The impact of sarcopenia on survival and treatment tolerance in patients with head and neck cancer treated with chemoradiotherapy

Abstract

Background: Sarcopenia appears to be a negative prognostic factor for poor survival outcomes and worse treatment tolerance in patients with head-and-neck squamous cell carcinoma (HNSCC). We evaluated sarcopenia's impact on overall survival (OS), disease-free survival (DFS) and chemo-radiation tolerance in patients with head-and-neck cancer (HNC) treated with chemoradiotherapy (CRT) from a monocentric observational study. Methods:We identified patients with HNC treated by CRT between 2009 and 2018 with pretreatment imaging using positron emission tomography-computed tomography scans (PET/CT). Sarcopenia was measured using the pretreatment PET/CT at the L3 vertebral body using previously published methods. Clinical variables were retrospectively retrieved. Results:Of 216 patients identified, 54 patients (25.47%) met the criteria for sarcopenia. These patients had a lower mean body mass index before treatment (21.92 vs. 25.65 cm/m 2 , p < 0.001) and were more likely to have a history of smoking (88.89% vs. 71.52%, p = 0.01), alcohol use (55.56% vs. 38.61%, p = 0.03) and positive human papilloma virus status (67.74% vs. 41.75%, p = 0.011). At 3 years of follow-up, OS and DFS were 75% and 70% versus 82% and 85% for sarcopenic and non-sarcopenic patients, respectively (p = 0.1 and p = 0.00015). On multivariate analysis, sarcopenia appeared as a pejorative factor on DFS (hazard ratio 2.174, p = 0.0001) in the overall cohort. Sarcopenic patients did not require more chemotherapy and radiation-treatment interruptions and did not suffer from more chemo-induced and radiation-induced grade 3-4 toxicities than their nonsarcopenic counterparts. Conclusion:Sarcopenia in HNSCC patients is an independent adverse prognostic factor for DFS after definitive chemoradiotherapy.

Radiopharmaceuticals for Skeletal Muscle PET Imaging

“…Muscle atrophy, characterized by the loss of mass and function in skeletal muscles resulting from an imbalance between protein synthesis and breakdown, encompasses conditions such as muscle malnutrition, muscle-wasting syndrome, and cachexia [4][5][6]. Diverse causes of muscle atrophy include insufficient physical activity, aging, disease, excessive stress, hormonal changes, and congenital factors [4,[7][8][9][10][11][12]. In contemporary medical discourse, muscle atrophy is defined as a pathological degenerative condition that negatively affects the quality of life and contributes to the mortality and morbidity of various diseases [4,13].…”

Effect of camel milk and pistachio-based product on cancer-induced sarcopenia in Sprague Dawley rats

“…Tolerance to surgery, radiation, and chemotherapy decrease because of compromised muscle mass. At cancer diagnosis up to 46-49% of patients suffer from sarcopenia (Bentahila et al, 2023). Variability exists in the prevalence of sarcopenia among patients with cancer depending on the type of cancer, metastasis (if present), disease stage, and diet quality.…”

Investigating sarcopenia, physical activity, and inflammation biomarkers in newly diagnosed oral cancer patients undergoing curative treatment: A prospective longitudinal study

“… 11 These negative outcomes include chemotherapy-related toxicities, 12 high risk of postoperative complications, 13 early treatment discontinuation, 14 and increased mortality rates. 12 , 15 Additionally, patients undergoing (chemo)radiation therapy often encounter notable decreases in skeletal muscle mass, muscle strength, physical activity (PA) levels, fatigue regulation, and overall quality of life during and after the treatment course. 16 A previous study 17 reported that 8.5% of patients with HNC attained the recommended levels of exercise following their treatment.…”