1111/1759-7714.14433
Abstrakt: Background: We compared the health-related quality of life (HRQOL) in patients undergoing trimodality therapy for resectable stage I-III esophageal cancer.
Methods: A total of 96 patients were randomized to standard neoadjuvant cisplatin and 5-fluorouracil chemotherapy plus radiotherapy (neoadjuvant) followed by surgical resection or adjuvant cisplatin, 5-fluorouracil, and epirubicin chemotherapy with concurrent extended volume radiotherapy (adjuvant) following surgical resection.
Results: There was no significant difference in the functional assessment of cancer therapy-esophageal (FACT-E) total scores between arms at 1 year (p = 0.759) with 36% versus 41% (neoadjuvant vs. adjuvant), respectively, showing an increase of ≥15 points compared to pre-treatment (p = 0.638). The HRQOL was significantly inferior at 2 months in the neoadjuvant arm for FACT-E, European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-OG25), and EuroQol 5-D-3 L in the dysphagia, reflux, pain, taste, and coughing domains (p < 0.05). Half of patients were able to complete the prescribed neoadjuvant arm chemotherapy without modification compared to only 14% in the adjuvant arm (p < 0.001). Chemotherapy related adverse events of grade ≥2 occurred significantly more frequently in the neoadjuvant arm (100% vs. 69%, p < 0.001). Surgery related adverse events of grade ≥2 were similar in both arms (72% vs. 86%, p = 0.107). There were no 30-day mortalities and 2% vs. 10% 90-day mortalities (p = 0.204). There were no significant differences in either overall survival (OS) (5-year: 35% vs. 32%, p = 0.409) or disease-free survival (DFS) (5-year: 31% vs. 30%, p = 0.710).
Conclusion: Trimodality therapy is challenging for patients with resectable esophageal cancer regardless of whether it is given before or after surgery. Newer and less toxic protocols are needed.
(© 2022 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)
Databáze: MEDLINE
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