Therapeutic evaluation of postoperative chemotherapy and chemoradiotherapy on cardiopulmonary complications in patients with esophageal squamous cell carcinoma

  • Gustavo Martins Aransiola Department of Biological Sciences, University de Brasilia, Asa Norte 70.910-900, Brazil
  • Mariana Alonso Nogueira Department of Biological Sciences, University de Brasilia, Asa Norte 70.910-900, Brazil
Keywords: chemotherapy, chemoradiotherapy, postoperative, esophageal cancer

Abstract

Background: Postoperative chemotherapy (pCT), together with chemoradiotherapy (pCRT), is well used for the treatment of squamous cell carcinoma in the esophagus. However, these adjuvant therapies may cause serious adverse effects resulting in higher postoperative morbidity.

Methods: In this study, we aim to assess and compare the postoperative cardiopulmonary complications as a result of pCT and pCRT in patients with esophageal cancer. PCT (n = 182) or pCRT (n = 153) was conducted to treat patients with esophageal cancer.

Results: A significantly higher percentage of pneumonia was diagnosed in patients with the pCRT treatment compared with pCT group (P < 0.01). In comparison to the pCT treated group, pCRT treatment patients showed significantly decreased early diastolic filling velocity (P < 0.01) and higher plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) (P < 0.01). Moreover, pCRT treatment was associated with higher pneumonia risk and increased NT-proBNP level significantly by a multivariate analysis.

Conclusion: pCRT treatment increased the percentage of cardiopulmonary complications in comparison with pCT treatment.

Downloads

Download data is not yet available.

References

Kumagai K, Rouvelas I, Tsai JA, Mariosa D, Klevebro F, Lindblad M, et al. Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers. Br J Surg. 2014;101(4):321–38. doi: 10.1002/bjs.9418

Song Y, Li L, Ou Y, Gao Z, Li E, Li X, et al. Identification of genomic alterations in oesophageal squamous cell cancer. Nature. 2014;509(7498):91–5. doi: 10.1038/nature13176

Worni M, Martin J, Gloor B, Pietrobon R, D’Amico TA, Akushevich I, et al. Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008. J Am Coll Surg. 2012;215(5):643–51. doi: 10.1016/j.jamcollsurg.2012.07.006

Chen H, Wang Z, Yang Z, Shang B, Liu X, Chen G. Prospective study of adjuvant radiotherapy on preventing lymph node metastasis after Ivor-lewis esophagectomy in esophageal cancer. Ann Surg Oncol. 2013;20(8):2721–6. doi: 10.1245/s10434-013-2928-3

Kurashige J, Kamohara H, Watanabe M, Tanaka Y, Kinoshita K, Saito S, et al. Serum microRNA-21 is a novel biomarker in patients with esophageal squamous cell carcinoma. J Surg Oncol. 2012;106(2):188–92. doi: 10.1002/jso.23064

Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19(1):68–74. doi: 10.1245/s10434-011-2049-9

Lv J, Cao XF, Zhu B, Ji L, Tao L, Wang DD. Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma. World J Gastroenterol. 2010;16(13):1649–54. doi: 10.3748/wjg.v16.i13.1649

Lyu X, Huang J, Mao Y, Liu Y, Feng Q, Shao K, et al. Adjuvant chemotherapy after esophagectomy: is there a role in the treatment of the lymph node positive thoracic esophageal squamous cell carcinoma? J Surg Oncol. 2014;110(7):864–8. doi: 10.1002/jso.23716

Xu Y, Liu J, Du X, Sun X, Zheng Y, Chen J, et al. Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer. Radiat Oncol. 2013;8:116. doi: 10.1186/1748-717X-8-116

Zhang SS, Yang H, Xie X, Luo KJ, Wen J, Bella AE, et al. Adjuvant chemotherapy versus surgery alone for esophageal squamous cell carcinoma: a meta-analysis of randomized controlled trials and nonrandomized studies. Dis Esophagus. 2014;27(6):574–84. doi: 10.1111/dote.12073

Klevebro F, Johnsen G, Johnson E, Viste A, Myrnas T, Szabo E, et al. Morbidity and mortality after surgery for cancer of the oesophagus and gastro-oesophageal junction: a randomized clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiation. Eur J Surg Oncol. 2015;41(7):920–6. doi: 10.1016/j.ejso.2015.03.226

Lindner K, Fritz M, Haane C, Senninger N, Palmes D, Hummel R. Postoperative complications do not affect long-term outcome in esophageal cancer patients. World J Surg. 2014;38(10):2652–61. doi: 10.1007/s00268-014-2590-3

Booka E, Takeuchi H, Nishi T, Matsuda S, Kaburagi T, Fukuda K, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine (Baltimore). 2015;94(33):e1369. doi: 10.1097/MD.0000000000001369

Erven K, Jurcut R, Weltens C, Giusca S, Ector J, Wildiers H, et al. Acute radiation effects on cardiac function detected by strain rate imaging in breast cancer patients. Int J Radiat Oncol Biol Phys. 2011;79(5):1444–51. doi: 10.1016/j.ijrobp.2010.01.004

Jingu K, Nemoto K, Kaneta T, Oikawa M, Ogawa Y, Ariga H, et al. Temporal change in brain natriuretic Peptide after radiotherapy for thoracic esophageal cancer. Int J Radiat Oncol Biol Phys. 2007;69(5):1417–23. doi: 10.1016/j.ijrobp.2007.05.054

Collinson PO, Gaze DC. Biomarkers of cardiovascular damage and dysfunction – an overview. Heart Lung Circ. 2007;16(suppl 3):S71–82. doi: 10.1016/j.hlc.2007.05.006

Bosch DJ, Muijs CT, Mul VE, Beukema JC, Hospers GA, Burgerhof JG, et al. Impact of neoadjuvant chemoradiotherapy on postoperative course after curative-intent transthoracic esophagectomy in esophageal cancer patients. Ann Surg Oncol. 2014;21(2):605–11. doi: 10.1245/s10434-013-3316-8

Lund M, Alexandersson von Dobeln G, Nilsson M, Winter R, Lundell L, Tsai JA, et al. Effects on heart function of neoadjuvant chemotherapy and chemoradiotherapy in patients with cancer in the esophagus or gastroesophageal junction – a prospective cohort pilot study within a randomized clinical trial. Radiat Oncol. 2015;10:16. doi: 10.1186/s13014-014-0310-7

Pultrum BB, Bosch DJ, Nijsten MW, Rodgers MG, Groen H, Slaets JP, et al. Extended esophagectomy in elderly patients with esophageal cancer: minor effect of age alone in determining the postoperative course and survival. Ann Surg Oncol. 2010;17(6):1572–80. doi: 10.1245/s10434-010-0966-7

Bosch DJ, Pultrum BB, de Bock GH, Oosterhuis JK, Rodgers MG, Plukker JT. Comparison of different risk-adjustment models in assessing short-term surgical outcome after transthoracic esophagectomy in patients with esophageal cancer. Am J Surg. 2011;202(3):303–9. doi: 10.1016/j.amjsurg.2011.04.003

Van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, Van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84. doi: 10.1056/NEJMoa1112088

Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000;232(2):225–32. doi: 10.1097/00000658-200008000-00013

Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004;88(2):71–7. doi: 10.1002/jso.20137

Lerut T, Moons J, Coosemans W, Van Raemdonck D, De Leyn P, Decaluwe H, et al. Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg. 2009;250(5):798–807. doi: 10.1097/SLA.0b013e3181bdd5a8

Reynolds JV, Ravi N, Hollywood D, Kennedy MJ, Rowley S, Ryan A, et al. Neoadjuvant chemoradiation may increase the risk of respiratory complications and sepsis after transthoracic esophagectomy. J Thorac Cardiovasc Surg. 2006;132(3):549–55. doi: 10.1016/j.jtcvs.2006.05.015

Vande Walle C, Ceelen WP, Boterberg T, Vande Putte D, Van Nieuwenhove Y, Varin O, et al. Anastomotic complications after Ivor Lewis esophagectomy in patients treated with neoadjuvant chemoradiation are related to radiation dose to the gastric fundus. Int J Radiat Oncol Biol Phys. 2012;82(3):e513–9. doi: 10.1016/j.ijrobp.2011.05.071

Lee HK, Vaporciyan AA, Cox JD, Tucker SL, Putnam JB, Jr., Ajani JA, et al. Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose-volume histogram parameters. Int J Radiat Oncol Biol Phys. 2003;57(5):1317–22. doi: 10.1016/S0360-3016(03)01373-7

Wang JZ, Li XA, D’Souza WD, Stewart RD. Impact of prolonged fraction delivery times on tumor control: a note of caution for intensity-modulated radiation therapy (IMRT). Int J Radiat Oncol Biol Phys. 2003;57(2):543–52. doi: 10.1016/S0360-3016(03)00499-1

Wei X, Liu HH, Tucker SL, Wang S, Mohan R, Cox JD, et al. Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2008;70(3):707–14. doi: 10.1016/j.ijrobp.2007.10.056

Hatakenaka M, Yonezawa M, Nonoshita T, Nakamura K, Yabuuchi H, Shioyama Y, et al. Acute cardiac impairment associated with concurrent chemoradiotherapy for esophageal cancer: magnetic resonance evaluation. Int J Radiat Oncol Biol Phys. 2012;83(1):e67–73. doi: 10.1016/j.ijrobp.2011.12.018

Karthikeyan G, Moncur RA, Levine O, Heels-Ansdell D, Chan MT, Alonso-Coello P, et al. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-analysis of observational studies. J Am Coll Cardiol. 2009;54(17):1599–606. doi: 10.1016/j.jacc.2009.06.028

Ryding AD, Kumar S, Worthington AM, Burgess D. Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis. Anesthesiology. 2009;111(2):311–9. doi: 10.1097/ALN.0b013e3181aaeb11

Cai GL, Chen J, Hu CB, Yan ML, Xu QH, Yan J. Value of plasma brain natriuretic peptide levels for predicting postoperative atrial fibrillation: a systemic review and meta-analysis. World J Surg. 2014;38(1):51–9. doi: 10.1007/s00268-013-2284-2

Liedman B, Johnsson E, Merke C, Ruth M, Lundell L. Preoperative adjuvant radiochemotherapy may increase the risk in patients undergoing thoracoabdominal esophageal resections. Dig Surg. 2001;18(3):169–75. doi: 10.1159/000050125

Liedman BL, Bennegard K, Olbe LC, Lundell LR. Predictors of postoperative morbidity and mortality after surgery for gastro-oesophageal carcinomas. Eur J Surg. 1995;161(3):173–80.

Published
2023-07-03
How to Cite
AransiolaG. M., & NogueiraM. A. (2023). Therapeutic evaluation of postoperative chemotherapy and chemoradiotherapy on cardiopulmonary complications in patients with esophageal squamous cell carcinoma. STEMedicine, 4(3), e181. https://doi.org/10.37175/stemedicine.v4i3.181
Section
Research articles