title: Relief of dysphagia during neoadjuvant treatment for cancer of the esophagus or gastroesophageal junction.
abstract: Dysphagia is the main symptom of cancer of the esophagus and gastroesophageal junction and causing nutritional problems and weight loss, often counteracted by insertion of self-expandable metal stents or nutrition via an enteral route. Clinical observations indicate that neoadjuvant therapy may effectively and promptly alleviate dysphagia, making such nutrition supportive interventions redundant before surgical resection. The objective of the current study was to carefully study the effects of induction neoadjuvant therapy on dysphagia and its subsequent course and thereby investigate the actual need for alimentary gateways for nutritional support. Thirty-five consecutive patients scheduled for neoadjuvant therapy were recruited and assessed regarding dysphagia and appetite at baseline, after the first cycle of preoperative treatment with either chemotherapy alone or with chemoradiotherapy and before surgery. Platinum-based therapy in combination with 5-fluorouracil was administered intravenously days 1-5 every 3 weeks and consisted of three treatments. Patients receiving combined chemoradiotherapy started radiotherapy on day one of second chemotherapy cycle. They received fractions of 2 Gy/day each up to a total dose of 40 Gy. Watson and Ogilvie dysphagia scores were used to assess dysphagia, while appetite was assessed by the Edmonton Assessment System Visual analogue scale-appetite questionnaire. Patients were evaluated at regular outpatient clinic visits or by telephone. The histological tumor response in the surgical specimen was assessed using the Chirieac scale. Ten patients scheduled for neoadjuvant chemotherapy and 25 patients scheduled for chemoradiotherapy were included in the analysis. There was a significant improvement in dysphagia in both treatment groups, according to both scales, already from baseline to the completion of the first chemotherapy cycle which remained to the end of the neoadjuvant treatment (P < 0.001). Appetite also improved after the first chemotherapy cycle (P = 0.03). Body weight did not change during any type of neoadjuvant therapy. We were unable to demonstrate any association between relief of dysphagia and the degree of histological response to neoadjuvant therapy in the surgical specimen. The present study shows that a platin - 5FU-based neoadjuvant chemotherapy, with or without concomitant radiotherapy, effectively and promptly relieves dysphagia in patients presenting with cancers of the esophagus or gastroesophageal junction already after the first cycle.
authors: Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors: B
authors: B
authors: Sunde
authors: Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden.
authors: J
authors: J
authors: Ericson
authors: Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors: K
authors: K
authors: Kumagai
authors: Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors: L
authors: L
authors: Lundell
authors: Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors: J A
authors: JA
authors: Tsai
authors: Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors: M
authors: M
authors: Lindblad
authors: Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors: I
authors: I
authors: Rouvelas
authors: Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.|Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors: S
authors: S
authors: Friesland
authors: Department of Pathology, Karolinska University Hospital, Stockholm, Sweden.
authors: N
authors: N
authors: Wang
authors: Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors: M
authors: M
authors: Nilsson
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D003680:Deglutition Disorders / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil
keywords: Watson scale; appetite scoring; dysphagia; esophageal cancer; neoadjuvant therapy