Early body weight loss during concurrent chemo‐radiotherapy for non‐small cell lung cancer

Abstract

Background and purposeRadiation-esophagitis and weight loss are frequently observed toxicities in patients treated with concurrent chemo-radiotherapy (CT-RT) for non-small cell lung cancer (NSCLC) and might be related. The purpose was to investigate whether weight loss already starts early after initiation of CT-RT and precedes radiation-esophagitis.Materials and methodsIn a retrospective cohort, weight and esophagitis grade ≥2 were assessed during the first weeks of (CT-)RT in patients treated with concurrent (n = 102) or sequential (n = 92) therapy. In a prospective validation study, data on body weight, esophagitis grade ≥2, nutritional intake and muscle strength were obtained before, during and following CT-RT.ResultsIn the retrospective cohort, early weight loss was observed in concurrently treated patients (p = 0.002), independent of esophagitis ≥ grade 2. Early weight loss was also observed in the prospective cohort (p = 0.003) and was not accompanied by decreases in nutritional intake. In addition lower limb muscle strength rapidly declined (p = 0.042). In the later weeks of treatment, further body weight loss occurred (p < 0.001) despite increased nutritional supplementation and body weight was only partly recovered after 4 weeks post CT-RT (p = 0.003).ConclusionsWeight loss during concurrent CT-RT for NSCLC starts early and prior to onset of esophagitis, requiring timely and intense nutritional rehabilitation.Electronic supplementary materialThe online version of this article (doi:10.1007/s13539-013-0127-5) contains supplementary material.

Skeletal muscle depletion during chemotherapy has a large impact on physical function in elderly Japanese patients with advanced non–small-cell lung cancer

“…Weight loss during cancer treatment is commonly observed in patients with lung cancer receiving chemotherapy [ 5 , 28 ] or thoracic radiotherapy [ 7 ], and is accompanied by a marked decrease in skeletal muscle mass [ 5 , 8 ]. Similarly, our patients had a significant decrease in body mass and skeletal muscle mass during the first 6–12 weeks of cancer treatment.…”

“…Patients with advanced non-small-cell lung cancer (NSCLC) frequently have cancer cachexia [ 4 , 5 ] and skeletal muscle depletion [ 5 , 6 ]. In addition, cancer treatment including radiotherapy [ 7 ], chemotherapy [ 8 ], and supportive care such as hospitalization [ 9 ] or the use of corticosteroids may cause muscle dysfunction [ 10 ]. Consequently, skeletal muscle depletion may cause physical dysfunction [ 11 – 14 ] and develop disability [ 15 – 17 ] before and during cancer treatment in NSCLC.…”

Early Weight Loss during Chemoradiotherapy Has a Detrimental Impact on Outcome in NSCLC

“…7 Nevertheless, our group has previously shown that weight loss may already occur in the first 3 weeks of CCRT, before onset of clinically relevant radiation esophagitis and irrespective of decreased dietary intake. 8 Furthermore, this early weight loss was accompanied by a rapid decline of muscle strength in the lower limbs. Taken together, the presence of weight loss and muscle weakness is indicative of early metabolic alterations that may warrant tailored nutritional or multimodal intervention.…”

Integrated Palliative Care and Oncologic Care in Non-Small-Cell Lung Cancer

“…Additionally, in advanced disease, the impact of these symptoms can be profound and can impact ability to deliver appropriate disease-modifying therapies [ 33 , 34 ]. It has also been noted that people with advanced cancer are often found to have fatty acid deficiency [ 35 ], which in various studies has been shown to affect nutritional status, functional status, physical activity, and quality of life in lung cancer patients during multimodality treatment [ 36 , 37 ].…”