title: Health-related quality of life in esophageal cancer: effect of neoadjuvant chemoradiotherapy followed by surgical intervention.
abstract: OBJECTIVE
  We sought to determine the effect of neoadjuvant chemoradiotherapy followed by surgical intervention on health-related quality of life in patients with esophageal cancer.
  
  
  METHODS
  Health-related quality of life was evaluated in a prospective phase II study of neoadjuvant chemoradiotherapy followed by esophagectomy in 52 patients with carcinoma of the esophagus. Esophagectomy was performed 6 weeks after completion of induction. Functional Assessment of Cancer Therapy-Esophageal scoring was performed before treatment, 7 weeks after initiation of neoadjuvant therapy, before resection, and at 1, 3, and 6 months and 1 year after resection.
  
  
  RESULTS
  Forty-three patients completed the entire treatment protocol. Functional Assessment of Cancer Therapy-Esophageal scores decreased significantly after chemoradiation at week 7 (120 vs 127 at baseline, P = .04) but returned to baseline levels before surgical intervention (127). Similarly, scores decreased significantly after surgical intervention (115 at 1 month, P = .02) but returned to baseline levels by 3 months postoperatively (127). At 1 year postoperatively, there was a statistically significant improvement in scores compared with those at baseline (139, P = .003). Functional Assessment of Cancer Therapy-Esophageal scores continued to increase over time for patients who were alive at least 1 year after the operation with or without disease but were observed to significantly decrease in those who died within 1 year after the operation (P = .0001). An increase in quality of life was associated with a significantly lower risk of death (P = .04).
  
  
  CONCLUSIONS
  Neoadjuvant therapy has a significant effect on health-related quality of life, but this is transient, with recovery to baseline within 5 to 7 weeks after completion of induction therapy. Health-related quality of life decreases again after surgical intervention but returns to baseline levels within 3 months.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Najib
authors.initials: N
authors.lastname: Safieddine
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Sayed Mohammed
authors.initials: SM
authors.lastname: Quadri
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hornby
authors.forename: Joanne
authors.initials: J
authors.lastname: Sulman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wong
authors.forename: Maha
authors.initials: M
authors.lastname: Guindi
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Gail
authors.initials: G
authors.lastname: Darling
mesh_terms: D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D011788:Quality of Life