Quality of life changes in esophageal cancer patients treated with preoperative or Radical ChemoRT
Pramod Kumar Gupta,
India
PO-1350
Abstract
Quality of life changes in esophageal cancer patients treated with preoperative or Radical ChemoRT
Authors: Pramod Kumar Gupta1, Shaleen Kumar2, Shalini Singh2, Shagun Misra2, Rajneesh Kumar Singh3, Alok Nath4, Neeraj Kumari5, K J M Das2, Punita Lal2
1Kalyan Singh Super Speciality Cancer Institute. Previously worked in Sanjay Gandhi Post Graduate Institute of Medical Sciences, Radiation Oncology, Lucknow, India; 2Sanjay Gandhi Post Graduate Institute of Medical Sciences, Radiotherapy, Lucknow, India; 3Sanjay Gandhi Post Graduate Institute of Medical Sciences, Surgical Gastroenterology, Lucknow, India; 4Sanjay Gandhi Post Graduate Institute of Medical Sciences, Pulmonary Medicine, Lucknow, India; 5Sanjay Gandhi Post Graduate Institute of Medical Sciences, Pathology, Lucknow, India
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Purpose or Objective
Preoperative chemoradiotherapy (CRT) followed by surgery or radical CRT is a standard of care in for stage II-III oesophageal cancers. Limited data is available on disease specific quality of life (QOL) changes in patients of esophageal cancer undergoing either preoperative CRT and surgery or radical CRT. We did a prospective observational analytical study to evaluate QOL score changes in patients treated with either preoperative CRT and surgery or radical CRT.
Material and Methods
A prospective observational analytical study was done between May 2015- March 2017. Adult patients with non metastatic stage II-III squamous cell esophageal carcinoma were included. Patients were given 2 cycles of neoadjuvant chemotherapy with Cisplatin and Capecitabine q3-weekly followed by either preoperative CRT(45 Gy) and surgery or radical CRT(50.4-66 Gy) treated with 3D-CRT/Intensity Modulated RT technique. Patients were asked to fill the disease specific European Organization for Research and Treatment of Cancer, EORTC QLQ-OES18 questionnaire at pre CRT, at completion and at 3 months respectively. A linear regression scale was applied to the mean values to transform scores into a scale ranging from 0 to 100. Mean scores with standard deviations(SD) were calculated. Wilcoxon Rank sum test and Freidman test was used to determine any significant difference.
Results
39 consecutive patients were enrolled for the study. 22(56%) patients received preoperative CRT(Median dose-45Gy) while 17(44%) had Radical CRT(median dose-60 Gy). Overall for both the groups, QLQ-OES18 symptom score showed that Dysphagia scale scores (Mean + SD) improved Post RT 3 months as compared to Pre RT 57.56+27.55 & 46.49+22.54 (p=0.039). Dry mouth scale scores also showed improvement at both RT completion and Post RT 3 months 15.33+22.75, 21.33 +28.13 &22.97+25.54 (p=0.035). For other scales no significant changes were observed. Scores for eating difficulties 28.82+23.23 & 32.26+27.43 (p=0.54), reflux 21.4+24.42 & 17.97+24.29 (p=0.46) and esophageal pain 17.82+19.96 & 15.39+19.38(p=0.31), trouble with coughing17.92+29.49& 17.15+27.43 (p=0.98), trouble with taste 18.77+31.35 & 18.74+28.40(p=0.88), choking when swallowing 14.5+23.98 & 10.21+24.31(p=0.23), speech difficulties 10.2+18.93 & 14.5+28.42 (p=0.29) and trouble swallowing saliva 20.46+34.71& 14.51+26.29 (p=0.78) for Pre RT and Post RT 3 months respectively. No significant difference in scores was found in any other QLQ-OES18 scales i.e. i.e. eating difficulties, esophageal pain, reflux, trouble with coughing, taste, swallowing saliva and speech difficulties in between preoperative and radical CRT groups.
Conclusion
Dysphagia and Dry mouth scales of EORTC QLQ-OES18 showed significant positive mean difference in both preoperative and radical CRT groups reflecting success of the treatment. However no significant differences were observed in other scales i.e. eating difficulties, esophageal pain, reflux, taste and speech difficulties in both preoperative and radical CRT groups.