Neoadjuvant/adjuvant chemotherapy for gastroesophageal cancers leads to improvement in overall survival and is currently a standard practice. We performed a retrospective study at the Clatterbridge Cancer Centre to examine its safety and identify risk factors.
Patients with gastroesophageal cancers who received cisplatin/5-FU based neoadjuvant and/or adjuvant chemotherapy were identified from electronic records. We looked at the number of emergency hospital admissions and death events within 30 days from receiving chemotherapy. Information was collected from hospital registry data and medical notes. We also looked at performance status (PS) (0/1 versus ≥ 2) and age (continuous variable) as potential factors for predicting the risk of death.
We identified 1121 patients May 2002- Feb 2015. 73% were male; PS 0-1 in 91%, 2 in 6% and unknown in 3%; median age 64 years (16-81). 62% received cisplatin/5FU or cisplatin/capecitabine (as in the OEO2 Trial) and 38% received epirubicin/cisplatin/capecitabine (as in the MAGIC Trial). Mortality data was available for all patients whereas admission data was available for only 360 patients. There were 98 30-day admissions and these affected 83 patients (23%). The 3 most common causes for admissions were: Gastrointestinal toxicities 45%, infection 15% and vascular events 10%. There were 31 30-day death events (2.8%). There was no difference in mortality rates according to PS but older age was associated with a higher incidence of death (Mann-Whitney test: P = 0.002). The median age for patients who died within 30 days from chemotherapy was 69 years. The group of patients ≥ 70 years (26% of the study population) had an odds ratio of 2.37 for dying compared with patients < 70 years.
In our experience, mortality rate after neoadjuvant/adjuvant chemotherapy for gastroesophageal cancers was similar to that reported in landmark studies: In OEO2 3% of patients died before surgery and in MAGIC 1.6% died within 60 days from chemotherapy. PS did not seem to predict risk of death but this can be attributed to the good selection of patients as only 6% had a PS of 2. Patients ≥ 70 years had a higher risk of death and this should be taken into consideration when assessing patients for chemotherapy.
Clinical trial identification
Legal entity responsible for the study
Clinical Effectiveness Department, The Clatterbridge Cancer Centre NHS Foundation Trust
All authors have declared no conflicts of interest.