Active surveillance of oesophageal cancer after response to neoadjuvant chemoradiotherapy: dysphagia is uncommon

Valkema, M.J.; Spaander, M.C.W.; Boonstra, J.J.; Dieren, J.M. van; Hazen, W.L.; Erkelens, G.W.; ... ; Lanschot, J.J.B. van (2023)

Article / Letter to editor

Background Active surveillance is being investigated as an alternative to standard surgery after neoadjuvant chemoradiotherapy for oesophageal cancer. It is unknown whether dysphagia persists or develops when the oesophagus is preserved after neoadjuvant chemoradiotherapy. The aim of this study was to assess the prevalence and severity of dysphagia during active surveillance in patients with an ongoing response. Methods Patients who underwent active surveillance were identified from the Surgery As Needed for Oesophageal cancer ('SANO') trial. Patients without evidence of residual oesophageal cancer until at least 6 months after neoadjuvant chemoradiotherapy were included. Study endpoints were assessed at time points that patients were cancer-free and remained cancer-free for the next 4 months. Dysphagia scores were evaluated at 6, 9, 12, and 16 months after neoadjuvant chemoradiotherapy. Scores were based on the European Organisation for Research and Treatment of Cancer oesophago-gastric quality-of-life questionnaire 25 (EORTC QLQ-OG25) (range 0-100; no to severe dysphagia). The rate of patients with a (non-)traversable stenosis was determined based on all available endoscopy reports. Results In total, 131 patients were included, of whom 93 (71.0 per cent) had adenocarcinoma, 93 (71.0 per cent) had a cT3-4a tumour, and 33 (25.2 per cent) had a tumour circumference of greater than 75 per cent at endoscopy; 60.8 to 71.0 per cent of patients completed questionnaires per time point after neoadjuvant chemoradiotherapy. At all time points after neoadjuvant chemoradiotherapy, median dysphagia scores were 0 (interquartile range 0-0). Two patients (1.5 per cent) underwent an intervention for a stenosis: one underwent successful endoscopic dilatation; and the other patient required temporary tube feeding. Notably, these patients did not participate in questionnaires. Conclusion Dysphagia and clinically relevant stenosis are uncommon during active surveillance.Dysphagia appears uncommon in patients with a clinically complete response until 16 months after neoadjuvant chemoradiotherapy according to the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study ('CROSS') regimen. In patients who might choose between standard surgery and active surveillance, the occurrence of persisting dysphagia during active surveillance is not an issue that needs to be taken into account.

• All authors: Valkema, M.J.; Spaander, M.C.W.; Boonstra, J.J.; Dieren, J.M. van; Hazen, W.L.; Erkelens, G.W.; Holster, I.L.; Linden, A. van der; Linde, K. van der; Oostenbrug, L.E.; Quispel, R.; Schoon, E.J.; Siersema, P.D.; Doukas, M.; Eyck, B.; Wilk, B.J. van der; Sluis, P.C. van der; Wijnhoven, B.P.L.; Lagarde, S.M.; Lanschot, J.J.B. van
• Date: 2023-07-07
• Journal: British Journal of Surgery
• Pages: 1381 - 1386
• DOI: doi:10.1093/bjs/znad211