Journal Article

Impact of Neoadjuvant Chemoradiotherapy on Postoperative Course after Curative-intent Transthoracic Esophagectomy in Esophageal Cancer Patients

Bosch, Dirk J., Plukker, John Th. M., Muijs, Christina T., Burgerhof, Johannes G. M., Beukema, Jannet C., Mul, Véronique E. M., Hospers, Geke A. P.

2014

Overview

Background Neoadjuvant chemoradiotherapy (CRT) improves locoregional control and overall survival in esophageal cancer patients. Although adverse events are relatively low during neoadjuvant CRT, severe postoperative adverse effects may occur, leading to morbidity and even mortality. We investigated the impact of a more frequently used neoadjuvant CRT regimen of 41.4 Gy/5 weeks radiotherapy with concurrent carboplatin and paclitaxel (CROSS schedule) on the postoperative course. Methods Between 2006 and 2012, a total of 96 esophageal cancer patients (staged cT1N+/T2–4a/N0–3 and M0) were treated according to the above neoadjuvant scheme. To reduce bias in this single-center study, we performed a propensity score-matched analysis with patients who underwent surgery alone ( n  = 230) from a prospectively maintained database ( n  = 326). Results Baseline characteristics between both groups were equally distributed in the matched cohort. In the neoadjuvant treated group, significantly more patients were diagnosed with pneumonia (27.1 vs. 51.0 %; p  = 0.001), pleural effusion (12.5 vs. 24.0 %; p  = 0.040), and arrhythmia (20.4 vs. 34.4 %; p  = 0.008). In addition, in the multivariate analysis, neoadjuvant CRT was significantly associated with an increased risk of pneumonia ( p  = 0.001, odds ratio 2.896), pleural effusion ( p  = 0.041, odds ratio 2.268), and arrhythmia ( p  = 0.023, odds ratio 2.215). Despite these outcomes, no differences were detected in duration of intensive care unit or hospital stay. Short-term mortality did not differ between both groups. Conclusions We observed an increase of cardiopulmonary complications in the neoadjuvant CRT group, without any effect on hospital or intensive care unit stay and mortality. Further research is warranted on the limitation of chemoradiation-induced cardiopulmonary toxicity.

• Publisher: Springer US,Springer Nature B.V
• Subject: Aged / Antineoplastic Combined Chemotherapy Protocols - adverse effects / Arrhythmias, Cardiac - diagnosis / Arrhythmias, Cardiac - etiology / Arrhythmias, Cardiac - mortality / Carboplatin - administration & dosage / Carcinoma, Squamous Cell - mortality / Carcinoma, Squamous Cell - pathology / Carcinoma, Squamous Cell - therapy / Case-Control Studies / Chemoradiotherapy - adverse effects / Combined Modality Therapy / Esophageal Neoplasms - mortality / Esophageal Neoplasms - pathology / Esophageal Neoplasms - therapy / Esophagectomy - adverse effects / Esophagectomy - methods / Female / Follow-Up Studies / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Staging / Oncology / Paclitaxel - administration & dosage / Pneumonia - diagnosis / Pneumonia - etiology / Pneumonia - mortality / Postoperative Complications - diagnosis / Postoperative Complications - etiology / Postoperative Complications - mortality / Prognosis / Prospective Studies / Surgery / Surgical Oncology / Survival Rate / Thoracic Oncology / Thoracotomy - adverse effects