Does body mass index at diagnosis or weight change during therapy predict toxicity or survival in intermediate risk rhabdomyosarcoma? A report from the Children's Oncology Group soft tissue sarcoma committee

Abstract

Background Weight loss prevalence and its impact on toxicities and survival in intermediate risk rhabdomyosarcoma (IRMS) patients are unknown. We evaluated the association between weight change during therapy and number of toxicities, hospital days, infections, and overall survival and between baseline body mass index (BMI) and survival in patients treated on Children’s Oncology Group trial D9803. Procedure Four hundred sixty-eight IRMS patients age ≥2 and <21 years treated on D9803 had required data. Regression models evaluated association between weight loss from baseline and toxicities, hospital days, infections, and survival. Kaplan–Meier curves and regression models evaluated baseline BMI percentile’s association with survival. Results Thirty-five percent and 37% of patients had >5% weight loss at 12 and 24 weeks, respectively, with 16% and 19% losing >10% weight respectively. Greater than 10% weight loss at 24 weeks was associated with more toxicities and hospital days during subsequent therapy but not infection rate or survival. Baseline underweight patients (<5th percentile BMI) had borderline inferior survival compared with baseline average weight patients while there was no difference in survival seen between average weight and overweight or obese patients. Conclusions Nearly one in five IRMS patients experienced >10% weight loss on therapy. This was associated with increased toxicity but not decreased survival compared with patients who had less weight loss. Baseline BMI percentile trended toward a significant association with survival. Future studies might investigate nutritional impact on quality of life and if weight loss is preventable by early nutritional intervention.

Abnormal body mass index at diagnosis in patients with Ewing sarcoma is associated with inferior tumor necrosis

“…Abundant evidence exists regarding the negative impact that abnormal pre‐diagnosis weight, and particularly obesity, has on treatment outcome in several types of malignant diseases in adults . More recently studies of the pediatric cancer population showed similar results . It is unclear what the causes responsible for these observations are.…”

“…It has been suggested that some biological factors in the tissues and at the cellular level of obese patients are responsible for the effect . Underweight patients may have a worse prognosis due to higher levels of toxicity during treatment . Chemotherapy‐induced necrosis has proved to be valuable in assessment of tumor chemosensitivity in Ewing sarcoma (EWS) patients .…”

What is new in the biology and treatment of pediatric rhabdomyosarcoma?

“…(35) Patients with low BMI (<5%ile), or those who lose significant weight experience greater toxicity than other children. Patients with low BMI may also have inferior survival.…”

Diet and exercise interventions for pediatric cancer patients during therapy: tipping the scales for better outcomes

“…A cohort of 133 newly diagnosed patients including brain and solid tumor patients showed increased BMI and fat mass within three months of and doubled by 12 months post diagnosis (21). In contrast, weight loss occurred in 37% of 468 patients with intermediate rhabdomyosarcoma, and low baseline BMI correlated with borderline inferior survival (22). Collectively, these data indicate that weight management early during cancer treatment is an opportunity for interventions, and to be successful, a nutritional program needs to be integrated into the clinical care model and must be sustained throughout treatment (23).…”