Purpose
Gold standard chemotherapy dosage is based on body surface area (BSA); however many patients experience dose-limiting toxicities (DLT). We aimed to evaluate the effectiveness of BSA, two-dimensional (2D) and three-dimensional (3D) body composition (BC) measurements derived from Lumbar 3 vertebra (L3) computed tomography (CT) slices, in predicting DLT in colon cancer patients.
Methods
203 patients (60.87 ± 12.42 years; 97 males, 47.8%) receiving adjuvant chemotherapy (Oxaliplatin and/or 5-Fluorouracil) were retrospectively evaluated. An artificial intelligence segmentation model was used to extract 2D and 3D body composition measurements from each patients' single mid-L3 CT slice as well as multiple-L3 CT scans to produce a 3D BC report. DLT was defined as any incidence of dose reduction or discontinuation due to chemotherapy toxicities. A receiver operating characteristic (ROC) analysis was performed on BSA and individual body composition measurements to demonstrate their predictive performance.
Results
A total of 120 (59.1%) patients experienced DLT. Age and BSA did not vary significantly between DLT and non-DLT group. Females were significantly more likely to experience DLT (p = 4.9 × 10–3). In all patients, the predictive effectiveness of 2D body composition measurements (females: AUC = 0.50–0.54; males: AUC = 0.50–0.61) was equivalent to that of BSA (females: AUC = 0.49; males: AUC = 0.58). The L3 3D skeletal muscle volume was the most predictive indicator of DLT (AUC of 0.66 in females and 0.64 in males).
Conclusion
Compared to BSA and 2D body composition measurements, 3D L3 body composition measurements had greater potential to predict DLT in CRC patients receiving chemotherapy and this was sex dependent.
Objectives:To review the outcome of patients with locally advanced rectal cancer who underwent short-course preoperative radiotherapy (SCPRT) with delayed total mesorectal excision. Methods: Consecutive patients with locally advanced rectal cancer who underwent SCPRT with delayed surgery between January 2011 and November 2014 in Tuen Mun Hospital were retrospectively reviewed. Results: Overall, 18 men and five women aged 36 to 88 years underwent SCPRT with delayed surgery owing to advanced age (n = 10), poor performance status (n = 7), and severe comorbidity (n = 6). All patients had at least one risk factor: threatened mesorectal fascia (n = 20), tumour stage 4 (n = 4), lymph node stage 2 (n = 7), and low-lying tumour (n = 5). After SCPRT, 19 of the 23 patients underwent anterior resection (n = 13) or abdominalperianal resection (n = 6) at a median of 11 weeks and achieved R0 (n = 17) or R1 (n = 2) resection. During a median follow-up of 13 months, eight patients died due to metastasis (n = 5), medical condition without evidence of progression (n = 2), or postoperative complications (n = 1). The median survival time of the 23 patients was 34 months. The 1-year overall survival was 75.1%; the 1-year cancer-specific survival was 82.5%; and the 1-year progression-free survival was 79.3%. In 19 patients who underwent resection, six developed metastatic disease. Two patients had local recurrence who also had synchronous distant metastasis. All patients completed SCPRT without interruption. Two patients had grade 3 or above toxicity: one had perforated bowel requiring emergency operation at 3 weeks and another had grade 3 leukopenia without evidence of sepsis. In the postoperative period (≤30 days), eight patients developed surgical complications including anastomotic leakage (n = 2), septic complications (n = 3), persistent perianal infection (n = 1), and ileus (n = 2). One patient died at postoperative day 12 due to myocardial infarction. One patient developed severe late radiotherapy-related toxicity of burst stump and pelvic abscess at 5 months. Conclusion: SCPRT with delayed surgery can downsize and downstage locally advanced rectal cancer and achieve a favourable toxicity profile. It is a viable option for patients who are unfit for preoperative long-course chemoradiotherapy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.