A window beneath the skin: how computed tomography assessment of body composition can assist in the identification of hidden wasting conditions in oncology that profoundly impact outcomes

Abstract

Advancements in image-based technologies and body composition research over the past decade has led to increased understanding of the importance of muscle abnormalities, such as low muscle mass (sarcopenia), and more recently low muscle attenuation (MA), as important prognostic indicators of unfavourable outcomes in patients with cancer. Muscle abnormalities can be highly prevalent in patients with cancer (ranging between 10 and 90 %), depending on the cohort under investigation and diagnostic criteria used. Importantly, both low muscle mass and low MA have been associated with poorer tolerance to chemotherapy, increased risk of post-operative infectious and non-infectious complications, increased length of hospital stay and poorer survival in patients with cancer. Studies have shown that systemic antineoplastic treatment can exacerbate losses in muscle mass and MA, with reported loss of skeletal muscle between 3 and 5 % per 100 d, which are increased exponentially with progressive disease and proximity to death. At present, no effective medical intervention to improve muscle mass and MA exists. Most research to date has focused on treating muscle depletion as part of the cachexia syndrome using nutritional, exercise and pharmacological interventions; however, these single-agent therapies have not provided promising results. Rehabilitation care to modify body composition, either increasing muscle mass and/or MA should be conducted, and its respective impact on oncology outcomes explored. Although the optimal timing and treatment strategy for preventing or delaying the development of muscle abnormalities are yet to be determined, multimodal interventions initiated early in the disease trajectory appear to hold the most promise.

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

“…Thus, a vicious cycle develops; cachexia reduces the possibility of using cytotoxic agents, thus leading to disease progression, and this in turn promotes the development of resistant cachexia . Most research to date has focused on treating muscle depletion as part of the cachexia syndrome using nutritional, exercise, and pharmacological interventions; however, these single‐agent therapies have not provided promising results …”

“…43 Most research to date has focused on treating muscle depletion as part of the cachexia syndrome using nutritional, exercise, and pharmacological interventions; however, these single-agent therapies have not provided promising results. 49 It is important to highlight that different instruments in literature for assessing loss of muscle mass can produce a relative variability in frequency of sarcopenia and cachexia, and there are multiple methods of adjusting the result for height or for BMI. 50 Recently, Blauwhoff-Buskermolen et al 51 found a large variation of prevalence of low muscle mass (13% to 93%) with different techniques (anthropometry, CT, and bioelectrical impedance) in cancer patients, and it has repercussion in diagnosis of cachexia and sarcopenia.…”

The relationship between computed tomography‐derived body composition, systemic inflammatory response, and survival in patients undergoing surgery for colorectal cancer

“…However, because of the increased number of patients presenting in an overweight or obese state in the developed world, the use of simple weight loss and BMI as a prognostic indicator has been questioned . The ability to use routine computed tomography (CT) scans to measure body composition, in particular skeletal muscle, has resulted in a marked increase in interest in using skeletal muscle index (SMI) and skeletal muscle density (SMD) to predict outcomes in patients with cancer, particularly in CRC …”

“…[4][5][6][7] The ability to use routine computed tomography (CT) scans to measure body composition, in particular skeletal muscle, has resulted in a marked increase in interest in using skeletal muscle index (SMI) and skeletal muscle density (SMD) to predict outcomes in patients with cancer, particularly in CRC. 8 There is evidence supporting a disproportionate loss of skeletal muscle tissue to be an independent prognostic factor for both cancer specific and overall survival in patients with CRC. 9 Specifically, muscle loss has been associated with poor treatment tolerance and efficacy, 10 worse quality of life, and increased morbidity.…”

Assessing skeletal muscle radiodensity by computed tomography: An integrative review of the applied methodologies

“…Previous reviews that summarized the appraisement of SM radiodensity by CT (Aubrey et al , 2014; Daly, Prado, & Ryan, 2018; Kazemi‐Bajestani, Mazurak, & Baracos, 2016) did not explore extensively the topics related to the methodological approach in different populations.…”