Quality of life (QOL) in esophageal cancer patients treated with tri-modality therapy: Is the CROSS protocol better?
Bibliographic record
Abstract
132 Background: To investigate the impact of trimodality therapy on QOL in esophageal cancer patients and compare the CROSS regimen to neoadjuvant cisplatin/5FU. Methods: In a non-randomized, prospective cohort study, patients undergoing neoadjuvant chemoradiation (CRT) and esophagectomy between June 2012 and Nov 2015, with esophageal adenocarcinoma or squamous cell cancer, T1-4N0-3 (AJCC 7thEd.), completed the EORTC-QLQ-C30 at baseline, end of RT, 6 months, and then annually. A 10-point difference in QOL scores was considered clinically significant. Results: Of 35 patients, 13 received cisplatin/5FU concurrent with 45-50 Gy/25fr; 22 received carboplatin/paclitaxel with 41.4 Gy/23fr (CROSS). Median follow up was 16 months (range 2-49). Questionnaire compliance ranged from 75-100%. Median differences (MD) for physical, role, cognitive, social, & global function, and fatigue, nausea/vomiting (N/V), pain, appetite, & constipation were clinically worse at the end of RT. Statistical worsening was found at the end of RT for global (MD -17, p = 0.001), physical (-17, p = 0.001), role (-33, p = 0.001), & social function (-17, p = 0.003), and for fatigue (28, p = 0.001), N/V (17, p = 0.003), pain (17, p = 0.01), dyspnea (0, p = 0.015), sleep disorder (0, p = 0.049) & appetite (33.3, p = 0.001). Clinical worsening persisted on several domains at 6 months. All scores at 1 year improved at least to baseline, except role functioning (-17, p = 1.0) and appetite (33, p = 0.5) which were clinically, but not statistically worse. No significant difference in QOL was found between cisplatin/5FU and CROSS groups at baseline or end of RT. At 6 months median scores were statistically significantly better for pain, fatigue, role, social, and global functioning in the CROSS group. Global QOL at 1 year remained significantly better in the CROSS group. Higher baseline global QOL was associated with improved OS (p = 0.04) and DFS (p = 0.02). Conclusions: QOL worsened across several domains until 6 months post-RT. Most scores returned to baseline or improved at 1 year except for role functioning and appetite. A larger cohort or controlled trial is needed to confirm our findings of a better long term QOL with the CROSS regimen.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".