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      The impact of sarcopenia on survival and treatment tolerance in patients with head and neck cancer treated with chemoradiotherapy

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          Abstract

          Background

          Sarcopenia appears to be a negative prognostic factor for poor survival outcomes and worse treatment tolerance in patients with head‐and‐neck squamous cell carcinoma (HNSCC). We evaluated sarcopenia's impact on overall survival (OS), disease‐free survival (DFS) and chemo‐radiation tolerance in patients with head‐and‐neck cancer (HNC) treated with chemoradiotherapy (CRT) from a monocentric observational study.

          Methods

          We identified patients with HNC treated by CRT between 2009 and 2018 with pretreatment imaging using positron emission tomography–computed tomography scans (PET/CT). Sarcopenia was measured using the pretreatment PET/CT at the L3 vertebral body using previously published methods. Clinical variables were retrospectively retrieved.

          Results

          Of 216 patients identified, 54 patients (25.47%) met the criteria for sarcopenia. These patients had a lower mean body mass index before treatment (21.92 vs. 25.65 cm/m 2, p < 0.001) and were more likely to have a history of smoking (88.89% vs. 71.52%, p = 0.01), alcohol use (55.56% vs. 38.61%, p = 0.03) and positive human papilloma virus status (67.74% vs. 41.75%, p = 0.011). At 3 years of follow‐up, OS and DFS were 75% and 70% versus 82% and 85% for sarcopenic and non‐sarcopenic patients, respectively ( p = 0.1 and p = 0.00015). On multivariate analysis, sarcopenia appeared as a pejorative factor on DFS (hazard ratio 2.174, p = 0.0001) in the overall cohort. Sarcopenic patients did not require more chemotherapy and radiation‐treatment interruptions and did not suffer from more chemo‐induced and radiation‐induced grade 3–4 toxicities than their non‐sarcopenic counterparts.

          Conclusion

          Sarcopenia in HNSCC patients is an independent adverse prognostic factor for DFS after definitive chemoradiotherapy.

          Abstract

          Sarcopenia in patients with head‐and‐neck squamous cell carcinoma treated by definitive chemoradiotherapy is an independent negative prognostic factor for disease‐free survival. Sarcopenic patients did not have more grade 3+ toxicities or more treatment interruptions.

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          The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.

          Stephen B. Edge, Carolyn C. Compton (2010)
          The American Joint Committee on Cancer and the International Union for Cancer Control update the tumor-node-metastasis (TNM) cancer staging system periodically. The most recent revision is the 7th edition, effective for cancers diagnosed on or after January 1, 2010. This editorial summarizes the background of the current revision and outlines the major issues revised. Most notable are the marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping. The future of cancer staging lies in the use of enhanced registry data standards to support personalization of cancer care through cancer outcome prediction models and nomograms.
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            Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image.

            Wei Shen, Mark Punyanitya, ZiMian Wang … (2004)
            A single abdominal cross-sectional computerized axial tomography and magnetic resonance image is often obtained in studies examining adipose tissue (AT) distribution. An abdominal image might also provide additional useful information on total body skeletal muscle (SM) and AT volumes with related physiological insights. We therefore investigated the relationships between abdominal SM and AT areas from single images and total body component volumes in a large and diverse sample of healthy adult subjects. Total body SM and AT volumes were derived by whole body multislice magnetic resonance imaging in 123 men [age (mean +/- SD) of 41.6 +/- 15.8 yr; body mass index of 25.9 +/- 3.4 kg/m(2)] and 205 women (age of 47.8 +/- 18.7 yr; body mass index of 26.7 +/- 5.6 kg/m(2)). Single abdominal SM and AT slice areas were highly correlated with total body SM (r = 0.71-0.92; r = 0.90 at L(4)-L(5) intervertebral space) and AT (r = 0.84-0.96; r = 0.94 at L(4)-L(5) intervertebral space) volumes, respectively. R(2) increased by only 5.7-6.1% for SM and 2.7-4.4% for AT with the inclusion of subject sex, age, ethnicity, scanning position, body mass index, and waist circumference in the model. The developed SM and AT models were validated in an additional 49 subjects. To achieve equivalent power to a study measuring total body SM or AT volumes, a study using a single abdominal image would require 17-24% more subjects for SM and 6-12% more subjects for AT. Measurement of a single abdominal image can thus provide estimates of total body SM and AT for group studies of healthy adults.
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              An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer.

              David J Adelstein, Yi Li, George Adams … (2003)
              The Head and Neck Intergroup conducted a phase III randomized trial to test the benefit of adding chemotherapy to radiation in patients with unresectable squamous cell head and neck cancer. Eligible patients were randomly assigned between arm A (the control), single daily fractionated radiation (70 Gy at 2 Gy/d); arm B, identical radiation therapy with concurrent bolus cisplatin, given on days 1, 22, and 43; and arm C, a split course of single daily fractionated radiation and three cycles of concurrent infusional fluorouracil and bolus cisplatin chemotherapy, 30 Gy given with the first cycle and 30 to 40 Gy given with the third cycle. Surgical resection was encouraged if possible after the second chemotherapy cycle on arm C and, if necessary, as salvage therapy on all three treatment arms. Survival data were compared between each experimental arm and the control arm using a one-sided log-rank test. Between 1992 and 1999, 295 patients were entered on this trial. This did not meet the accrual goal of 362 patients and resulted in premature study closure. Grade 3 or worse toxicity occurred in 52% of patients enrolled in arm A, compared with 89% enrolled in arm B (P <.0001) and 77% enrolled in arm C (P <.001). With a median follow-up of 41 months, the 3-year projected overall survival for patients enrolled in arm A is 23%, compared with 37% for arm B (P =.014) and 27% for arm C (P = not significant). The addition of concurrent high-dose, single-agent cisplatin to conventional single daily fractionated radiation significantly improves survival, although it also increases toxicity. The loss of efficacy resulting from split-course radiation was not offset by either multiagent chemotherapy or the possibility of midcourse surgery.
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                Author and article information

                Contributors
                Catherine Durdux: catherine.durdux@aphp.fr
                Journal
                Journal ID (nlm-ta): Cancer Med
                Journal ID (iso-abbrev): Cancer Med
                Journal ID (doi): 10.1002/(ISSN)2045-7634
                Journal ID (publisher-id): CAM4
                Title: Cancer Medicine
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2045-7634
                Publication date (Electronic): 20 October 2022
                Publication date Collection: February 2023
                Volume: 12
                Issue: 4 ( doiID: 10.1002/cam4.v12.4 )
                Pages: 4170-4183
                Affiliations
                [ 1 ] Department of Radiation Oncology European Georges Pompidou Hospital Paris France
                [ 2 ] Department of Nuclear Medicine Henri Becquerel Cancer Center Rouen France
                Author notes
                [*] [* ] Correspondence

                Catherine Durdux, Department of Radiation Oncology, European Georges Pompidou Hospital, AP‐HP, 20 Rue Leblanc, 75015 Paris, France.

                Email: catherine.durdux@ 123456aphp.fr

                Author information
                https://orcid.org/0000-0003-3787-5962
                Article
                Publisher ID: CAM45278 Other ID: CAM4-2022-04-1740.R1
                DOI: 10.1002/cam4.5278
                PMC ID: 9972161
                PubMed ID: 36263581
                SO-VID: 8249f4ea-c708-4f90-bab2-4b0ced412c96
                Copyright © © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 17 June 2022
                Date received : 28 April 2022
                Date accepted : 24 June 2022
                Page count
                Figures: 2, Tables: 4, Pages: 14, Words: 5520
                Categories
                Subject: Research Article
                Subject: RESEARCH ARTICLES
                Subject: Clinical Cancer Research
                Custom metadata
                source-schema-version-number 2.0
                cover-date February 2023
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.5 mode:remove_FC converted:28.02.2023

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: head and neck cancer,radiotherapy,sarcopenia,survival,toxicities
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: head and neck cancer, radiotherapy, sarcopenia, survival, toxicities

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