Patients triaged to neoadjuvant chemotherapy have higher rates of sarcopenia: An opportunity for prehabilitation

Fadadu, Priyal; Polen-De, Clarissa; McGree, Michaela E.; Weaver, Amy L.; Moynagh, Michael R.; Takahashi, Naoki; Langstraat, Carrie; Cliby, William A.; Kumar, Amanika

doi:10.1016/j.ygyno.2020.10.025

Cited by 12 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the majority of OC patients show a quick response to the first-line treatment with carboplatin and paclitaxel, and therefore there is no further development of muscle consumption ( 51 ). Previous studies demonstrated that patients undergoing NACT were more likely sarcopenic compared to patients undergoing primary cytoreductive surgery (p = 0.04); however, no changes in body composition induced by NACT were found ( 52 ). Despite the lack of body composition changes in our subset of NACT patients, there is growing evidence that pre-habilitation protocols, as part of the enhanced recovery after surgery concept, may improve surgical outcomes, by bringing a fitter patient to surgery and decreasing treatment morbidity ( 53 ).…”

Section: Discussionmentioning

confidence: 88%

Computed Tomography–Based Body Composition in Patients With Ovarian Cancer: Association With Chemotoxicity and Prognosis

et al. 2021

View full text Add to dashboard Cite

PurposeTo assess the association between computed tomography (CT)-derived quantitative measures of body composition profiling and chemotherapy-related complications, in terms of dose reduction, premature discontinuation of chemotherapy, and cycle delays in patients with ovarian cancer. Secondary purposes were to evaluate associations between sarcopenia and survival, and to evaluate differences in body composition profiling at baseline and after neoadjuvant chemotherapy.Materials and MethodsThe study population was retrospectively selected from a database of patients with newly diagnosed ovarian cancer (any stage) referred to our Institution between Feb 2011 and Mar 2020. Clinical data were recorded, and CT images at the level of the 3rd lumbar vertebra were stored. By using specific software, skeletal muscle area (SMA), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle density (SMD) were extracted. Skeletal muscle index (SMI) was then calculated. Statistical analysis was performed by logistic regression models to identify body composition features predictive of dose reduction, premature end of chemotherapy, and cycle delays. Kaplan-Meier analyses were performed to assess overall survival (OS) and progression-free survival (PFS). The log-rank test was used to determine differences in OS and PFS between sarcopenic and non-sarcopenic patients. Wilcoxon test was performed to compare body composition features before and after neoadjuvant chemotherapy (NACT).ResultsSixty-nine patients were included. A significant association was found between VAT and cycle delays (OR = 1.01, z = 2.01, 95% CI: 1.00–1.02, p < 0.05), between SMA and early discontinuation of chemotherapy (OR = 1.03, z = 2.10, 95% CI: 1.00–1.05, p < 0.05), and between mean SMD and cycle delays (OR = 0.92, z = −2.70, 95%CI: 0.87–0.98, p < 0.01). No significant difference emerged for OS in sarcopenic and non-sarcopenic patients, nor in CT body composition features before and after NACT.ConclusionsIn ovarian cancer patients, CT-derived body composition profiling might predict the risk of chemotoxicity. In particular, VAT and SMD are associated with chemotherapy cycle delays, and SMA with early discontinuation of chemotherapy.

show abstract

Section: Discussionmentioning

confidence: 88%

Computed Tomography–Based Body Composition in Patients With Ovarian Cancer: Association With Chemotoxicity and Prognosis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Single measured preoperative low skeletal muscle density has been shown to be more strongly associated with negative outcomes than low skeletal muscle mass in gynecologic cancer [6] [e] [10]. Only one recent study evaluated the change in skeletal muscle density during NACT for ovarian cancer [32]. This retrospective cohort study reported that skeletal muscle density significantly increased during NACT, while SMI significantly decreased.…”

Section: Discussionmentioning

confidence: 99%

Loss of skeletal muscle density during neoadjuvant chemotherapy in older women with advanced stage ovarian cancer is associated with postoperative complications

Zanden¹,

Soolingen²,

Viddeleer³

et al. 2022

European Journal of Surgical Oncology

View full text Add to dashboard Cite

Objective: To assess the association between loss of lumbar skeletal muscle mass and density during neoadjuvant chemotherapy (NACT) and postoperative complications after interval cytoreductive surgery (CRS) in older patients with ovarian cancer. Materials and methods: This multicenter, retrospective cohort study included patients aged 70 years and older with primary advanced stage ovarian cancer (International Federation of Gynecology and Obstetrics stage III-IV), treated with NACT and interval CRS. Skeletal muscle mass and density were retrospectively assessed using Skeletal Muscle Index (SMI) and Muscle Attenuation (MA) on routinely made Computed Tomography scans before and after NACT. Loss of skeletal muscle mass or density was defined as >2% decrease per 100 days in SMI or MA during NACT. Results: In total, 111 patients were included. Loss of skeletal muscle density during NACT was associated with developing any postoperative complication 30 days after interval CRS both in univariable (Odds Ratio (OR) 3.69; 95% Confidence Interval (CI) 1.57e8.68) and in multivariable analysis adjusted for functional impairment and WHO performance status (OR 3.62; 95%CI 1.27e10.25). Loss of skeletal muscle density was also associated with infectious complications (OR 3.67; 95%CI 1.42e9.52) and unintended discontinuation of adjuvant chemotherapy (OR 5.07; 95%CI 1.41e18.19). Unlike loss of skeletal muscle density, loss of skeletal muscle mass showed no association with postoperative outcomes. Conclusion: In older patients with ovarian cancer, loss of skeletal muscle density during NACT is associated with worse postoperative outcomes. These results could add to perioperative risk assessment, guiding the decision to undergo surgery or the need for perioperative interventions.

show abstract

“…It is appropriate that prehabilitation interventions have been so extensively investigated, as almost half of the CRC patients are considered frail and thus are at significantly higher risk of postoperative complications and worse functional recovery (Bausys et al 2022). As many oncological surgery patients who undergo neoadjuvant chemotherapy become sarcopenic and frail before their operations, physical prehabilitation efforts that improve functional capacity may have outsized benefits in this preoperative phase (Fadadu et al 2021). Prospective evidence has been reported suggesting that a synergistic relationship may even exist between neoadjuvant chemotherapy and physical prehabilitation, whereby both oncological outcomes (such as tumour regression) and surgical outcomes improve (Zylstra et al 2022).…”

Section: Prehabilitation In Cancer and Non-cancer Populationsmentioning

confidence: 99%

Prehabilitation before general surgery: Worth the effort?

Kovoor,

Nann,

Chambers

et al. 2023

Journal of Perioperative Practice

View full text Add to dashboard Cite

Prehabilitation, or interventions before surgery aimed at improving preoperative health and postoperative outcomes, has various forms. Although it may confer benefit to patients undergoing general surgery, this is not certain. Furthermore, although it may yield a net monetary gain, it is also likely to require substantial monetary and non-monetary investment. The impact of prehabilitation is highly variable and dependent on multiple factors. Physical function and pulmonary outcomes are likely to be improved by most forms of prehabilitation involving physical and multimodal exercise programmes. However, other surgical outcomes have demonstrated mixed results from prehabilitation. Within this issue, the measures used for evaluating baseline patient biopsychosocial health are important, and collecting sufficient data to accurately inform patient-centred prehabilitation programmes is only possible through thorough clinical and laboratory investigation and synthesised metrics such as cardiopulmonary exercise testing. Although a multimodal approach to prehabilitation is the current gold standard, societal factors may affect engagement with programmes that require a significant in-person activity. However, this is weighed against the substantial financial and non-financial investment that accompanies many programmes. The overall effectiveness and optimal mode of intervention across the discipline of general surgery remains unclear, and further research is needed to prove prehabilitation’s full worth.

show abstract

Patients triaged to neoadjuvant chemotherapy have higher rates of sarcopenia: An opportunity for prehabilitation

Cited by 12 publications

References 30 publications

Computed Tomography–Based Body Composition in Patients With Ovarian Cancer: Association With Chemotoxicity and Prognosis

Computed Tomography–Based Body Composition in Patients With Ovarian Cancer: Association With Chemotoxicity and Prognosis

Loss of skeletal muscle density during neoadjuvant chemotherapy in older women with advanced stage ovarian cancer is associated with postoperative complications

Prehabilitation before general surgery: Worth the effort?

Contact Info

Product

Resources

About