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J Thorac Cardiovasc Surg 2009;137:41-42
© 2009 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Kenneth A. Kesler (Indianapolis, Ind). For many years, we have measured indicators, such as operative mortality, levels of morbidity, and cure rates, to determine the success of treatment for locally advanced esophageal cancer, and we have made reasonable progress with respect to all of these particular variables over time. The operative risks for these operations have become acceptable. Induction therapy with cisplatin-based chemotherapy and concurrent radiation therapy has, for the most part, become accepted as the treatment of choice for patients with adequate performance status. As the authors of this study point out, however, overall survival improvements with induction therapy have been unfortunately modest, and meaningful survival benefits are probably limited to the subset of patients who demonstrate a significant or complete pathologic response. Until we have some mechanism to identify the subset of patients who will significantly benefit from platin-based induction therapy or, better yet, we have more effective chemotherapy agents, many patients with locally advanced esophageal cancer will not only not derive survival benefit from induction therapy but, as this prospective study demonstrates, will experience morbidity, including a temporary loss of QOL, which is significant in patients with limited median survival.

We therefore acknowledge the efforts of Dr Darling and her colleagues in Toronto, who have taken the next step to measure HRQOL as an important outcome variable. This study will not only serve as a point of reference with respect to QOL outcomes for this particular induction treatment strategy but hopefully as a starting point at which QOL instruments are routinely included in future prospective clinical trials for locally advanced esophageal cancer.

I have 3 questions. In this study you used the FACT-E questionnaire to quantitate HRQOL, which is an instrument you have validated in a previous study. Do . . . [Full Text of this Article]