Cardiopulmonary fitness before and after neoadjuvant chemotherapy in patients with oesophagogastric cancer

Navidi, M; Phillips, Alexander W; Griffin, S. M.; Duffield, K E; Greystoke, Alastair; Sumpter, Katherine; Sinclair, R. C. F.

doi:10.1002/bjs.10802

Cited by 40 publications

(27 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The average time between CT scans was 85 days and it is alarming to see such a degree of muscle loss during a relatively short time period. The results are also consistent with studies that have shown deconditioning during neoadjuvant therapy using other methods, including CPEX 16 and biometrics. 13 The systemic effects of neoadjuvant therapy coupled with the increased metabolic demands and inflammatory response from cancer and poor nutrition associated with dysphagia 16,24 are the likely culprits of this loss of TPA.…”

Section: Discussionsupporting

confidence: 90%

“…The results are also consistent with studies that have shown deconditioning during neoadjuvant therapy using other methods, including CPEX 16 and biometrics. 13 The systemic effects of neoadjuvant therapy coupled with the increased metabolic demands and inflammatory response from cancer and poor nutrition associated with dysphagia 16,24 are the likely culprits of this loss of TPA. The observed deconditioning during neoadjuvant treatment could be addressed with further studies aimed at prehabilitation and optimizing nutrition.…”

Section: Discussionsupporting

confidence: 90%

“…These results are similar to the findings by Reisinger et al 1 who used specialized software to measure the change of all muscle groups combined at the L4 vertebral level. 13 The systemic effects of neoadjuvant therapy coupled with the increased metabolic demands and inflammatory response from cancer and poor nutrition associated with dysphagia 16,24 are the likely culprits of this loss of TPA. The average time between CT scans was 85 days and it is alarming to see such a degree of muscle loss during a relatively short time period.…”

Section: Discussionmentioning

confidence: 99%

“…12 The combination of neoadjuvant treatment and cachexia associated with oesophageal cancer can lead to deconditioning and loss of muscle mass prior to surgery. 1,[13][14][15][16] Reisinger et al 1 showed that a greater loss of muscle mass during neoadjuvant treatment (measured using specialized software on computed tomography (CT) scans by combining all the muscle groups seen at the fourth lumbar level) was associated with an increased mortality in stage 3 and 4 oesophageal cancer patients. 1 Despite the ease of measuring TPA on most radiological software systems, the change in TPA during neoadjuvant therapy has not been used to predict post-operative outcomes in oesophagectomy patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Decreased total psoas muscle area after neoadjuvant therapy is a predictor of increased mortality in patients undergoing oesophageal cancer resection

Yassaie

Keane

French

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background: Oesophagectomy for locally advanced cancer carries high rates of morbidity and mortality. Patients require a thorough risk assessment alongside preoperative counselling. Total psoas area (TPA) measurements have been used as a surrogate marker of sarcopenia to predict post-operative complications in oesophageal cancer patients. No studies to date have determined whether there is an association between the proportion of TPA lost during neoadjuvant therapy and post-operative outcomes. Methods: Clinical data and imaging of patients who underwent neoadjuvant therapy followed by open two-stage oesophagectomy between January 2008 and April 2018 were analysed retrospectively. Patients who did not undergo restaging computed tomography scan prior to surgery were excluded from the study. The TPA was measured on two crosssectional slices at L4 on computed tomography scans pre-and post-neoadjuvant therapy. Results: A total of 53 patients who met inclusion criteria were identified. The mean loss of TPA was 7.3%. Patients who had a decrease of TPA of more than 4% had significantly increased 30-day mortality compared to those who lost 4% or less (24% versus 0%, P = 0.02). Patients aged over 65 years who also had a loss of TPA >4% had significantly increased 30-day mortality (37% versus 2.9%, odds ratio 19, P = 0.008). Conclusion: A decrease in TPA of >4% is associated with a significantly higher risk of post-operative mortality in patients undergoing neoadjuvant therapy followed by oesophagectomy. Measuring the loss of TPA during neoadjuvant treatment could be a novel aid to preoperative risk assessment.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Decreased total psoas muscle area after neoadjuvant therapy is a predictor of increased mortality in patients undergoing oesophageal cancer resection

Yassaie

Keane

French

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…However, the ability to predetermine the impact of neoadjuvant therapy on disease stage based on specific biological factors of a tumor may further individualize oncological therapy. This may spare a subgroup of patients the adverse physiological impact of neoadjuvant oncological therapy, 41 in whom, as identified by this paper, neoadjuvant therapy leads to static or worsening stage with no apparent improvement in survival.…”

Section: Discussionmentioning

confidence: 90%

Significance of Neoadjuvant Downstaging in Carcinoma of Esophagus and Gastroesophageal Junction

et al. 2020

View full text Add to dashboard Cite

Objective. To determine the impact of downstaging on outcomes in esophageal cancer, the prognostic value of clinical and pathological stage, and the difference in survival in patients with similar pathological stages with and without neoadjuvant treatment. Background. There is little data evaluating adenocarcinoma and squamous cell carcinoma (SCC) and difference in outcomes for similar pathological stage with and without neoadjuvant treatment. Patients and Methods. Consecutive patients with esophageal cancer from a single center were evaluated. Patients with esophageal adenocarcinoma or SCC treated with transthoracic esophagectomy and two-field lymphadenectomy were included. Comparison of outcomes with those primarily treated with surgery was made. The cTNM and ypTNM 8th edition was used. Results. This study included 992 patients, of whom 417 received surgery alone and 575 received neoadjuvant therapy and surgery. In the neoadjuvant group, 7 (1%) had cTNM stage 2 and 418 (73%) had cTNM stage 3. Downstaging rates were similar between adenocarcinoma and SCC (54% vs. 61%, p = 0.5). Downstaging was associated with longer survival than patients with no change (adenocarcinoma, median: 82 vs. 26 months, p \ 0.001; SCC, median: NR vs. 29 months, p \ 0.001). On Cox regression analysis, downstaging was associated with significantly longer survival in adenocarcinoma but not in SCC. For SCC and more advanced adenocarcinoma, overall survival was significantly better when comparing like-for-like ypTN to pTN groups. Conclusions. Pathological stage provides a better estimate of prognosis compared with clinical stage. Downstaged patients may have an improved outcome over those with comparable pathological stage who did not receive neoadjuvant treatment.

show abstract

Effects of high-intensity exercise training on physical fitness, quality of life and treatment outcomes after oesophagectomy for cancer of the gastro-oesophageal junction: PRESET pilot study

et al. 2020

View full text Add to dashboard Cite

Background: Treatment for cancer of the gastro-oesophageal junction (GOJ) can result in considerable and persistent impairment of physical fitness and health-related quality of life (HRQoL). This controlled follow-up study investigated the feasibility and safety of postoperative exercise training. Methods: Patients with stage I-III GOJ cancer were allocated to 12 weeks of postoperative concurrent aerobic and resistance training (exercise group) or usual care (control group). Changes in cardiorespiratory fitness, muscle strength and HRQoL were evaluated. Adherence to adjuvant chemotherapy, hospitalizations and 1-year overall survival were recorded to assess safety. Results: Some 49 patients were studied. The exercise group attended a mean of 69 per cent of all prescribed sessions. After exercise, muscle strength and cardiorespiratory fitness were increased and returned to pretreatment levels. At 1-year follow-up, the exercise group had improved HRQoL (+13⋅5 points, 95 per cent c.i. 2⋅2 to 24⋅9), with no change in the control group (+3⋅7 points, −5⋅9 to 13⋅4), but there was no difference between the groups at this time point (+9⋅8 points, −5⋅1 to 24⋅8). Exercise was safe, with no differences in patients receiving adjuvant chemotherapy (14 of 16 versus 16 of 19; relative risk (RR) 1⋅04, 95 per cent c.i. 0⋅74 to 1⋅44), relative dose intensity of adjuvant chemotherapy (mean 57 versus 63 per cent; P = 0⋅479), hospitalization (7 of 19 versus 6 of 23; RR 1⋅41, 0⋅57 to 3⋅49) or 1-year overall survival (80 versus 79 per cent; P = 0⋅839) for exercise and usual care respectively. Conclusion: Exercise in the postoperative period is safe and may have the potential to improve physical fitness in patients with GOJ cancer. No differences in prognostic endpoints or HRQoL were observed. Registration number: NCT02722785 (https://www.clinicaltrials.gov).

show abstract

Cardiopulmonary fitness before and after neoadjuvant chemotherapy in patients with oesophagogastric cancer

Abstract: There was a decrease in cardiorespiratory reserve immediately after neoadjuvant chemotherapy that was sustained up to the point of surgery at 4 weeks after chemotherapy.

Cited by 40 publications

References 29 publications

Decreased total psoas muscle area after neoadjuvant therapy is a predictor of increased mortality in patients undergoing oesophageal cancer resection

Decreased total psoas muscle area after neoadjuvant therapy is a predictor of increased mortality in patients undergoing oesophageal cancer resection

Significance of Neoadjuvant Downstaging in Carcinoma of Esophagus and Gastroesophageal Junction

Effects of high-intensity exercise training on physical fitness, quality of life and treatment outcomes after oesophagectomy for cancer of the gastro-oesophageal junction: PRESET pilot study

Contact Info

Product

Resources

About