The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery

Jackson, Sarah E., West, M.A., Raw, D., Marwood, S., Ambler, G., Cope, T.M., Shrotri, M., Sturgess, R.P., Calverley, P.M.A., Ottensmeier, C.H. and Grocott, M.P.W. (2014) The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery European Journal of Surgical Oncology, 40, (10), pp. 1313-1320. (doi:10.1016/j.ejso.2014.03.010). (PMID:24731268).


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BACKGROUND: Neoadjuvant chemotherapy (NAC) followed by surgery for resectable oesophageal or gastric cancer improves outcome when compared with surgery alone. However NAC has adverse effects. We assess here whether NAC adversely affects physical fitness and whether such an effect is associated with impaired survival following surgery.

METHODS: We prospectively studied 116 patients with oesophageal or gastric cancer to assess the effect of NAC on physical fitness, of whom 89 underwent cardiopulmonary exercise testing (CPET) before NAC and proceeded to surgery. 39 patients were tested after all cycles of NAC but prior to surgery. Physical fitness was assessed by measuring oxygen uptake (VO? in ml kg(-1) min(-1)) at the estimated lactate threshold (?L) and at peak exercise (VO? peak in ml kg(-1) min(-1)).

RESULTS: VO? at ?L and at peak were significantly lower after NAC compared to pre-NAC values: VO? at ?L 14.5 ± 3.8 (baseline) vs. 12.3 ± 3.0 (post-NAC) ml kg(-1) min(-1); p ? 0.001; VO? peak 20.8 ± 6.0 vs. 18.3 ± 5.1 ml kg(-1) min(-1); p ? 0.001; absolute VO? (ml min(-1)) at ?L and peak were also lower post-NAC; p ? 0.001. Decreased baseline VO? at ?L and peak were associated with increased one year mortality in patients who completed a full course of NAC and had surgery; p = 0.014.

CONCLUSION: NAC before cancer surgery significantly reduced physical fitness in the overall cohort. Lower baseline fitness was associated with reduced one-year-survival in patients completing NAC and surgery, but not in patients who did not complete NAC. It is possible that in some patients the harms of NAC may outweigh the benefits.

Trials Registry Number: NCT01335555.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1016/j.ejso.2014.03.010
ISSNs: 0748-7983 (print)
Keywords: neoadjuvant chemotherapy, cardiopulmonary exercise testing, cancer surgery, survival, oesphagogastric, physical fitness
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RD Surgery
R Medicine > RM Therapeutics. Pharmacology
Organisations: Clinical & Experimental Sciences
ePrint ID: 372838
Date :
Date Event
27 March 2014e-pub ahead of print
October 2014Published
Date Deposited: 23 Dec 2014 11:29
Last Modified: 17 Apr 2017 06:54
Further Information:Google Scholar

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