para-aortic nodal involvement (but not VA or SQA indices) were predictors of worse OS on multivariable analysis. Patients with sarcopenia did not have more treatment-related grade 2 and above (48.2% vs 45.7%, p Z 0.84) or grade 3 and above toxicities (24.7% vs 25.7%, p Z 1.0); however, low VA and SQA indices were both associated with increased grade 3 and higher treatment-related toxicities (p Z 0.02 and p<0.01, respectively). Conclusion: Sarcopenia is an independent risk factor for worse OS and PFS among patients treated with CRT for LACC, but does not appear to increase treatment-related toxicity. In contrast, increased VA and SQA may be protective from treatment-related toxicities. While these body composition factors are not easily modifiable at time of cancer diagnosis, they can help guide prognosis. Disruptions in body composition may warrant interventions such as dietary modification or exercise. Prospective studies are needed to investigate tailored treatment planning in terms of radiotherapy volumes, dose, and fractionation in the setting of sarcopenia and low VA and SQA.
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