• Respiratory care · Aug 2016

    Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study.

    • Isabelle Fresard, Marc Licker, Dan Adler, Alban Lovis, John Robert, Wolfram Karenovics, John Diaper, Jean-Paul Janssens, Frederic Triponez, Frederic Lador, Thierry Rochat, Vicente Espinosa, Chetna Bhatia, Bengt Kayser, and Pierre-Olivier Bridevaux.
    • Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. Division of Pulmonary Medicine, Hôpital de La Tour, Geneva, Switzerland. isabelle.fresard@latour.ch.
    • Respir Care. 2016 Aug 1; 61 (8): 1059-66.

    BackgroundIn non-small-cell lung cancer patients, high peak oxygen uptake (peak V̇O2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V̇O2 .MethodsCardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC+, n = 19; NAC-, n = 15).ResultsAdjusted peak V̇O2 was lower in NAC + compared with NAC- subjects (-5.3 mL/min/kg [95% CI -8.3 to -2.2], P = .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC+ subjects, whereas peak heart rate and breathing reserve were similar. NAC+ subjects presented lower values of diffusion capacity for carbon monoxide (DLCO) (P = .035) and hemoglobin concentrations (P < .001). DLCO was strongly correlated with peak V̇O2 (r(2) = 0.56). Adjustment for DLCO reduced the effect of NAC on peak V̇O2 without suppressing it.ConclusionsNAC was associated with lower preoperative peak V̇O2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.Copyright © 2016 by Daedalus Enterprises.

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