Changes in cardiopulmonary reserves associated with neoadjuvant therapy in patients with esophageal cancer

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e15589 Background: Recent treatment trends for resectable esophageal cancer have moved toward the addition of neoadjuvant chemoradiotherapy. This additional therapy, however, places these patients at increased risk for loss of physiologic/functional capacity. If present, such declines can delay resection of the primary tumor until the patient has physiologically recovered from this insult. To determine whether physiological reserves decline, peak exercise performance was assessed before and after completing neoadjuvant therapy Methods: In this prospective study seventeen male patients (60.5 + 7.1 years) with esophageal cancers underwent a symptom limited, standard ramp bicycle ergometer cardiopulmonary exercise test (CPET) before and after completing neoadjuvant therapy. The exercise protocol sequentially entailed 3 minutes of quiet resting, 3 minutes of unloaded cycling, ramp protocol to peak exercise tolerance, and 3 minutes of recovery. Ramp rates (5–25 watts/.min) were individually chosen to achieve test durations of 8–12 minutes. Expired gases were measured for volume and gas fractions via breath-by-breath analysis (Medical Graphics CardiO2/CP system). STATISTICAL ANALYSIS: Physiological data were analyzed by paired t-tests (α=0.05). Data are presented as mean + standard deviation. Results: Pre treatment exercise testing occurred immediately before onset of treatment. Post treatment exercise testing typically occurred 45 + 17 days after neoadjuvant ended and 11 + 10 days before surgery. Peak exercise capacity (VO2peak) and anaerobic threshold declined 11.9 % and 10.5 % respectively (p < 0.01) over the neoadjuvant therapy treatment period. Both oxygen pulse (VO2/HR) and pulse pressure product (HR X SP) at VO2peak also significantly declined (p< 0.01) over the treatment period. Conclusions: These results suggest 1) both systemic and peripheral changes contribute to an overall physiological and functional decline in patients undergoing neoadjuvant therapy and 2) efforts aimed at preserving optimal physiological/functional capacity may be warranted during this period. No significant financial relationships to disclose.