食管癌和直肠癌患者新辅助放化疗期间运动干预的可行性及临床潜力

Feasibility and clinical potential of exercise interventions during neoadjuvant chemoradiotherapy in patients with esophageal and rectal cancer.

作者信息

Mast Isa H, Gootjes Elske C, Rütten Heidi, den Hartogh Mariska D, Brouwer Calvin G, Nagtegaal Iris D, van der Post Rachel S, Hopman Maria T E, Heuvel Baukje van den, Rosman Camiel, de Wilt Johannes H W, Klarenbeek Bastiaan R, Buffart Laurien M

机构信息

Department of Medical BioSciences, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands.

Department of Medical Oncology, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands.

出版信息

J Sport Health Sci. 2025 May 24:101060. doi: 10.1016/j.jshs.2025.101060.

DOI:10.1016/j.jshs.2025.101060

PMID:40419137

Abstract

BACKGROUND

Exercise during neoadjuvant chemoradiotherapy (NCRT) has potential to mitigate treatment-related declines in physical fitness, and to improve clinical outcomes, including toxicity and tumor response. However, optimal frequency and timing of exercise remains to be determined. Therefore, this pilot trial aimed to assess feasibility of 2 different exercise interventions during NCRT in patients with esophageal and rectal cancer and to evaluate potential clinical effects.

METHODS

Patients were randomized into 1 of 3 study arms during NCRT: (a) 30-min aerobic exercise in-hospital within 1 h prior to each radiotherapy fraction (ExPR), (b) two 60-min supervised combined aerobic and resistance exercise sessions per week (AE+RE), and (c) usual care (UC). Feasibility was assessed by examining participation rate and exercise adherence. Intervention effects on physical fitness, health-related quality of life, treatment-related toxicity, and tumor response in patients with esophageal cancer were explored using regression analyses and 85% confidence intervals (85% CI).

RESULTS

Thirty-seven patients with esophageal cancer (participation rate: 45%) and 2 patients with rectal cancer (participation rate: 14%) were included. Median session attendance was 98% (interquartile range (IQR): 96-100) in the ExPR and 78% (IQR: 33-100) in the AE+RE group. We found clinically relevant benefits of exercise on maximal oxygen uptake (VO)(ExPR: β = 9.7 mL/kg/min, 85% CI: 6.9-12.6; AE+RE: β = 5.6 mL/kg/min, 85% CI: 2.6-8.5) and treatment-related toxicity (ExPR: β = -2.8, 85% CI: -5.4 to -0.2; AE+RE: β = -2.6, 85% CI: -5.3 to 0.0). Additionally, good tumor response was found in 70% in AE+RE and ExPR vs. 55% in UC (OR = 1.9, 85% CI: 0.5-7.7).

CONCLUSION

Starting prehabilitation during NCRT is feasible, can increase starting fitness of traditional pre-surgical programs, and has potential to improve clinical outcomes.

摘要

背景

新辅助放化疗（NCRT）期间进行运动有可能减轻与治疗相关的体能下降，并改善临床结局，包括毒性反应和肿瘤反应。然而，运动的最佳频率和时间仍有待确定。因此，这项试点试验旨在评估在食管癌和直肠癌患者的NCRT期间两种不同运动干预措施的可行性，并评估其潜在的临床效果。

方法

患者在NCRT期间被随机分为3个研究组之一：（a）每次放疗前1小时内在医院进行30分钟有氧运动（ExPR），（b）每周进行两次60分钟的有氧和抗阻联合监督运动（AE+RE），（c）常规护理（UC）。通过检查参与率和运动依从性来评估可行性。使用回归分析和85%置信区间（85%CI）探讨干预对食管癌患者体能、健康相关生活质量、治疗相关毒性和肿瘤反应的影响。

结果

纳入了37例食管癌患者（参与率：45%）和2例直肠癌患者（参与率：14%）。ExPR组的中位疗程出席率为98%（四分位间距（IQR）：96 - 100），AE+RE组为78%（IQR：33 - 100）。我们发现运动对最大摄氧量（VO）有临床相关益处（ExPR：β = 9.7 mL/kg/min，85%CI：6.9 - 12.6；AE+RE：β = 5.6 mL/kg/min，85%CI：2.6 - 8.5）以及对治疗相关毒性有影响（ExPR：β = -2.8，85%CI：-5.4至-0.2；AE+RE：β = -2.6，85%CI：-5.3至0.0）。此外，AE+RE组和ExPR组中70%的患者有良好的肿瘤反应，而UC组为55%（OR = 1.9，85%CI：0.5 - 7.7）。