Effectiveness of early exercise on reducing skeletal muscle loss during preoperative neoadjuvant chemotherapy for esophageal cancer

Ikeda, Tomohiro; Noma, Kazuhiro; Maeda, Nobuyo; Tanabe, Satoshi; Sakamoto, Yoko; Katayama, Yoshimi; Shirakawa, Yasuhiro; Fujiwara, Toshiyoshi; Senda, Masuo

doi:10.1007/s00595-021-02449-5

Cited by 14 publications

(18 citation statements)

References 32 publications

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“…Earlier meta-analyses [8,9] identified that male sex is associated with higher rates of muscle loss. Here, male colorectal cancer patients with metastatic disease showed muscle loss of À8.3%/100 days [25], testicular cancer patients showed muscle loss up to À11.9%/100 days [20,21], and four new studies in neoadjuvant chemotherapy for esophageal/esophagogastric cancer, which has a high proportion of male individuals [16][17][18][19], showed relatively high intensity of muscle change (À7.2% to À9%/100 days). Muscle loss in the intermediate range were seen in a series of single reports, including Hodgkin's Lymphoma (À5.6%/ 100 days) [22], neoadjuvant chemotherapy for advanced ovarian cancer (6%/100 d) [15], curative intent chemoradiotherapy for head and neck cancer (À3.8%/100 days) [26] and targeted therapy cabozantinib in renal cell carcinoma (À4.6%/100 days) [27].…”

Section: Muscle Lossmentioning

confidence: 87%

“…The rate of muscle loss on postoperative day 7 in both ghrelin groups was lower than that in the placebo group (high dose vs. placebo: 2.8 vs. 8.5%, P < 0.001; low dose vs. placebo: 4.9 vs. 8.5%, P ¼ 0.028). The interest of this study is that substantial muscle losses have been described during the neoadjuvant chemotherapy that precedes esophagectomy [8,[16][17][18][19]. Although the efficacy of ghrelin intervention postoperatively could assist in restoring some of these losses, earlier intervention during neoadjuvant treatment could also be considered.…”

Section: Therapeutic Strategies To Mitigate Systemic Cancer Therapy-i...mentioning

confidence: 99%

“…Three clinical studies include preliminary data on interventions to mitigate skeletal muscle loss in patients with esophageal cancer and used CT imaging to record muscle loss rate as an outcome measure. Ikeda et al [17] conducted a secondary analysis (CT image review) of a clinical trial in which patients were randomized to early and deferred exercise training during neoadjuvant treatment. Multivariable analysis revealed that early exercise reduced the risk of CT-defined skeletal muscle loss (OR = 0.25, 95% CI 0.09–0.65, P = 0.006).…”

Section: Therapeutic Strategies To Mitigate Systemic Cancer Therapy-i...mentioning

confidence: 99%

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Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet

Klassen

Schiessel

Baracos

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewSystemic cancer therapy-associated skeletal muscle wasting is emerging as a powerful impetus to the overall loss of skeletal muscle experienced by patients with cancer. This review explores the clinical magnitude and biological mechanisms of muscle wasting during systemic cancer therapy to illuminate this adverse effect. Emerging strategies for mitigation are also discussed.Recent findingsClinical findings include precise, specific measures of muscle loss over the course of chemotherapy, targeted therapy and immunotherapy. All these therapeutic classes associate with quantitatively important muscle loss, independent of tumor response. Parallel experimental studies provide understanding of the specific molecular basis of wasting, which can include inhibition of protein synthesis, proliferation and differentiation, and activation of inflammation, reactive oxygen species, autophagy, mitophagy, apoptosis, protein catabolism, fibrosis and steatosis in muscle. Strategies to mitigate these muscle-specific adverse effects of cancer therapy remain in the earliest stages of development.SummaryThe adverse side effect of cancer therapy on skeletal muscle has been largely ignored in the development of cancer therapeutics. Given the extent to which loss of muscle mass and function can bear on patients’ function and quality of life, protection/mitigation of these side effects is a research priority.

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Section: Muscle Lossmentioning

confidence: 87%

Section: Therapeutic Strategies To Mitigate Systemic Cancer Therapy-i...mentioning

confidence: 99%

Section: Therapeutic Strategies To Mitigate Systemic Cancer Therapy-i...mentioning

confidence: 99%

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Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet

Klassen

Schiessel

Baracos

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…The mean age of the participants ranged from 59.2 to 67.0 years, 74.7 to 100% were men, and the mean BMI ranged from 21.1 to 28.9 kg/m2. Three studies [ 13 , 26 , 33 ] used neoadjuvant chemoradiotherapy, five [ 15 , 27 , 29 , 30 , 32 ] used neoadjuvant chemotherapy, and three [ 14 , 28 , 31 ] used neoadjuvant chemoradiotherapy or chemotherapy.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [ 13 , 26 , 33 ] used neoadjuvant chemoradiotherapy, five [ 15 , 27 , 29 , 30 , 32 ] used neoadjuvant chemotherapy, and three [ 14 , 28 , 31 ] used neoadjuvant chemoradiotherapy or chemotherapy.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of prehabilitation during neoadjuvant therapy for patients with esophageal or gastroesophageal junction cancer: a systematic review

Ikeda,

Toyama,

Harada

et al. 2024

Esophagus

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Progression of the physical weakness during neoadjuvant therapy (NAT) in patients with esophageal or gastroesophageal junction cancer is a serious problem; however, prehabilitation during NAT has the potential to overcome the unmet need. Nevertheless, systematic reviews on this topic have not been summarized. Therefore, this systematic review aimed to determine prehabilitation’s effectiveness, acceptability, and safety during NAT for patients with esophageal or gastroesophageal junction cancer. An electronic search was performed in the MEDLINE, Web of Science, CENTRAL, CINAHL, and PEDro databases. A meta-analysis was conducted to assess the effectiveness of prehabilitation during NAT, along with a descriptive analysis of acceptance and safety. This study analyzed data from three randomized controlled trials (RCTs) and nine non-RCTs involving 664 patients. The meta-analysis of two RCTs demonstrated that prehabilitation during NAT may be more effective than usual care in enhancing tolerance to NAT and grip strength; moreover, one RCT and three non-RCTs revealed that prehabilitation may reduce the risk of postoperative complications. The adherence rates for exercise programs in two RCTs and seven non-RCTs were 55–76%. Additionally, two studies reported a 76% adherence rate for multimodal prehabilitation programs, including exercise, dietary, and psychological care. Six studies reported no serious prehabilitation-related adverse events during NAT. Prehabilitation during NAT may be a safe and beneficial intervention strategy for patients with esophageal or gastroesophageal junction cancer. However, the investigation of strategies to enhance adherence is essential. Furthermore, additional high-quality RCTs are needed to examine the effect of prehabilitation during NAT.

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Association of Preoperative Physical Fitness With Post‐Esophagectomy Pneumonia in Older With Locally Advanced Esophageal Cancer: An Exploratory Prospective Study

Harada,

Tsuji,

Ueno

et al. 2024

Journal of Surgical Oncology

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BackgroundsCurrently, there is a lack of evidence of prehabilitation during neoadjuvant chemotherapy (NAC) to prevent pneumonia of older patients. This study aimed to investigate the association of preoperative physical fitness after NAC with post‐esophagectomy pneumonia in older patients with locally advanced esophageal cancer (LAEC).MethodsThis single‐center exploratory prospective cohort study included 80 patients aged ≥ 65 years with LAEC scheduled for curative esophagectomy after NAC between 2021 and 2023. The post‐NAC short incremental shuttle walk test (ISWT) by sex was established using the Youden index. The association of the post‐NAC short ISWT with postoperative pneumonia was investigated via Firth's penalized logistic regression model with statistical significance set as two‐tailed p < 0.05.ResultsA total of 69 patients were analyzed. The mean post‐NAC ISWT values were 353.5 m. Short ISWT distance was defined as ≤ 395 and ≤ 195 m for men and women, respectively. Postoperative pneumonia developed in 17 (25%) patients. Short post‐NAC ISWT distance was significantly associated with postoperative pneumonia (adjusted odds ratio: 1.840, 95%CI: 1.760–28.440, p = 0.004).ConclusionsDecline in physical fitness was associated with post‐esophagectomy pneumonia, which may be a key targeted factor of prehabilitation during NAC for older patients with LAEC.

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Effectiveness of early exercise on reducing skeletal muscle loss during preoperative neoadjuvant chemotherapy for esophageal cancer

Cited by 14 publications

References 32 publications

Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet

Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet

Effectiveness of prehabilitation during neoadjuvant therapy for patients with esophageal or gastroesophageal junction cancer: a systematic review

Association of Preoperative Physical Fitness With Post‐Esophagectomy Pneumonia in Older With Locally Advanced Esophageal Cancer: An Exploratory Prospective Study

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