Prognostic Impact of Sarcopenia’s Occurrence during Radiotherapy in Oropharyngeal Cancer Patients

Abstract

The current study aims to profile sarcopenic condition (both at baseline and developed during treatment) in oropharyngeal carcinoma (OPC) patients treated with curative radiotherapy (RT) +/− chemotherapy and to evaluate its impact on oncological outcomes and toxicity. A total of 116 patients were included in this retrospective single-center study. Sarcopenia assessment at baseline and at 50 Gy re-evaluation CT was obtained from two different methodologies: (i) the L3-skeletal muscle index (SMI) derived from the contouring of the cross-sectional area (CSA) of the masticatory muscles (CSA-MM); and (ii) the paravertebral and sternocleidomastoid muscles at the level of the third cervical vertebra (CSA-C3). Based on L3-SMI from CSA-MM, developing sarcopenic condition during RT (on-RT sarcopenia) was associated with worse progression-free survival (PFS) (p = 0.03) on multivariable analysis and a trend of correlation with overall survival (OS) was also evident (p = 0.05). According to L3-SMI derived from CSA-C3, on-RT sarcopenia was associated with worse PFS (p = 0.0096) and OS (p = 0.013) on univariate analysis; these associations were not confirmed on multivariable analysis. A significant association was reported between becoming on-RT sarcopenia and low baseline haemoglobin (p = 0.03) and the activation of nutritional counselling (p = 0.02). No significant associations were found between sarcopenia and worse RT toxicity. Our data suggest that the implementation of prompt nutritional support to prevent the onset of sarcopenia during RT could improve oncological outcomes in OPC setting.

Impact of low skeletal muscle mass in oropharyngeal cancer patients treated with radical chemo-radiotherapy: A mono-institutional experience

“…Also, Karavolia et al 36 demonstrated, in a large cohort of 977 head and neck patients, that sarcopenia was an independent prognostic factor for the development of physician-rated acute grade ⩾ 3 dysphagia and late grade ⩾ 2 and grade ⩾ 3 dysphagia, probably for its impact on the swallowing glands. On the contrary, Huang et al 37 and, very recently, Bergamaschi et al 38 could not find an association between sarcopenia and radiotherapy toxicity in 82 nasopharyngeal cancer patients and 116 oropharingeal cancer patients respectively. In our series the acute toxicity profile was not significantly higher in low SMI patients, even if a tendency to a reduced tolerance to radiotherapy could be found.…”