Early Skeletal Muscle Loss in Non-Small Cell Lung Cancer Patients Receiving Chemoradiation and Relationship to Survival

Kiss, Nicole; Beraldo, Julian; Everitt, Sarah

doi:10.1007/s00520-018-4563-9

Cited by 30 publications

(40 citation statements)

References 32 publications

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“…Our results are supported by studies showing a loss of SMI 9,16–20 and SMD 16–19 during first‐line treatment in NSCLC patients. Most studies investigated patients receiving chemotherapy alone but Kiss et al 19 . studied stage I‐III NSCLC patients receiving chemoradiotherapy.…”

Section: Discussionsupporting

confidence: 86%

Changes in muscle measures during chemoradiotherapy in patients with limited stage small cell lung cancer

Valan

Halvorsen

Jordhøy

et al. 2020

JCSM Clinical Reports

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BackgroundConcurrent chemoradiotherapy is the recommended treatment for limited stage small cell lung cancer. Severe side‐effects, which might cause loss of muscle mass, are frequent. Low skeletal muscle index (SMI) and radiodensity (SMD) are associated with inferior survival and more toxicity in cancer patients, but few have investigated this in small cell lung cancer, and none have investigated whether these muscle measures change during chemoradiotherapy. Patients from a trial comparing two schedules of thoracic radiotherapy (TRT) were analysed (n = 157). We investigated if SMI and SMD changed during treatment; whether changes are negative prognostic factors; or associated with severe toxicity.MethodsSkeletal muscle index and SMD were assessed from computerized tomography scans taken before and after chemoradiotherapy. Patients with analysable computerized tomography scans who completed TRT were eligible.ResultsSixty‐eight patients (43.3%) were analysed. Median age was 63 (range 40–85), 16% had performance status 2 and 92% stage III. Mean SMI decreased from 46.25 to 42.13 cm2/m2 and mean SMD from 38.40 to 37.46 Hounsfield units. Loss of SMD was significantly associated with less Grades 3–4 toxicity (P = 0.027) and less Grades 3–4 esophagitis (P = 0.029). Loss of SMI was significantly associated with shorter survival in multivariable (P = 0.037) but not in univariable analysis (P = 0.094). Loss of SMD was significantly associated with better survival in both univariable (P = 0.006) and multivariable analyses (P = 0.013).ConclusionsThere were large individual variations in changes in muscle measures during chemoradiotherapy, but the majority experienced a loss of both SMI and SMD. There was no consistent prognostic value of changes in muscle measures or consistent associations with severe treatment toxicity.

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Section: Discussionsupporting

confidence: 86%

Changes in muscle measures during chemoradiotherapy in patients with limited stage small cell lung cancer

Valan

Halvorsen

Jordhøy

et al. 2020

JCSM Clinical Reports

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“…Handgrip weakness has been shown to correlate with survival in several chronic disease conditions [9,10]. A study in patients with locally advanced, metastatic, or recurrent NSCLC or gastrointestinal malignancy has shown that handgrip strength is also a prognostic factor in the setting of advanced malignancy [6]. However, these authors did not correct their analysis for WHO PS score, which is considered an important prognostic factor, related to handgrip strength.…”

Section: Discussionmentioning

confidence: 99%

“…Computed tomography-derived low muscle mass, as a marker of impaired performance, is a strong prognostic factor for mortality in patients with non-small cell lung cancer (NSCLC). [5][6][7] However, ideally, the evaluation of performance status should be cheap, fast, and easy to implement in routine practice. Handgrip strength is a simple and quick measure of muscle function.…”

Section: Introductionmentioning

confidence: 99%

Handgrip weakness, low fat‐free mass, and overall survival in non‐small cell lung cancer treated with curative‐intent radiotherapy

Burtin

Bezuidenhout

Sanders

et al. 2020

J cachexia sarcopenia muscle

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Background Assessment of handgrip strength and fat-free mass provides quick and objective information on muscle performance and mass that might complement subjective World Health Organization Performance Status (WHO PS). We investigated to what extent the presence of pre-treatment handgrip weakness and low fat-free mass index (FFMI) provides additional prognostic information on top of well-established prognostic factors (including WHO PS) in non-small cell lung cancer (NSCLC) patients selected for curative-intent (chemo)radiation. Methods Prospectively, patients with early and locally advanced NSCLC (stages I-III) treated with (chemo)radiation were enrolled. Handgrip weakness and low FFMI, derived from bioelectrical impedance analysis, were defined using normative values and were correlated with overall survival (OS). Results We included 936 patients (age 68 ± 10 years; 64% male; 19% stage I, 9% stage II, and 72% stage III disease; 26% handgrip weakness; 27% low FFMI). In patients with good performance status (WHO PS 0 or 1), handgrip weakness and low FFMI were significant prognostic factors for OS, after adjustment for age, gender, disease stage, and co-morbidities. The combined presence of handgrip weakness and low FFMI was a strong prognostic factor for OS when compared with patients with normal handgrip strength and FFMI (hazard ratio: 1.79, 95% confidence interval: 1.34-2.40, P < 0.0001). In patients with impaired performance status (WHO PS ≥ 2, 19% of sample), handgrip weakness and low FFMI were not related to OS. Conclusions In early and locally advanced NSCLC patients treated with curative-intent (chemo)radiation who have good WHO PS, patients with combined handgrip weakness and low FFMI have the worst prognosis.

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Section: Resultsmentioning

confidence: 99%

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Section: Resultsmentioning

confidence: 99%

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

Poltronieri

Paula

Chaves

2020

Clin Physio Funct Imaging

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Low‐radiodensity skeletal muscle has been related to the degree of muscle fat infiltration and seems to be associated with worse outcomes. The aim of this study was to summarize the methodologies used to appraise skeletal muscle radiodensity by computed tomography, to describe the terms used in the literature to define muscle radiodensity and to give recommendations for its measurement standardization. An integrative bibliographic review in four databases included studies published until August 2019 in Portuguese, English or Spanish and performed in humans, adults and/or the elderly, of both sex, which investigated skeletal muscle radiodensity through computed tomography (CT) of the region between the third and fifth lumbar vertebrae and evaluated at least two muscular groups. One hundred and seventeen studies were selected. We observed a trend towards selecting all abdominal region muscle. A significant methodological variation in terms of contrast use, selection of skeletal muscle areas, radiodensity ranges delimitation and their cut‐off points, as well as the terminologies used, was also found. The methodological differences detected are probably due to the lack of more precise information about the correlation between skeletal muscle radiodensity by CT and its molecular composition, among others. Therefore, until the gaps are addressed in future studies, authors should avoid arbitrary approaches when reporting skeletal muscle radiodensity, especially when it comes to prognosis inference. Studies using both CT and direct methods of muscle composition evaluation are encouraged, to enable the definition and validation of the best approach to classify fat‐infiltrated muscle tissue, which will favour the nomenclature uniformization.

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Early Skeletal Muscle Loss in Non-Small Cell Lung Cancer Patients Receiving Chemoradiation and Relationship to Survival

Cited by 30 publications

References 32 publications

Changes in muscle measures during chemoradiotherapy in patients with limited stage small cell lung cancer

Changes in muscle measures during chemoradiotherapy in patients with limited stage small cell lung cancer

Handgrip weakness, low fat‐free mass, and overall survival in non‐small cell lung cancer treated with curative‐intent radiotherapy

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

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