Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 4 Issue 12

The Effect of Neo-adjuvant Cancer Therapy on Fitness for Anaesthesia and Surgery; A Prospective Cohort Study

Samir Rahmani1*, Dermot Burke2, Paul Jarvis3, Nicolas Orsi4, Michele Cummings4, Shelagh Turvill5 and Simon J Howell2

1Department of Surgery, Nevill Hall Hospital, Abergavenny, Monmouthshire, UK
2Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St. James’s University Hospital, Leeds, UK
3Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
4Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
5Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK

*Corresponding Author: Samir Rahmani, Nevill Hall Hospital, Department of Surgery, Abergavenny, Monmouthshire, UK.

Received: October 12, 2020; Published: November 19, 2020

Reprints View PDF Related Articles

×

Abstract

Background: Rectal cancer treatment with neoadjuvant radiotherapy or chemoradiotherapy (NAT) prior to anaesthesia and surgery may reduce fitness and so increase perioperative risk. Understanding the mechanisms by which NAT reduces functional capacity will inform the development of preoperative risk reduction strategies such as prehabilitation. We hypothesized that the effects of NAT are mediated through the inflammatory response and changes in body composition with loss of muscle.

Objectives: The objectives of the study were to examine the associations between changes in functional reserve measured by cardiopulmonary exercise testing (CPET) and the inflammatory responses and changes in body composition produced by NAT.

Design: Prospective cohort study.

Setting: United Kingdom regional cancer centre.

Patients: Thirty-six patients (28 male) who received preoperative long course chemoradiotherapy (LCCR) n = 24, or short course radiotherapy (SCRT) n = 12 prior to rectal cancer surgery were studied. Patients unable to perform CPET were excluded.

Main Outcome Measures: Assessments were made before and within two weeks after NAT. Anaerobic threshold (AT) and peak oxygen consumption (VO2peak) were measured by CPET. Body composition was assessed by bioelectrical impedance and blood samples taken for assay of cytokines and other inflammatory markers.

Results: LCCR patients had a significant decline in VO2peak (p = 0.005) and reductions in several anthropometric variables (all p < 0.01) after NAT. SCRT patients had no significant changes in their functional capacity data but showed changes in a number of anthropometric variables (all p < 0.04) after NAT. Cytokines and inflammatory markers showed wide variability. There were no clinically important associations between changes in functional capacity and changes in either anthropomorphic variables or biomarkers.

Conclusion: Our data confirm the impact of NAT on fitness for surgery. They are not consistent with an association between the changes in functional capacity seen with preoperative NAT and either changes in body composition or the inflammatory response to preoperative cancer treatment.

Keywords: Neoadjuvant Therapy; Radiotherapy; Chemoradiotherapy

×

References

  1. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer
  2. Giovannucci E WK Cotcar ISD, Fraumeni J, eds. Cancer. Epidemiology and Prevention. 3rd ed. Oxford University Press (2006).
  3. Turk PS and Wanebo HJ. “Results of surgical treatment of nonhepatic recurrence of colorectal carcinoma”. Cancer 71 (1993): 4267-4277.
  4. Santiago RJ., et al. “Chemoradiotherapy in the treatment of rectal cancer”. Hematology/Oncology Clinics of North America 16 (2002): 995-1014.
  5. Garcia-Aguilar J., et al. “Optimal timing of surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial”. Annals of Surgery 254 (2011): 97-102.
  6. de Campos-Lobato LF., et al. “Neoadjuvant therapy for rectal cancer: the impact of longer interval between chemoradiation and surgery”. Journal of Gastrointestinal Surgery 15 (2011): 444-450.
  7. Richards CH., et al. “The impact of perioperative risk, tumor pathology and surgical complications on disease recurrence following potentially curative resection of colorectal cancer”. Annals of Surgery 254 (2011): 83-89.
  8. West MA., et al. “The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients”. European Journal of Surgical Oncology 40 (2014): 1421-1428.
  9. Moran J., et al. “Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review”. British Journal of Anaesthesia 116 (2016): 177-191.
  10. Jack S., et al. “The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery”. European Journal of Surgical Oncology 40 (2014): 1313-1320.
  11. Schubert C., et al. “The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review”. Brain, Behaviour and Immunity 21 (2007): 413-427.
  12. “ATS/ACCP Statement on cardiopulmonary exercise testing”. American Journal of Respiratory and Critical Care Medicine 167 (2003): 211-277.
  13. Sarhill N., et al. “Assessment of nutritional status and fluid deficits in advanced cancer”. American Journal of Hospice and Palliative Care 20 (2003): 465-473.
  14. Roberts HC., et al. “A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach”. Age and Ageing 40 (2011): 423-429.
  15. Foster KR and Lukaski HC. “Whole-body impedance--what does it measure?” The American Journal of Clinical Nutrition 64 (1996): 388S-396S.
  16. Kushner RF., et al. “Use of bioelectrical impedance analysis measurements in the clinical management of patients undergoing dialysis”. The American Journal of Clinical Nutrition 64 (1996): 503S-509S.
  17. Klampfer L. “Cytokines, inflammation and colon cancer”. Current Cancer Drug Targets 11 (2011): 451-464.
  18. Aldinucci D and Colombatti A. “The inflammatory chemokine CCL5 and cancer progression”. Mediators of Inflammation (2014): 292376.
  19. He XX., et al. “Macrophage migration inhibitory factor promotes colorectal cancer”. Molecular Medicine (Cambridge, Mass) 15 (2009): 1-10.
  20. Palma G., et al. “Interleukin 18: friend or foe in cancer”. Biochimica et Biophysica Acta 1836 (2013): 296-303.
  21. Waldner MJ., et al. “Interleukin-6--a key regulator of colorectal cancer development”. International Journal of Biological Sciences 8 (2012): 1248-1253.
  22. Lasek W., et al. “Interleukin 12: still a promising candidate for tumor immunotherapy?” Cancer Immunology, Immunotherapy 63 (2014): 419-35.
  23. Leitch EF., et al. “Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer”. British Journal of Cancer 97 (2007): 1266-1270.
  24. DeVita VT Jr and Chu E. “A history of cancer chemotherapy”. Cancer Research 68 (2008): 8643-8653.
  25. “Local recurrence rate in a randomised multicentre trial of preoperative radiotherapy compared with operation alone in resectable rectal carcinoma. Swedish Rectal Cancer Trial”. European Journal of Surgery 162 (1996): 397-402.
  26. Ruo L and Guillem JG. “Major 20th-century advancements in the management of rectal cancer”. Diseases of the Colon and Rectum 42 (1999): 563-578.
  27. Skarlatos J., et al. “Hypofractionated radiotherapy with concurrent 5-fluorouracil radiosensitisation for recurrent or locally advanced colorectal cancer. A phase II study”. International Journal of Colorectal Disease 11 (1996): 206-210.
  28. Guren MG., et al. “Dietary intake and nutritional indicators are transiently compromised during radiotherapy for rectal cancer”. European Journal of Clinical Nutrition 60 (2006): 113-119.
  29. Tsujimoto H., et al. “Preoperative chemoradiotherapy for esophageal cancer enhances the postoperative systemic inflammatory response”. Japanese Journal of Clinical Oncology 36 (2006): 632-637.
  30. Wilson RJ., et al. “Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery”. British Journal of Anaesthesia 105 (2010): 297-303.
  31. Snowden CP., et al. “Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery”. Annals of Surgery 251 (2010): 535-541.
  32. Ellis KJ. “Human body composition: in vivo methods”. Physiology Review 80 (2000): 649-680.
  33. Lopes JP., et al. “Nutritional status assessment in colorectal cancer patients”. Nutrición Hospitalaria 28: 412-418.
  34. Ollenschlager G. “Nutritional deficiency during aggressive treatment of tumors”. Fortschr Med 109 (1991): 533-4
  35. de Luis DA., et al. “Postsurgery enteral nutrition in head and neck cancer patients”. European Journal of Clinical Nutrition 56 (2002): 1126-1129.
  36. Cosnes J., et al. “Malnutrition in chronic radiation enteritis. Study of 100 patients”. Annals of Clinical Gastroenterology and Hepatology 24 (1988): 7-12.
  37. Deitel M and To TB. “Major intestinal complications of radiotherapy. Management and nutrition”. Archives of Surgery 122 (1987): 1421-1424.
  38. Cohen S., et al. “Muscle wasting in disease: molecular mechanisms and promising therapies”. Nature Reviews Drug Discovery 14 (2015): 58-74.
  39. Gupta D., et al. “Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis”. Journal of Clinical Epidemiology 59 (2006): 704-709.
  40. West MA., et al. “The effect of neoadjuvant chemoradiotherapy on whole-body physical fitness and skeletal muscle mitochondrial oxidative phosphorylation in vivo in locally advanced rectal cancer patients--an observational pilot study”. PLoS One 9 (2014): e111526.
  41. Deboeck G., et al. “Exercise to predict outcome in idiopathic vs associated pulmonary arterial hypertension”. European Respiratory Journal 40 (2012): 1410-1419.
  42. Kosmas C., et al. “Cardiotoxicity of fluoropyrimidines in different schedules of administration: a prospective study”. Journal of Cancer Research and Clinical Oncology 134 (2008): 75-82.
  43. Tsibiribi P., et al. “Cardiac lesions induced by 5-fluorouracil in the rabbit”. Human and Experimental Toxicology 25 (2006): 305-309.
×

Citation

Citation: Samir Rahmani., et al. “The Effect of Neo-adjuvant Cancer Therapy on Fitness for Anaesthesia and Surgery; A Prospective Cohort Study". Acta Scientific Medical Sciences 4.12 (2020): 53-63.



Table of Contents


Metrics

Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.403

Indexed In





Contact US





Creative Commons License Open Access by Acta Scientific is licensed under a Creative Commons Attribution 4.0 International License
Based on a work at https://actascientific.com

ff

Acta-Publications

ff

© 2021 Acta Scientific, All rights reserved.