title: Preoperative adjuvant radiochemotherapy may increase the risk in patients undergoing thoracoabdominal esophageal resections.
abstract: OBJECTIVE
  Fatigue and malaise are common symptoms after radiochemotherapy which could affect patients' working capacity and add to the subsequent postoperative risk. The aim of the study was to investigate whether neoadjuvant radiochemotherapy in patients scheduled for a thoracoabdominal resection impairs their working capacity and adds to the postoperative risk.
  
  
  METHODS
  29 patients with resectable tumors (T(3) or N(1)) and a working capacity of > or =80 W on a bicycle test were included into the study. The tumor stage was determined by endoscopic ultrasound and computed tomography scan. The patients were given neoadjuvant radiochemotherapy during 38 days, consisting of two cycles of 5-fluorouracil (1,000 mg/m(2)) daily during 5 days and cisplatinum (100 mg/m(2)) on two occasions. Accelerated radiochemotherapy to a total dose of 40.8 Gy was given. Surgery was planned 4-6 weeks after completion of therapy. The patients had a bicycle test before induction of neoadjuvant treatment and 2-5 days prior to the operation.
  
  
  RESULTS
  Three patients died already during the course of neoadjuvant treatment. The 26 remaining patients who had a bicycle test decreased their working capacity by a mean of 30 W (p < 0.0001). Ten patients had a decrease of their working capacity to < or = 90 W, of whom 6 died within 3 months postoperatively, and of the patients who had the working capacity decreased to < or = 80 W, 4 out of 5 died during the corresponding postoperative period. None of the patients, who performed >100 W at the second preoperative bicycle test died.
  
  
  CONCLUSIONS
  Preoperative adjuvant radiochemotherapy, according to the present schedule, clearly exerts a detrimental effect on the patients' working capacity. A physical performance, at the time of the operation, < or = 80-90 W strongly predicts the subsequent postoperative risk. Similar adjuvant therapies may, therefore, in fact be harmful to some patients scheduled for a thoracoabdominal resection.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. liedman@sahlgrenska.se
authors.forename: B
authors.initials: B
authors.lastname: Liedman
authors.forename: E
authors.initials: E
authors.lastname: Johnsson
authors.forename: C
authors.initials: C
authors.lastname: Merke
authors.forename: M
authors.initials: M
authors.lastname: Ruth
authors.forename: L
authors.initials: L
authors.lastname: Lundell
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects*; D004943:Esophagogastric Junction / Q000601:surgery; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012044:Regression Analysis; D012306:Risk