Evaluation of quality of life following placement of self-expanding plastic stents as a bridge to surgery in patients receiving neoadjuvant therapy for esophageal cancer

Abstract

Purpose: To determine whether self-expanding plastic stent (SEPS) placement significantly improves quality of life and maintains optimal nutrition while allowing full-dose neoadjuvant therapy (NAT) in patients with esophageal cancer.

Patients and methods: A prospective, dual-institution, single-arm, phase II (http://ClinicalTrials.gov: NCT00727376) evaluation of esophageal cancer patients undergoing NAT prior to resection. All patients had a self-expanding polymer stent placed prior to NAT. The European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25, Functional Assessment of Cancer Therapy-Anorexia, and Functional Assessment of Cancer Therapy-General surveys were administered prior to stenting, within 1 week post-stent placement, and at the completion of neoadjuvant therapy.

Results: Fifty-two patients were enrolled; 3 (5.8%) had stent migrations requiring replacement. There were no instances of esophageal erosion or perforation. All patients received some form of neoadjuvant therapy. Thirty-six (69%) received chemoradiation; 34 (93%) of these patients received the planned dose of chemotherapy, and 27 (75%) received the full planned dose of radiotherapy. There were 16 (31%) patients receiving chemotherapy alone; 12 (74%) of patients in the chemotherapy-alone group completed the planned dose of therapy.

Conclusion: Placement of SEPS appears to provide significant improvement in quality of life related to dysphagia and eating restriction in patients with esophageal cancer undergoing neoadjuvant therapy. Consideration of SEPS instead of percutaneous feeding tube should be initiated as a first line in dysphagia palliation and NAT nutritional support.

Keywords: Esophageal cancer; Esophageal stenting; Neoadjuvant therapy; Quality of life.

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.

EORTC-OG25. Swallowing/dysphagia QOL scores, in which a lower score indicates better overall QOL, showed a significant improvement in QOL at week 1 and consistency in maintaining that improved QOL to week 9. Abbreviations: EORTC, European Organisation for Research and Treatment of Cancer; QOL, quality of life.

Figure 2.

FACT QOL scales from baseline to 9 weeks in all patients undergoing neoadjuvant therapy after esophageal stenting. (A): Physical (higher score is worse QOL). (B): Social (higher score is better QOL). (C): Emotional (higher score is worse QOL). (D): Functional (higher score is better QOL). Abbreviations: FACT, Functional Assessment of Cancer Therapy; QOL, quality of life.

Figure 3.

FACT QOL score (lower score is better) showed an immediate QOL improvement related to swallowing, which was maintained through the neoadjuvant course. Abbreviations: FACT, Functional Assessment of Cancer Therapy; QOL, quality of life.

Figure 4.

Global QOL evaluation. (A): QLQ-C30 scores over 9 weeks of neoadjuvant therapy demonstrating a decrease in overall QOL. (B): Overall health over the past week, demonstrating a decline in QOL over neoadjuvant therapy. Abbreviation: QOL, quality of life.