Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer

Abstract

• Changes in CT body composition occur after neoadjuvant chemotherapy in oesophageal cancer. • Sarcopenia was more prevalent after neoadjuvant chemotherapy. • Fat mass, fat-free mass and weight decreased after neoadjuvant chemotherapy. • Changes in body composition were associated with CRM positivity. • Changes in body composition did not affect perioperative complications and survival.

Nutritional Management of Esophageal Cancer Patients

“…Results from a small cohort of esophageal cancer patients showed that 26% of patients were sarcopenic before the initiation of neoadjuvant chemotherapy and this percentage increased to 43% after its completion. There was Nutritional Management of Esophageal Cancer Patients http://dx.doi.org/10.5772/intechopen.69607a significant loss of fat mass and skeletal muscle mass which was associated with risk of circumferential resection margin positivity [50]. In another study, sarcopenia was present in 56 and 67% of patients before and after neoadjuvant chemoradiotherapy, respectively.…”

“…In addition, sarcopenic patients who underwent esophagectomy had significantly higher rate of respiratory complications compared to nonsarcopenic subjects, but there was no difference in the incidence of overall complications between the two groups [47][48][49]. Sarcopenia has also impact on chemotherapy outcome since decreased muscle mass is associated with dose-limiting toxicity and pathological chemotherapy response in patients receiving neoadjuvant chemotherapy [50][51][52]. Therefore, it is imperative to estimate patients' muscle mass not only preoperatively but also before the οnset of chemotherapy, bearing in mind that sarcopenia is frequently masqued by obesity making it more difficult to define patients' needs for intervention.…”

Impact of Sarcopenia in Patients with Unresectable Locally Advanced Esophageal Cancer Receiving Chemoradiotherapy

“…The reason for the frequent adverse events was that in a patient with a small lean compartment, a high drug dose is distributed in a small volume. Recent studies have shown that skeletal muscle volume decreases after neoadjuvant chemotherapy (37,38), and 43.6% of patients show more than 10% of body weight loss during definitive chemoradiotherapy for advanced esophageal cancer (39). Patients undergoing chemotherapy for gastrointestinal cancer who experience weight loss usually suffer more frequent and severe toxicities (33).…”

Nutrition in peri-operative esophageal cancer management

“…A recent pilot study shows that sarcopenic and sarcopenic obese patients may be at a higher risk for dose-limiting toxicity during chemotherapy compared to non-sarcopenic patients with esophageal cancer [58]. A widespread prevalence of sarcopenia before surgery has been reported in patients with esophageal and gastric cancer, ranging from 43% to 79% [59,60]. Sarcopenia before surgery, assessed by CT-based skeletal muscle mass measurements, is associated with impaired overall survival in patients with esophageal cancer [30].…”