Significant Weight Loss in the Neoadjuvant Setting Is Predictive of Whether Patients Undergo Surgery Following Chemoradiation for Locally Advanced Esophageal Cancer

Abstract

Weight loss is an important controllable risk factor for patients receiving neoadjuvant concurrent chemotherapy and radiation for locally advanced esophageal cancer. Poor nutritional status is believed to increase the likelihood of treatment interruption and hospitalizations. In this study, we examined the impact of weight loss and nutritional status in patients undergoing neoadjuvant chemoradiation. We prospectively collected data on weight change and performance status on 71 patients with esophageal cancer between February 2012 and December 2013 undergoing neoadjuvant chemoradiation prior to surgical resection. Variables assessed in our analysis included Eastern Cooperative Oncology Group (ECOG) performance status, weight changes, and feeding tube placement with endpoints including hospitalizations, use of IV fluids, and whether patients received surgery. Patients encountered a significant reduction in ECOG functional status following neoadjuvant chemoradiation (93% class 0 or 1 pre-treatment vs 69% class 0 or 1 post-treatment; p = 0.001). Patients experienced a median weight loss of 5 kg during their treatment (median weight: 84 kg pre-treatment vs 79 kg post-treatment; p = 0.0001). Additionally, weight loss was a predictor of patients not receiving surgery (OR 1.27 per unit kg decrease, 95% CI = 1.09-1.54; p = 0.004). Patients who had greater than 5% loss in total body weight experienced more hospitalizations during treatment (p = 0.04) and had a higher frequency of IV fluid use (p = 0.001). Nine patients (13%) had a feeding tube placed prior to undergoing treatment and an additional seven (10%) patient’s required feeding tube placement during treatment. Patients with feeding tubes placed prior to treatment experienced a weight loss of -2 kg (range -6 to 0 kg) vs -4 kg (range -12 to 1 kg) in those patients that did not have a tube placed (p = 0.08). However, patients with tube placement prior to treatment were less likely to receive surgery (11%) vs those that did not have a feeding tube placed (61%) (p = 0.006). A decrease in functional status and weight loss was noted with neoadjuvant treatment. Weight loss was a significant predictor of whether patients received surgery. Furthermore, declines in body weight exceeding 5% increase the number of hospitalizations and interruptions experienced during treatment. Prompt nutritional intervention is indicated for patients with esophageal cancer as they undergo neoadjuvant chemoradiation in anticipation of surgical resection.