Upper GI 26

Neo-adjuvant chemoradiation before surgery for oesophageal cancer is designed to downstage loco-regional disease and increase the chance of cure. Because this intensive tri-modality approach may have major toxicity, increase operative risks and impact on quality of life (QoL), this study examined clinical and QoL outcomes during neo-adjuvant treatment for oesophageal cancer. Between November 2000 and December 2001, 26 patients with loco-regional (stage IIb/III) oesophageal cancer commenced treatment with infusional chemotherapy and radiotherapy followed by oesophagectomy. QoL was assessed using the QLQ-C30 and QLQ-OES24 before treatment, and at 7 and 12 weeks during neo-adjuvant treatment, before surgery and 6 weeks after surgery. A total of 19 out of 26 completed tri-modality treatment (two postoperative deaths), seven (27 per cent) did not proceed to oesophagectomy (four deaths, two disease progression, one deteriorating general health). Functional aspects of QoL (physical, social and emotional well being) deteriorated during neo-adjuvant treatment, stabilized before surgery then fell again in the early postoperative phase. Most symptom scores worsened during neo-adjuvant treatment except for difficulties with eating, which improved. Six weeks after surgery, all symptom scores were the same or worse than at diagnosis. Significantly better physical function scores (P = 0.005) and less problems with dysphagia (P = 0.009) were reported by patients who completed three treatment schedules than by patients who did not proceed to surgery. Tri-modality treatment is associated with significant mortality, a quarter of patients do not undergo oesophagectomy and QoL during the neo-adjuvant and surgical stages deteriorates markedly. These major problems must be offset against any potential long-term survival benefits.