Association of Body Composition With Survival and Locoregional Control of Radiotherapy-Treated Head and Neck Squamous Cell Carcinoma

Abstract

IMPORTANCE Major weight loss is common in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy (RT). How baseline and posttreatment body composition affects outcome is unknown. OBJECTIVE To determine whether lean body mass before and after RT for HNSCC predicts survival and locoregional control. DESIGN, SETTING, AND PARTICIPANT Retrospective study of 2840 patients with pathologically proven HNSCC undergoing curative RT at a single academic cancer referral center from October 1, 2003, to August 31, 2013. One hundred ninety patients had computed tomographic (CT) scans available for analysis of skeletal muscle (SM). The effect of pre-RT and post-RT SM depletion (defined as a CT-measured L3 SM index of less than 52.4 cm2 /m2 for men and less than 38.5 cm2 /m2 for women) on survival and disease control was evaluated. Final follow-up was completed on September 27, 2014, and data were analyzed from October 1, 2014, to November 29, 2015. MAIN OUTCOMES AND MEASURES Primary outcomes were overall and disease-specific survival and locoregional control. Secondary analyses included the influence of pre-RT body mass index (BMI) and interscan weight loss on survival and recurrence. RESULTS Among the 2840 consecutive patients who underwent screening, 190 had whole-body positron emission tomography–CT or abdominal CT scans before and after RT and were included for analysis. Of these, 160 (84.2%) were men and 30 (15.8%) were women; their mean (SD) age was 57.7 (9.4) years. Median follow up was 68.6 months. Skeletal muscle depletion was detected in 67 patients (35.3%) before RT and an additional 58 patients (30.5%) after RT. Decreased overall survival was predicted by SM depletion before RT (hazard ratio [HR], 1.92; 95% CI, 1.19–3.11; P = .007) and after RT (HR, 2.03; 95% CI, 1.02–4.24; P = .04). Increased BMI was associated with significantly improved survival (HR per 1-U increase in BMI, 0.91; 95% CI, 0.87–0.96; P < .001). Weight loss without SM depletion did not affect outcomes. Post-RT SM depletion was more substantive in competing multivariate models of mortality risk than weight loss–based metrics (Bayesian information criteria difference, 7.9), but pre-RT BMI demonstrated the greatest prognostic value. CONCLUSIONS AND RELEVANCE Diminished SM mass assessed by CT imaging or BMI can predict oncologic outcomes for patients with HNSCC, whereas weight loss after RT initiation does not predict SM loss or survival.

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

“…Grossberg and colleagues recently reported that in a cohort of 190 patients with HNSCC treated with definitive radiation, decreased overall survival was associated with baseline sarcopenia (Hazard Ratio (HR) 1.92, 95 % confidence interval [CI] 1.19-3.11) and post-radiation sarcopenia (HR 2.03, 95 % CI 1.02-4.24). However, in this analysis, weight loss alone, without associated loss of skeletal muscle, was not associated with worse clinical outcomes [32]. Further, when they evaluated by subsites, skeletal muscle depletion was associated with decreased survival in patients with nonoropharyngeal cancer (n = 51) but not in patients with oropharyngeal cancer (n = 139).…”

The Impact of Skeletal Muscle Depletion on Head and Neck Squamous Cell Carcinoma

“…Grossberg et al [27] reported that patients with HNSCC with a low SMA measured by CT before or after RT treatment had poor OS. To our knowledge, our study is the first to investigate the impact of sarcopenia and a low FFM measured by CT in patients receiving different definitive treatments (surgery and RT).…”

Association of pretreatment body mass index and survival in human papillomavirus positive oropharyngeal squamous cell carcinoma

“…Given that the mean weight loss during definitive intensity modulated radiation therapy to the oropharynx exceeds 20 pounds this is a plausible hypothesis 18 . Recently, Grossberg found that in patients undergoing definitive chemo/radiotherapy for head and neck cancer that pretreatment skeletal muscle depletion was predictive of overall survival but depletion during treatment was not 19 . However, this association was not found among oropharyngeal primaries when stratified by subsite.…”