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

Wendrich, Anne W.; Swartz, Justin E.; Bril, Sandra I.; Wegner, Inge; Graeff, Alexander de; Smid, Ernst J.; Bree, Remco de; Pothen, Ajit J.

doi:10.1016/j.oraloncology.2017.05.012

Cited by 185 publications

(298 citation statements)

References 44 publications

Supporting

Mentioning

267

Contrasting

Unclassified

Order By: Relevance

“…In our study, patients with sarcopenia, cachexia, and low muscle attenuation presented higher toxicity values compared to their controls, however without statistical significance for most variables. This result may be partly attributed to good control of the chemotherapy treatment dosage which minimized the adverse effects, since the relationship between reduced muscle mass and toxicity to chemotherapy is known . Other studies have shown similar results, finding body composition that is predictive of Grades 3–4 toxicities in colorectal cancer patients .…”

Section: Discussionmentioning

confidence: 66%

“…Differences in body composition have been frequently related in studies, and a probable explanation for toxicities is based on pharmacokinetics of dosing chemotherapy when calculated using body surface area parameters of fat‐free mass, which really represents the distribution volume of cytotoxic chemotherapy drugs . The presence of sarcopenia that requires low muscle mass as well as evidence of low muscle strength or physical performance, is believed to be associated with higher chemotoxicity . However, most of the studies which have evaluated the associations between body composition and toxicity are retrospective studies and did not include other conditions associated with muscle mass loss such as the presence of cachexia, or muscle attenuation .…”

Section: Introductionmentioning

confidence: 99%

“…Other common condition in cancer patients is cachexia, recognized by previous studies as a multifactorial and often irreversible syndrome characterized by inflammation and loss of muscle with or without the loss of fat mass leading to progressive functional impairment . Another characteristic of cachexia would be involuntary weight loss in the absence of simple starvation, and this assessment may be difficult in clinical practice, especially for investigation in retrospective studies.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study

Rocha

Marcadenti

Medeiros

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

Background Chemotherapy is an effective treatment with good clinical response in patients with cancer. However, it can cause exacerbated toxicities in patients and consequently change the course of treatment. Some factors may interfere with this toxicity such as body composition, especially in gastrointestinal cancer. The aim of this study was to evaluate the effects of body composition, nutritional status, and functional capacity scale in predicting the occurrence of toxicities in gastrointestinal cancer patients during chemotherapy treatment. Methods This is a prospective study with gastrointestinal cancer patients at the beginning of chemotherapy treatment. Sarcopenia and muscle attenuation were assessed using the skeletal muscle index from computerized tomography by measuring cross‐sectional areas of the L3 tissue (cm 2 /m 2 ). Cachexia was graded according to involuntary weight loss associated with sarcopenia. Nutritional status was assessed by using anthropometric evaluation and Patient‐Generated Subjective Global Assessment. Functional capacity was evaluated by handgrip strength and Eastern Cooperative Oncology Group (ECOG) Performance Status scale. Haematological gastrointestinal and dose‐limiting toxicities (DLTs) were defined according to National Cancer Institute Common Toxicity Criteria. The associations among sarcopenia, cachexia, nutritional status, and functional capacity with DLT were assessed by univariate and multivariate Cox regression model. Results A total of 60 patients were evaluated (55% male, 60.9 ± 14.0 years) and followed up for a mean of 55 days. Most patients had normal weight (44.2%) and good ECOG Performance Status (≤1) at baseline (78%). During the chemotherapy period, the most prevalent toxicities were diarrhoea, nausea, and anorexia, but the presence of DLT was similar between cycles ( P > 0.05). Cachexia was associated with a higher toxicity manifested by diarrhoea ( P = 0.02), nausea ( P = 0.02), and anorexia ( P < 0.01 and P = 0.03 at Cycles 1 and 2, respectively). Sarcopenic and cachetic individuals experienced more toxicities and DLT during chemotherapy. The only factors associated with DLT in the multivariate Cox regression analyses including the presence of metastasis and the chemotherapy protocol were cachexia and the ECOG scale ( P < 0.001 for both). Conclusions Cachexia and ECOG score may identify patients with an increased risk for developing severe toxicity events during chemotherapy treatment for gastrointestinal cancer.

show abstract

Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study

Rocha

Marcadenti

Medeiros

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

show abstract

“…It can be anticipated that both are at least partly related to sarcopenia. The first study using the C3 measurement method to assess SMM in HNC patients undergoing chemoradiotherapy found that low SMM was an independent predictor of the occurrence of chemotherapy dose-limiting toxicity [21]. A recent study in HNC patients undergoing laryngectomy for laryngeal cancer showed that low SMM, as measured at the level of L3, was an independent predictor of the occurrence of a pharyngocutaneous fistula and of the occurrence of any wound complication [31].…”

Section: Discussionmentioning

confidence: 99%

“…This method allows for evaluation of SMM in HNC patients on routinely performed imaging, in a similar manner as is used in patients with other types of cancer. This measurement method for SMM was recently used in three studies in head and neck cancer patients [21–23]. …”

Section: Introductionmentioning

confidence: 99%

Interobserver agreement of skeletal muscle mass measurement on head and neck CT imaging at the level of the third cervical vertebra

Bril

Wendrich

Swartz

et al. 2019

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

ObjectivesSkeletal muscle mass (SMM) is most often assessed in cancer patients on abdominal computed tomography (CT) imaging at the level of the third lumbar vertebra (L3). Abdominal CT imaging is not routinely performed in head and neck cancer (HNC) patients. Recently, a novel method to assess SMM on a single transversal CT slice at the level of the third cervical vertebra (C3) was published. The objective of this study was to assess the robustness of this novel C3 measurement method in terms of interobserver agreement.Patients and methodsPatients diagnosed with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) at our center between 2007 and 2011 were evaluated. Fifty-four patients with were randomly selected for analysis. Six observers independently measured the cross-sectional muscle area (CSMA) at the level of C3 using a predefined, written protocol as instruction. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs), a Bland–Altman plot and Fleiss’ kappa (κ).ResultsThe agreement in vertebra selection between all observers was excellent (Fleiss’ κ: 0.96). There was a substantial agreement between all observers in single slice selection (Fleiss’ κ: 0.61). For all CSMA measurements, ICCs were excellent (0.763–0.969; all p < 0.001). The Bland–Altman plot showed good agreement between measurements, with narrow limits of agreement.ConclusionInterobserver agreement for SMM measurement at the level of C3 was excellent. Assessment of SMM at the level of C3 is easy and robust and can performed on routinely available imaging in HNC patients.

show abstract

Development and Validation of an Automated Image-Based Deep Learning Platform for Sarcopenia Assessment in Head and Neck Cancer

Saraf

Ravipati

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceSarcopenia is an established prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC); the quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical skeletal muscle segmentation and cross-sectional area. However, manual muscle segmentation is labor intensive, prone to interobserver variability, and impractical for large-scale clinical use.ObjectiveTo develop and externally validate a fully automated image-based deep learning platform for cervical vertebral muscle segmentation and SMI calculation and evaluate associations with survival and treatment toxicity outcomes.Design, Setting, and ParticipantsFor this prognostic study, a model development data set was curated from publicly available and deidentified data from patients with HNSCC treated at MD Anderson Cancer Center between January 1, 2003, and December 31, 2013. A total of 899 patients undergoing primary radiation for HNSCC with abdominal computed tomography scans and complete clinical information were selected. An external validation data set was retrospectively collected from patients undergoing primary radiation therapy between January 1, 1996, and December 31, 2013, at Brigham and Women’s Hospital. The data analysis was performed between May 1, 2022, and March 31, 2023.ExposureC3 vertebral skeletal muscle segmentation during radiation therapy for HNSCC.Main Outcomes and MeasuresOverall survival and treatment toxicity outcomes of HNSCC.ResultsThe total patient cohort comprised 899 patients with HNSCC (median [range] age, 58 [24-90] years; 140 female [15.6%] and 755 male [84.0%]). Dice similarity coefficients for the validation set (n = 96) and internal test set (n = 48) were 0.90 (95% CI, 0.90-0.91) and 0.90 (95% CI, 0.89-0.91), respectively, with a mean 96.2% acceptable rate between 2 reviewers on external clinical testing (n = 377). Estimated cross-sectional area and SMI values were associated with manually annotated values (Pearson r = 0.99; P &lt; .001) across data sets. On multivariable Cox proportional hazards regression, SMI-derived sarcopenia was associated with worse overall survival (hazard ratio, 2.05; 95% CI, 1.04-4.04; P = .04) and longer feeding tube duration (median [range], 162 [6-1477] vs 134 [15-1255] days; hazard ratio, 0.66; 95% CI, 0.48-0.89; P = .006) than no sarcopenia.Conclusions and RelevanceThis prognostic study’s findings show external validation of a fully automated deep learning pipeline to accurately measure sarcopenia in HNSCC and an association with important disease outcomes. The pipeline could enable the integration of sarcopenia assessment into clinical decision making for individuals with HNSCC.

show abstract

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

Cited by 185 publications

References 44 publications

Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study

Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study

Interobserver agreement of skeletal muscle mass measurement on head and neck CT imaging at the level of the third cervical vertebra

Development and Validation of an Automated Image-Based Deep Learning Platform for Sarcopenia Assessment in Head and Neck Cancer

Contact Info

Product

Resources

About