19: CARDIOPULMONARY FUNCTION FOLLOWING NEO-ADJUVANT CHEMOTHERAPY FOR OESOPHAGO-GASTRIC ADENOCARCINOMA

Abstract

Abstract Background and aim The role of perioperative chemotherapy in oesophago-gastric adenocarcinoma is well established. Epirubicin, Cisplatin/Oxaliplatin and Capecitabine (ECX/EOX) based regimens have recently been challenged by Fluoruracil, Leucovorin, Oxaliplatin and Docetaxel (FLOT). We aimed to assess whether these regimens had variable effects on patient cardiopulmonary fitness and subsequent suitability for major surgery following treatment. Methods Cardiopulmonary exercise (CPEX) testing was used to provide objective estimation of cardiopulmonary function metrics including peak oxygen consumption (VO₂ max), anaerobic threshold (AT) and ventilatory efficiency (VeVCO₂ slope). Paired CPEX testing was performed in participants undergoing treatment for oesophago-gastric adenocarcinoma pre and post FLOT (n = 26) or ECX/EOX (n = 51) chemotherapy regimens, as selected by the multidisciplinary team. Univariate non-parametric testing was used to assess differences for significance. Results Participants undergoing FLOT were younger [median (IQR): 61(12.5) □□. 69(11) years, P = 0.003] and had a higher pre-chemotherapy VO₂ max/m2 [929(231) □□. 838(198) ml/m2/min, P = 0.040] and FEV1 [3.5(0.8) □□. 2.9(0.6), P = 0.017] compared to those undergoing ECX/EOX. Other metrics including BMI, weight, VO₂ max/kg, AT, VeVCO₂ slope, FVC and FEV1 were not significantly different at baseline. There was no difference in time to CPEX testing after completing chemotherapy treatment [median 27 □□. 27 days]. Both FLOT and ECX/EOX significantly reduced VO₂ max/kg [−2.85(4.0) & -1.70(3.5) ml/kg/min], VO₂ max/m2 [−101(193) & -68(155) ml/m2/min] and AT [−1.35(2.7) & -1.1(2.3) ml/kg/min] respectively (all P < 0.001), with no significant absolute or proportional differences found between the groups. Respiratory function was not altered. Conclusion A reduction in cardiopulmonary function should be accounted for when planning surgery for oesophago-gastric cancer following neo-adjuvant chemotherapy. We did not find significant differences in cardiopulmonary function reduction between chemotherapy regimens in this cohort. However, there was a trend towards a greater reduction in cardiopulmonary function after FLOT and studies in larger cohorts of patients are needed to clarify this.