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

BackgroundNeoadjuvant 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.MethodsWe 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 (V˙O2 in ml kg−1 min−1) at the estimated lactate threshold (θˆL) and at peak exercise (V˙O2 peak in ml kg−1 min−1).ResultsV˙O2 at θˆL and at peak were significantly lower after NAC compared to pre-NAC values: V˙O2 at θˆL 14.5 ± 3.8 (baseline) vs. 12.3 ± 3.0 (post-NAC) ml kg−1 min−1; p   ≤ 0.001; V˙O2 peak 20.8 ± 6.0 vs. 18.3 ± 5.1 ml kg−1 min−1; p   ≤ 0.001; absolute V˙O2 (ml min−1) at θˆL and peak were also lower post-NAC; p   ≤ 0.001. Decreased baseline V˙O2 at θˆL and peak were associated with increased one year mortality in patients who completed a full course of NAC and had surgery; p = 0.014.ConclusionNAC 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.