Dr
Casper Simonsen
(Center for Physical Activity Research (CFAS), University Hospital Copenhagen - Rigshospitalet)
Background: Perioperative treatment is the standard of care for resectable gastroesophageal cancer; however, physical deterioration during neoadjuvant treatment is common and may ultimately preclude tumor surgery. Here, we compared exercise training with control on the likelihood of not undergoing tumor surgery following neoadjuvant treatment.
Methods: In this parallel-group, two-arm, single-blinded, randomized controlled trial, patients with resectable gastroesophageal cancer undergoing perioperative treatment were randomized 1:1 to exercise training (EX) twice weekly from diagnosis until surgery or control (CON). The primary outcome was not undergoing tumor surgery with curative intent. Secondary outcomes were cardiorespiratory fitness, discontinuation of neoadjuvant treatment, postoperative complications, and overall survival.
Results: In total, 202 participants were included in the modified intention-to-treat analyses. The participants in EX attended a median of 76% of the planned sessions. In EX, 10 patients out of 101 did not undergo tumor surgery with curative intent compared with 8 out of 101 in CON (OR 1.28; 95% CI 0.48-3.38; P = 0.623). Exercise training led to higher cardiorespiratory fitness (+14.5 watt; 95% CI 2.0-26.2). Discontinuation of the neoadjuvant treatment was required for 15% in EX and 18% in CON (OR 0.81; 95% CI 0.38-1.72). Clavien-Dindo grade ≥3 postoperative complications were experienced by 30% in EX and 27% in CON (OR 1.16; 95% CI 0.61-2.20). The overall survival rates at 3-years for EX and CON were 51% (95% CI: 42-62) and 65% (95% CI: 56-75), respectively (HR 1.52 [95% CI: 1.02-2.45]). The 5-year survival rates, included post doc, were 46% (95% CI: 37-58) and 55% (95% CI: 45-67) for the exercise and control group, respectively (HR 1.45, 95% CI: 0.96-2.19].
Conclusion: Preoperative exercise training does not reduce the likelihood of not undergoing surgery following neoadjuvant treatment for gastroesophageal cancer. Our finding that exercise training was associated with an increased mortality rate warrants further investigation.
Keywords
Prehabilitation, Gastroesophageal, Neoadjuvvant treatment, Treatment outcomes
| Abstract submitters declaration |
yes
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| Conflict of Interest & Ethical Approval |
yes
|
Dr
Casper Simonsen
(Center for Physical Activity Research (CFAS), University Hospital Copenhagen - Rigshospitalet)
Dr
Pieter de Heer
(Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark)
Dr
Simon Nørskov Thomsen
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Ms
Rikke Krabek
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Ms
Sarah Thorsen-Streit
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Dr
Mark Preben Printz Lyngbæk
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Ms
Anna Sundberg
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Ms
Anne Sofie Hjort
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Dr
Rajendra Singh Garbyal
(Department of Pathology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark)
Dr
Louise Lang Lehrskov
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Dr
Thomas Skårup Kristensen
(Department of Radiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark)
Dr
Jens Georg Hillingsø
(Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark)
Dr
Jon Kroll Bjerregaard
(Department of Oncology, University Hospital of Copenhagen – Rigshospitalet, Copenhagen, Denmark)
Dr
Lene Bæksgaard
(Department of Oncology, University Hospital of Copenhagen – Rigshospitalet, Copenhagen, Denmark)
Dr
Anders Tolver
(Danish Cancer Society, Copenhagen, Denmark)
Dr
Lars Bo Svendsen
(Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark)
Dr
Bente Klarlund Pedersen
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
Dr
Camilla Qvortrup
(Department of Oncology, University Hospital of Copenhagen – Rigshospitalet, Copenhagen, Denmark)
Dr
Michael Patrick Achiam
(Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark)
Dr
Jesper Frank Christensen
(Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark)
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