Low muscle mass is associated with early termination of chemotherapy related to toxicity in patients with head and neck cancer. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Sealy, Martine J.; Dechaphunkul, Tanadech; van der Schans, Cees P.; Krijnen, Wim P.; Roodenburg, Jan L.N.; Walker, John; Jager-Wittenaar, Harriët; Baracos, Vickie E.
• Is Part Of: Clinical nutrition. Volume 39:Issue 2(2020)
• Page Start: 501
• Page End: 509
• Publication Date: 2020-02
• Subjects: Computed tomography -- Muscle mass -- Body composition -- Chemotherapy -- Treatment toxicity -- Head and neck cancer; HNC head and neck cancer -- CT computed tomography -- CRT concomitant radiotherapy and chemotherapy treatment -- SxCRT concomitant radiotherapy and chemotherapy treatment with prior surgery -- T4 4th thoracic vertebra -- L3 3rd lumbar vertebra -- ECOG performance status Eastern Cooperative Oncology Group performance status -- BMI body mass index -- SMA skeletal muscle area -- SMI skeletal muscle index -- SCAD Smoothly Clipped Absolute Deviation -- AIC minimum Akaike Information Criterion -- BIC minimizing Bayesian Information Criterion; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2019.02.029
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: We studied whether low pre-treatment muscle mass, measured with CT at thoracic (T4) or lumbar level (L3) associates with early termination of chemotherapy related to toxicity in head and neck cancer (HNC) patients. Methods: This was a retrospective chart and image review. Adult HNC patients treated with (surgery and) platinum-based chemo-radiotherapy were included if a pre-treatment CT scan at T4 or L3 level was available. Muscle mass was evaluated by assessment of skeletal muscle index (SMI; cm 2 /m 2 ). T4 and L3 SMI measurements were corrected for deviation from their respective means and were merged into one score for SMI difference (cm 2 /m 2 ). All cases were assessed for presence of toxicity-related unplanned early termination of chemotherapy ('early termination'). Univariate and multivariate logistic regression models were used to investigate associations between pooled SMI and early termination. Results: 213 patients (age: 57.9 ± 10.3 y, male: 77%, T4 image: 45%) were included. A significant association between SMI as a continuous variable and early termination was found, both in the univariate analysis (p = 0.007, OR = 0.96 [0.94–0.99]) and the multivariate analysis (p = 0.021, OR 0.96 [0.92–0.99]). The multivariate models identified potential associations with type of chemotherapy, presence of co-morbidity, a combination of (former) smoking and alcohol consumption, and sex. Conclusion: Lower muscle mass was robustly associated with higher odds of early termination of chemotherapy in HNC patients. Further prospective studies are required to tailor the care for patients with low muscle mass and to avoid early termination of chemotherapy.