Impact of neo-adjuvant chemotherapy on cardiorespiratory reserve, sarcopenia and quality of life in oesophago-gastric carcinoma

Abstract

Background The UK management of locally advanced oesophago-gastric (OG) adenocarcinoma includes three cycles of MAGIC protocol neoadjuvant chemotherapy (NAC). NAC may have a detrimental impact on fitness, quality of life and sarcopenia. Determination of the oxygen uptake at the anaerobic threshold (AT) by cardiopulmonary exercise testing (CPET) objectively measures cardiorespiratory reserve (fitness). AT can be used to predict perioperative risk. Sarcopenia is defined by decreased skeletal muscle mass and is a poor prognostic factor. Patients view their health by means of quality of life (QOL) rather than traditional clinical outcomes. This study was conducted to determine the impact of neoadjuvant chemotherapy on fitness, sarcopenia and quality of life following neoadjuvant chemotherapy. Methods Patients with locally advanced OG adenocarcinoma were recruited. CPET, sarcopenia and QOL were measured before and following NAC. AT and peak oxygen uptake (VO2 Peak) were used to assess fitness before NAC, immediately after, and at two and four weeks interval post neoadjuvant chemotherapy. Computerised topography (CT) at staging and upon completion of NAC was used to measure sarcopenia (muscle mass and function). Quality of life was assessed at similar intervals to CPET, using European Organisation for Research and Treatment quality of life questionnaires: EORTC QOL-Core 30 and QLQ-Oesophagogastric 25. Results Thirty one patients with a median age of 65 (41-81) were recruited, 27 patients completed all three cycles of NAC. The results of pre and post NAC measured parameters, represented in mean (+/-1 standard deviation) are as follow: Anaerobic Threshold (ml/kg/min) 15.3 (3.4) versus 11.9(2.5) P<0.01, Peak Oxygen Uptake (ml/kg/min) 21.7 (3.9) versus 17.5(3.0) P<0.01, Mean Muscle Index (cm2 /m2 ) 53.3 versus 49.6(9.5) P <0.001, Grip Strength 39.4 (6.6) versus 36.5(6.5) P<0.01 and Global Health Status (QoL) 72.2(20.5) versus 59.3(25.3) p=0.043. Conclusion NAC significantly impacts fitness, sarcopenia levels and QoL. Preventing this reduction through development of ‘prehabilitation’ strategies, or optimising timing of surgery after recovery of the observed decline, may decrease perioperative risk, reduce postoperative complications and improve quality life. This should be the focus of future studies.