SynthesisQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation2026
Assessing the impact of neoadjuvant chemotherapy and chemoradiotherapy on quality of life during treatment in esophageal cancer: a systematic review and meta-analysis.
Synthesis in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to assess how neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) affect the quality of life (QoL) of patients with locally advanced esophageal cancer at various time points before and after surgery. Rather than a direct head-to-head comparison, this study sought to characterize and contrast within-group QoL change patterns associated with each treatment strategy.
methodsWe conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. Four databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched for studies reporting perioperative QoL outcomes in patients receiving nCT or nCRT. QoL data were extracted from validated instruments, including the EORTC QLQ-C30, QLQ-OES18, FACT-E, and Spitzer Index. A random-effects model was used to calculate pooled mean differences (MDs) with 95% confidence intervals (CIs). Sensitivity analyses were conducted for outcomes with high heterogeneity (I2 > 50%).
resultsFifteen studies met the inclusion criteria: 8 involving nCT and 12 involving nCRT. nCT was associated with improvements in symptom domains such as pain and appetite loss, with minimal impact on global functioning. In contrast, nCRT led to significant QoL deterioration before surgery and at 3 months postoperatively, with increases in fatigue, dyspnea, and diarrhea. Most QoL measures returned to baseline within 12 months postoperatively, although some domains showed persistent impairments.
conclusionDistinct perioperative QoL trajectories were observed following nCT and nCRT. nCT was generally associated with reduced preoperative symptom burden and limited functional decline, whereas nCRT was associated with transient but clinically relevant short-term QoL deterioration, followed by partial recovery within one year. These findings describe treatment-specific QoL patterns rather than direct comparative effects, underscoring the importance of routine QoL monitoring to support individualized perioperative care.
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