title: Effects of neoadjuvant chemo or chemoradiotherapy for oesophageal cancer on perioperative haemodynamics: A prospective cohort study within a randomised clinical trial.
abstract: Neoadjuvant chemoradiotherapy might improve oncological outcome compared with chemotherapy after surgery for oesophagus or gastrooesophageal junction cancer. However, radiotherapy may induce cardiovascular side-effects that could increase the risk of perioperative adverse effects and postoperative morbidity.
  
  
  
  The aim of this study was to compare the perioperative haemodynamics in patients undergoing oesophagectomy following neoadjuvant chemotherapy or chemoradiotherapy for cancer.
  
  
  
  A prospective single-centre cohort study within a randomised multi-centre trial.
  
  
  
  A Swedish University Hospital from January 2009 to March 2013.
  
  
  
  A total of 31 patients (chemotherapy 17, chemoradiotherapy 14) included in a multi-centre trial randomising chemotherapy vs. chemoradiotherapy and operated at Karolinska University Hospital, Huddinge.
  
  
  
  Cisplatin and 5-fluorouracil, either with or without concurrent radiotherapy (40 Gy), were given prior to surgery. Cardiac function was assessed with LiDCOplus (LiDCO Ltd, London, United Kingdom), echocardiography, troponin T and N-terminal pro-B-type natriuretic peptide, before, during and after surgery.
  
  
  
  The primary outcome was the interaction effect of the neoadjuvant treatment on stroke volume index during the perioperative period. Secondary outcomes were the interaction effects of oxygen delivery index, cardiac index, echocardiography and biochemical markers.
  
  
  
  The groups were matched regarding comorbidities, but patients in the chemoradiotherapy group were older (66 vs. 60 years P = 0.03). Haemodynamic values changed in a similar way in both groups during the study period. The chemoradiotherapy group had a lower cardiac index before surgery (2.9 vs. 3.4 l min m, P = 0.03). On the third postoperative day, both groups displayed a hyperdynamic state compared with baseline, with no increase in troponin T, and a similar increase in N-terminal pro-B-type natriuretic peptide.
  
  
  
  Neoadjuvant chemoradiotherapy for oesophageal or gastrooesophageal junction cancer seems to induce only a marginal negative effect on cardiac function compared with neoadjuvant chemotherapy. This difference did not remain when patients' haemodynamics were challenged by surgery.
  
  
  
  ClinicalTrials.gov identifier: NCT01362127.
authors.affiliation: From the Department of Anaesthesiology and Intensive Care, CLINTEC, Division of Anaesthesiology (ML, SK), Centre for Digestive Diseases, CLINTEC, Division of Surgery (JAT, MN, LL), Department of Medicine, Section of Cardiology, Division of Cardiology and School of Technology and Health, Royal Institute of Technology (RW). All at Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Lund
authors.forename: Jon A
authors.initials: JA
authors.lastname: Tsai
authors.forename: Magnus
authors.initials: M
authors.lastname: Nilsson
authors.forename: Reidar
authors.initials: R
authors.lastname: Winter
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Sigridur
authors.initials: S
authors.lastname: Kalman
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D059248:Chemoradiotherapy / Q000379:methods*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D020360:Neoadjuvant Therapy / Q000379:methods*; D010446:Peptide Fragments / Q000097:blood; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain