The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients

Eur J Surg Oncol. 2014 Nov;40(11):1421-8. doi: 10.1016/j.ejso.2014.03.021. Epub 2014 Apr 12.

Abstract

Background: Neoadjuvant chemoradiotherapy (NACRT) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone. Our primary hypothesis was that NACRT impairs objectively-measured physical fitness. We also wished to explore the relationship between fitness and postoperative outcome.

Method: In an observational study, we prospectively studied 27 consecutive patients, of whom 25 undertook cardiopulmonary exercise testing (CPET) 2 weeks before and 7 weeks after standardized NACRT, then underwent surgery. In-hospital post-operative morbidity and mortality were recorded. Patients were followed up to 1 year for mortality. Data was analysed blind to clinical details. Receiver-operating characteristic (ROC) analysis defined the predictive value of CPET for in-hospital morbidity at day 5.

Results: Oxygen uptake ( [Formula: see text] in ml kg(-1) min(-1)) at estimated lactate threshold (θˆL) and at peak exercise ( [Formula: see text] at peak in ml kg(-1) min(-1)) both significantly decreased post-NACRT: [Formula: see text] at θˆL 12.1 (pre-NACRT) vs. 10.6 (post-NACRT), p < 0.001 (95%CI -1.7, -1.2); [Formula: see text] at peak 18.1 vs. 16.7, p < 0.001 (95%CI -3.1, -1.0). Optimal [Formula: see text] at θˆL and peak pre-NACRT for predicting postoperative morbidity were 12.0 and 18.1 ( [Formula: see text] at θˆL - AUC = 0.71, 77% sensitive and 75% specific; [Formula: see text] at peak - AUC = 0.75, 78% sensitive and 76% specific). Optimal [Formula: see text] at θˆL and peak post-NACRT for predicting postoperative morbidity were 10.7 and 16.7 ( [Formula: see text] at θˆL - AUC = 0.72, 77% sensitive and 83% specific; [Formula: see text] at peak - AUC = 0.80, 85% sensitive and 83% specific).

Conclusion: NACRT before major rectal cancer surgery significantly decreased physical fitness as assessed by CPET.

Trials registry number: NCT01334593.

Keywords: Cancer surgery; Cardiopulmonary exercise testing; Morbidity; Neoadjuvant chemoradiotherapy; Physical fitness; Rectal cancer.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Antimetabolites, Antineoplastic / therapeutic use*
  • Capecitabine
  • Chemoradiotherapy, Adjuvant
  • Cohort Studies
  • Deoxycytidine / analogs & derivatives*
  • Deoxycytidine / therapeutic use
  • Exercise Test
  • Female
  • Fluorouracil / analogs & derivatives*
  • Fluorouracil / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Oxygen Consumption*
  • Physical Fitness*
  • Postoperative Complications*
  • Prospective Studies
  • ROC Curve
  • Rectal Neoplasms / therapy*
  • Rectum / surgery*

Substances

  • Antimetabolites, Antineoplastic
  • Deoxycytidine
  • Capecitabine
  • Fluorouracil

Associated data

  • ClinicalTrials.gov/NCT01334593