P-OGC20 Can prehabilitation prevent development of sarcopenia during neoadjuvant chemotherapy for oesophagogastric adenocarcinoma?

Abstract

Abstract Background Sarcopenia characterised as a loss of muscle mass and function is prevalent in cancer populations. It is known to occur in patients receiving neoadjuvant treatment and is associated with poorer outcomes. Thus, minimizing sarcopenia may lead to improved patient prognosis. It has been suggested that exercise can reverse and prevent sarcopenia. Little is known as to whether prehabilitation as an intervention to enhance patients’ functional capacity prior to surgery can lead to sarcopenia prevention. Methods Patients enrolled into a prospective prehabilitation study (ChemoFit) during neoadjuvant chemotherapy (NAC) for oesophagogastric adenocarcinoma (OGA) had their radiological sarcopenia measured before and after neoadjuvant chemotherapy (NAC). Radiological sarcopenia and lean body mass (LBM) were measured from computed tomography scans at the level of the L3 vertebra. ChemoFit patients were compared with an historical cohort (NO-PREHAB) which did not undergo prehabilitation and which had their radiological sarcopenia evaluated prospectively prior to and after NAC for OGA. Results Patients in the ChemoFit group were younger compared to the NO-PREHAB group (median age 70 vs 65, p = 0.04). Otherwise there were no differences in gender, BMI, smoking status, comorbidities, tumour location and clinical stage of the disease. Radiological sarcopenia was present prior to NAC in 17/36 (47%) which increased to 26/36 (72%) after NAC amongst ChemoFit patients. Sarcopenia prior to NAC in the NO-PREHAB cohort was 12/28 (43%) which increased to 16/28 (57%) post NAC. Intergroup difference (p = 0.291). Median (IQR) ΔLBM at two time points was in ChemoFit -2.6kg (-5.2;-0.6) and in NO-PREHAB -3.1kg (-4.7;-1.0) (p = 0.730). Conclusions Radiological sarcopenia increased in both groups during NAC for OGA. Prehabilitation did not prevent this from happening. Other strategies must be explored in order to mitigate against sarcopenia.