Centre of Inflammation and Metabolism/Centre for Physical Activity Research Copenhagen Denmark.
Department of Surgical Gastroenterology C Copenhagen Denmark.
BJS Open. 2018 Oct 24;3(1):74-84. doi: 10.1002/bjs5.50110. eCollection 2019 Feb.
Neoadjuvant chemotherapy or chemoradiotherapy is used widely before tumour resection in cancer of the gastro-oesophageal junction (GOJ). Strategies to improve treatment tolerability are warranted. This study examined the safety and feasibility of preoperative exercise training during neoadjuvant treatment in these patients.
Patients were allocated to a standard-care control group or an exercise group, who were prescribed standard care plus twice-weekly high-intensity aerobic exercise and resistance training sessions. The primary endpoint was the incidence of serious adverse events (SAEs) that prevented surgery, including death, disease progression or physical deterioration. Preoperative hospital admission, postoperative complications, changes in patient-reported quality of life and pathological treatment response were also recorded. In the exercise group, adherence to exercise and changes in aerobic fitness, muscle strength and body composition were measured.
The incidence of SAEs was not increased in the exercise group. The risk of failure to reach surgery was 5 21 per cent in the control group (risk ratio (RR) 0·23, 95 per cent c.i. 0·04 to 1·29), the risk of preoperative hospital admission was 15 38 per cent respectively (RR 0·39, 0·12 to 1·23) and the risk of postoperative complications was 58 57 per cent (RR 1·06, 0·61 to 1·73). The exercise group attended a mean of 17·5 sessions, and improved fitness, muscle strength and Functional Assessment of Cancer Therapy - Esophageal (FACT-E) total score compared with the baseline level.
Preoperative exercise training during neoadjuvant treatment in patients with GOJ cancer is safe and feasible, with improvements in fitness, strength and quality of life. Preoperative exercise training may be associated with a lower risk of critical SAEs that preclude surgery or result in hospitalization.
新辅助化疗或放化疗广泛用于胃食管交界癌（GOJ）肿瘤切除前。需要有策略地提高治疗耐受性。本研究检验了 GOJ 癌症患者新辅助治疗期间术前运动训练的安全性和可行性。
患者被分配到标准护理对照组或运动组，运动组除标准护理外，还接受每周两次的高强度有氧运动和抗阻训练。主要终点是发生无法手术的严重不良事件（SAE）的发生率，包括死亡、疾病进展或身体恶化。还记录了术前住院、术后并发症、患者报告的生活质量变化和病理治疗反应。在运动组中，测量了对运动的依从性以及有氧运动能力、肌肉力量和身体成分的变化。
运动组的 SAE 发生率没有增加。对照组未能达到手术的风险为 5 21%（风险比（RR）0·23，95%置信区间 0·04 至 1·29），术前住院的风险分别为 15 38%（RR 0·39，0·12 至 1·23），术后并发症的风险为 58 57%（RR 1·06，0·61 至 1·73）。运动组平均参加了 17·5 次训练，与基线相比，其体能、肌肉力量和癌症治疗功能评估-食管（FACT-E）总分均有所提高。
GOJ 癌症患者新辅助治疗期间的术前运动训练是安全且可行的，可提高体能、力量和生活质量。术前运动训练可能与降低无法手术或导致住院的严重 SAE 风险相关。
