Randomized clinical trial of exercise training during neoadjuvant treatment for gastroesophageal cancer: impact on tumor resection

Physical deterioration and disease progression during neoadjuvant treatment can preclude tumor surgery in patients with gastroesophageal cancer. Whether preoperative exercise training can increase the probability of undergoing tumor surgery is not known. The prospective randomized PRESET-RCT trial at Copenhagen University Hospital (Denmark) compared the impact of exercise training versus usual care on the likelihood of not undergoing tumor surgery with curative intent after neoadjuvant treatment for gastroesophageal cancer. Participants were randomized 1:1 to preoperative exercise training from diagnosis until tumor surgery (n=101) or control (n=101). In the exercise group, 10 participants (9.9%) did not undergo tumor surgery with curative intent, compared with 8 (7.9%) in the control group (OR 1.28; p=0.62). There were no between-group differences in permanent discontinuation of neoadjuvant treatment or postoperative complications. The overall survival rates at 3 years for the exercise and control group wer 51.0% and 65.0% (HR 1.58; 95% CI 1.02-2.45). The authors conclude that these findings do not support the use of exercise training during neoadjuvant treatment among patients with gastroesophageal cancer (visual abstract).