title: Is a change in patient-reported dysphagia after induction chemotherapy in locally advanced esophageal cancer a predictive factor for pathological response to neoadjuvant chemoradiation?
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Effingerstr. 40, 3008 Bern, Switzerland. karin.ribi@sakk.ch
authors.forename: Karin
authors.initials: K
authors.lastname: Ribi
authors.forename: Dieter
authors.initials: D
authors.lastname: Koeberle
authors.forename: Jan C
authors.initials: JC
authors.lastname: Schuller
authors.forename: Hanspeter
authors.initials: H
authors.lastname: Honegger
authors.forename: Arnaud
authors.initials: A
authors.lastname: Roth
authors.forename: Viviane
authors.initials: V
authors.lastname: Hess
authors.forename: Peter
authors.initials: P
authors.lastname: Moosmann
authors.forename: Roger
authors.initials: R
authors.lastname: von Moos
authors.forename: Markus
authors.initials: M
authors.lastname: Borner
authors.forename: Norbert
authors.initials: N
authors.lastname: Lombriser
authors.forename: Bernhard
authors.initials: B
authors.lastname: Pestalozzi
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruhstaller
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology* / Q000473:pathology; D004435:Eating; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D018307:Neoplasms, Squamous Cell / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome