Low skeletal muscle mass is a predictive factor for chemotherapy dose-limiting toxicity in patients with locally advanced head and neck cancer. (August 2017)

• Record Type: Journal Article
• Authors: Wendrich, Anne W.; Swartz, Justin E.; Bril, Sandra I.; Wegner, Inge; de Graeff, Alexander; Smid, Ernst J.; de Bree, Remco; Pothen, Ajit J.
• Is Part Of: Oral oncology. Volume 71(2017)
• Page Start: 26
• Page End: 33
• Publication Date: 2017-08
• Subjects: Sarcopenia -- Skeletal muscle mass -- Lean body mass -- Head and neck neoplasms -- Radiochemotherapy -- Chemotherapy dose-limiting toxicity -- Computer-assisted image analysis; SMM skeletal muscle mass -- CDLT chemotherapy dose-limiting toxicity -- HNSCC head and neck squamous cell carcinoma -- LA-HNSCC locally advanced head and neck squamous cell carcinoma -- RCT radiochemotherapy -- C3 third cervical vertebra -- L3 third lumbar vertebra -- CSA cross-sectional area -- HU Hounsfield Units -- OS overall survival -- LBM lean body mass; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2017.05.012
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Low skeletal muscle mass is an independent risk factor for chemotherapy dose-limiting toxicity. Patients experiencing chemotherapy dose-limiting toxicity have a lower overall survival. Estimation of skeletal muscle mass on CT-scans may identify patients at risk of chemotherapy dose-limiting toxicity. Abstract: Objectives: Low skeletal muscle mass (SMM) or sarcopenia is emerging as an adverse prognostic factor for chemotherapy dose-limiting toxicity (CLDT) and survival in cancer patients. Our aim was to determine the impact of low SMM on CDLT in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) treated with primary radiochemotherapy (RCT). Patients and methods: Consecutive patients diagnosed with LA-HNSCC and treated with primary RCT between 2007 and 2011 in our center were included. Clinical variables were retrospectively retrieved and SMM was measured at the level of the third cervical vertebra using pre-treatment head and neck CT-scans. After determining a cut-off value for low SMM, multivariate analysis was performed to identify prognostic factors for CDLT. Results: Of 112 patients included, 30.4% experienced CDLT. The optimal cut-off value for low SMM as a predictor of CDLT was ≤43.2 cm 2 /m 2 . Using this cut-off, 54.5% patients had low SMM. Patients with low SMM experienced CDLT more frequently than patients with normal SMM (44.3% vs. 13.7%, p < 0.001) and received a higher dose of chemotherapy/kg lean body mass (estimated from SMM, p = 0.044). At multivariate analysis, low SMM was independently inversely associated with CDLT (OR 0.93, 95%CI: 0.88–0.98). Patients experiencing CDLT had a lower overall survival than patients who did not (mean 36.6 vs. 54.2 months, p = 0.038). Conclusion: Low SMM is an independent risk factor for CDLT in LA-HNSCC patients treated with primary RCT. Pre-therapeutic estimation of SMM using routine CT-scans of the head and neck region may identify patients at risk of CDLT.