Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Elliott, Jessie A; O’Byrne, Lisa; Foley, Geraldine; Murphy, Conor; Doyle, Suzanne; King, Sinéad; Guinan, Emer; Ravi, Narayanasamy; Reynolds, John V.

doi:10.1002/bjs.11218

Cited by 20 publications

(17 citation statements)

References 45 publications

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“…CT-defined sarcopenia was conducted as described previously 17,18. Pulmonary physiology, including diffusion capacity for carbon monoxide, forced expiratory volume in first second, and forced vital capacity, was assessed at baseline and 1 month postneoadjuvant therapy as per guidelines 19,20…”

Section: Methodsmentioning

confidence: 99%

CROSS Versus FLOT Regimens in Esophageal and Esophagogastric Junction Adenocarcinoma

et al. 2022

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Background: The FLOT protocol and the CROSS trimodality regimen represent current standards in the management of locally advanced esophageal adenocarcinoma. In the absence of published Randomised Controlled Trial data, this propensity-matched comparison evaluated tolerance, toxicity, impact on sarcopenia and pulmonary physiology, operative complications, and oncologic metrics. Methods: Two hundred and twenty-two patients, 111 in each arm, were included from 2 high-volume centers. Computed tomography-measured sarcopenia, and pulmonary function (forced expiratory volume in first second/forced vital capacity/diffusion capacity for carbon monoxide) were compared pretherapy and posttherapy. Operative complications were defined as per the Esophageal Complications Consensus Group (ECCG) criteria, and severity per Clavien-Dindo. Tumor regression grade and R status were measured, and survival estimated per Kaplan-Meier. Results: A total of 83% were male, cT3/cN+ was 92%/68% for FLOT, and 86%/60% for CROSS. The full prescribed regimen was tolerated in 40% of FLOT patients versus 92% for CROSS. Sarcopenia increased from 16% to 33% for FLOT, and 14% to 30% in CROSS (P<0.01 between arms). Median decrease in diffusion capacity for carbon monoxide was −8.25% (−34 to 25) for FLOT, compared with −13.8%(−38 to 29), for CROSS (P=0.01 between arms). Major pathologic response was 27% versus 44% for FLOT and CROSS, respectively (P=0.03). In-hospital mortality, respectively, was 1% versus 2% (P=0.9), and Clavien Dindo >III 22% versus 27% (P=0.59), however, respiratory failure was increased by CROSS, at 13% versus 3% (P<0.001). Three-year survival was similar at 63% (FLOT) and 60% (CROSS) (P=0.42). Conclusions: Both CROSS and FLOT resulted in equivalent survival. Operative outcomes were similar, however, the CROSS regimen increased postoperative respiratory failure and atrial fibrillation. Less than half of patients received the prescribed FLOT regimen, although toxicity rates were acceptable. These data support clinical equipoise, caution, however, may be advised with CROSS in patients with greatest respiratory risk.

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Section: Methodsmentioning

confidence: 99%

CROSS Versus FLOT Regimens in Esophageal and Esophagogastric Junction Adenocarcinoma

et al. 2022

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“…25,26 In this context, we have recently reported that nCRT alters pulmonary physiology, in particular diffusion capacity (DLCO). 27 The observations from this study suggest that lung changes postoperatively in patients who had nCRT may not be infection related, and whether preoperative radiation and 1-lung anesthesia predispose to non-infective acute lung injury or consolidation requires further study.…”

Section: Discussionmentioning

confidence: 80%

The Complexity of Defining Postoperative Pneumonia After Esophageal Cancer Surgery: A Spectrum of Lung Injury Rather Than a Simple Infective Complication?

Raftery

Murphy²,

Donohoe³

et al. 2020

Annals of Surgery

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Objective: To analyze the spectrum of Centers for Disease Control and Prevention (CDC)-defined pneumonia after esophageal cancer surgery. Summary Background Data: Pneumonia is commonly documented after esophageal cancer surgery, and reducing its incidence is central to both ERAS development and to the evidence-base for minimally invasive approaches. The existing definitions of pneumonia based on hospital acquired pneumonia classifications may be suboptimal in this context and merits strict academic scrutiny. Methods: Patients (2013-2018) treated with curative intent by open surgery were studied. Pneumonia was defined per the CDC definition. Risk factors and associations were analyzed, as was the implications of positive cultures. Multivariable logistic regression examined independently predictive factors of pneumonia and oncologic outcomes. Results: Of 343 patients, 56 (16%) had defined pneumonia, 22 (39%) with positive cultures. Preoperative respiratory disease predicted pneumonia (P = 0.043). Neoadjuvant therapy was significantly (P = 0.004) associated with culture negative pneumonia, and age (P = 0.001) with culture positive pneumonia. In multivariable analysis, pneumonia was associated (P < 0.05) with respiratory comorbidity, tumor site, and neoadjuvant chemoradiation. Pneumonia did not impact on overall survival (P = 0.807). Discussion: CDC-defined pneumonia occurred in 16% of cases. Culture-negative pneumonia accounted for 61% of cases and was significantly associated with neoadjuvant chemoradiation. Pneumonia as currently defined seems to represent a spectrum of etiology and severity in the post-esoph-agectomy patient, with infection per se rarely proven, suggesting a need to reevaluate its definition, severity classification, and preventive and treatment strategies.

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“…Com base nesses achados e na literatura consultada, ratifica-se que os efeitos da quimioterapia sobre a função pulmonar são mais bem evidenciados meses após a conclusão do tratamento 27 . Apoiando esse pressuposto, o trabalho de Dietz et al 28 acompanhou um grupo de adultos sobreviventes ao câncer na infância e constatou que 25 anos após a terapia, os pacientes manifestavam tosse crônica, fibrose pulmonar, necessidade de suplementação de oxigênio e pneumonia.…”

Section: Discussionunclassified

Avaliação da função pulmonar de pacientes oncológicos submetidos a quimioterapia

Magno¹,

Cruz²,

Marques³

et al. 2021

ASSOBRAFIR Ciênc

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Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Cited by 20 publications

References 45 publications

CROSS Versus FLOT Regimens in Esophageal and Esophagogastric Junction Adenocarcinoma

CROSS Versus FLOT Regimens in Esophageal and Esophagogastric Junction Adenocarcinoma

The Complexity of Defining Postoperative Pneumonia After Esophageal Cancer Surgery: A Spectrum of Lung Injury Rather Than a Simple Infective Complication?

Avaliação da função pulmonar de pacientes oncológicos submetidos a quimioterapia

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