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Atasoy BM, Demirel B, Ekşi Özdaş FN, Devran B, Kılıç ZN, Gül D. The role of radiotherapy planning images in monitoring malnutrition and predicting prognosis in head and neck cancer patients: a pilot study. Radiat Oncol 2025; 20:70. [PMID: 40319283 PMCID: PMC12049786 DOI: 10.1186/s13014-025-02645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 04/22/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Adaptive treatment planning can be made in radiotherapy of head and neck cancer patients for reasons such as changes in tumor volume or weight loss. This study aims to find the role of treatment planning images in monitoring radiotherapy-induced malnutrition and predicting the malnutrition-induced prognosis in head and neck cancer patients. METHODS For this study, we analyzed 30 patients who received radiotherapy in our clinic between September 2018 and September 2021. Those patients, both regular and completed weekly dietitian counseling notes during radiotherapy and available adaptive radiotherapy planning images, were included in the analysis. All patients had weekly nutritional interventions, including nutritional and anthropometric changes in weight, height, body mass index (BMI), and lean body mass (LBM). Skeletal muscle volume, called cervical muscle gauge (CMG), was measured from the simulation images of beginning and adaptive radiotherapy. Inflammatory parameters, including the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the systemic inflammatory index (SII), were also calculated from weekly total blood counts. For the analysis, anthropometric measurements were compared at the beginning and adaptive treatment time. Progression-free (PFS) and overall (OS) survival were calculated according to weight and CMG changes. RESULTS The median weight loss percentage was 4.8% (0 to 24%). The mean percentage of weight changes, LBM, and CMG were 6.33%, 3.47%, and 9.28%, respectively. Results indicated that BMI (p = 006), weight (p < 0.001), LBM (p < 0.001), and CMG (p = 0.057) decreased during radiotherapy. Hemoglobin levels decreased (p = 0.005), and inflammatory markers increased. There were significant correlations between weight and LBM (p < 0.0001) and CMG (p = 0.005) loss. The median follow-up was 26 months. Loss of weight (PFS; 65.5% vs. 35.7%, p = 0.09, OS; 73.7% vs. 32.1%, p = 0.09), LBM (PFS; 75% vs. 41.1%, p = 0.118, OS; 65.6% vs. 52%, p = 0.221) and CMG (PFS; 56.3% vs. 47.1%, p = 0.516, OS;76.9% vs. 32.4%, p = 0.059) negatively affected three-year survival. CONCLUSIONS Cervical muscle volume measurement may help predict malnutrition in patients receiving radiotherapy for head and neck cancer. Our study shows adaptive planning images may be used for this approach. In addition, this method may help to predict prognosis due to malnutrition in patients undergoing radiotherapy.
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Affiliation(s)
- Beste M Atasoy
- Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Türkiye.
- S.B.-M.Ü. Pendik Eğitim ve Arastırma Hastanesi Radyasyon Onkolojisi Klinigi, Fevzi Cakmak Mah. Muhsin Yaziciıoglu cad. No: 6, Pendik/Istanbul, 34899, Türkiye.
| | - Birsen Demirel
- Faculty of Health Science Department of Nutrition and Dietetics, Ondokuz Mayıs University, Samsun, Türkiye
| | - Feyza Nur Ekşi Özdaş
- Nutrition and Dietetic Division, MH-Marmara University Pendik Education and Research Hospital, Istanbul, Türkiye
| | - Bennur Devran
- Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Türkiye
| | | | - Dilek Gül
- Radiation Oncology Clinic, MH-Marmara University Pendik Education and Research Hospital, Istanbul, Türkiye
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Vickers AJ, McSweeney DM, Choudhury A, Weaver J, Price G, McWilliam A. The prognostic significance of sarcopenia in patients treated with definitive radiotherapy: A systematic review. Radiother Oncol 2025; 203:110663. [PMID: 39647527 DOI: 10.1016/j.radonc.2024.110663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 11/27/2024] [Accepted: 12/02/2024] [Indexed: 12/10/2024]
Abstract
Sarcopenia describes the degenerative loss of muscle mass and strength, and is emerging as a pan-cancer prognostic biomarker. It is linked with increased treatment toxicity, decreased survival and significant healthcare financial burden. Systematic analyses of sarcopenia studies have focused on outcomes in patients treated surgically or with systemic therapies. There are few publications concerning patients treated with radiotherapy. This manuscript presents a pan-cancer systematic review of the association between sarcopenia and survival outcomes in patients treated with definitive (chemo-)radiotherapy. A literature search was performed, with 26 studies identified, including a total of 5,784 patients. The prognostic significance of sarcopenia was mixed. This may reflect lack of consensus in methods used to measure skeletal muscle mass and define sarcopenia. Many papers analyse small samples and present sarcopenia cutoffs optimised on the local population, which may not generalise to external populations. Recent advances in artificial intelligence allow for automatic measurement of body composition by segmenting the muscle compartment on routinely collected imaging. This provides opportunity for standardisation of measurement methods and definitions across populations. Adopting sarcopenia diagnosis into clinical workflows could reduce futile treatments and associated financial burden, by reducing treatment toxicities, and improving treatment completion, patient survival, and quality-of-life after cancer.
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Affiliation(s)
- Alexander J Vickers
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Dónal M McSweeney
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jamie Weaver
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Gareth Price
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Alan McWilliam
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Laurén J, Keski-Säntti H, Mäkitie A, Arponen O. Imaging-based evaluation of cervical muscle mass and 6-month survival in males with hypopharyngeal carcinoma. Acta Oncol 2024; 63:950-957. [PMID: 39688227 DOI: 10.2340/1651-226x.2024.40481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 11/30/2024] [Indexed: 12/18/2024]
Abstract
BACKGROUND A significant proportion of newly diagnosed patients with hypopharyngeal carcinoma (HC) are at risk of early death and may not benefit from cancer treatments. Our objective was to assess whether an image-based evaluation of muscle mass could identify patients at risk of impaired survival. MATERIALS AND METHODS This retrospective study consisted of male patients diagnosed with HC treated at Helsinki University Hospital between 2005 and 2014 (N = 66). Cross-sectional areas of skeletal muscles at the level of the third cervical vertebra (C3) and at the level of the thoracic aortic apex were analyzed using magnetic resonance images and/or computed tomography images. Survival-based cutoff values for low muscle index values were determined using the receiver operating characteristics curves. Kaplan-Meier analyses and Cox proportional hazard models were used to evaluate the associations between the muscle indexes and survival rates. RESULTS Several muscle indexes were associated with 6-month and 5-year survival. The 6-month survival rate of males with a low sternocleidomastoid muscle index (cutoff 1.73 cm2/m2) was 66%, as opposed to the 97% survival rate for those with an above-the-cutoff muscle index (hazard ratio 13.0 [95% CI 1.5, 116.6]). In a multivariate Cox model adjusted for age, sex, tumor stage, and grade, lower sternocleidomastoid muscle index was significantly associated with decreased 6-month survival. INTERPRETATION C3-level muscle indexes, particularly the sternocleidomastoid muscle index, are a promising marker in the identification of patients at risk of early mortality and could add confidence in decision-making when choosing between active and palliative care.
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Affiliation(s)
- Jouni Laurén
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Radiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Otso Arponen
- Department of Radiology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Koh JH, Lim CYJ, Tan LTP, Makmur A, Gao EY, Ho JSY, Tan JA, See A, Tan BKJ, Tan LF, Tan BYQ. Prevalence and Association of Sarcopenia with Mortality in Patients with Head and Neck Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2024; 31:6049-6064. [PMID: 38847986 DOI: 10.1245/s10434-024-15510-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/09/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND The objective of this meta-analysis was to assess the association of sarcopenia defined on computed tomography (CT) head and neck with survival in head and neck cancer patients. METHODS Following a PROSPERO-registered protocol, two blinded reviewers extracted data and evaluated the quality of the included studies using the Quality In Prognostic Studies (QUIPS) tool, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. A meta-analysis was conducted using maximally adjusted hazard ratios (HRs) with the random-effects model. Heterogeneity was measured using the I2 statistic and was investigated using meta-regression and subgroup analyses where appropriate. RESULTS From 37 studies (11,181 participants), sarcopenia was associated with poorer overall survival (HR 2.11, 95% confidence interval [CI] 1.81-2.45; p < 0.01), disease-free survival (HR 1.76, 95% CI 1.38-2.24; p < 0.01), disease-specific survival (HR 2.65, 95% CI 1.80-3.90; p < 0.01), progression-free survival (HR 2.24, 95% CI 1.21-4.13; p < 0.01) and increased chemotherapy or radiotherapy toxicity (risk ratio 2.28, 95% CI 1.31-3.95; p < 0.01). The observed association between sarcopenia and overall survival remained significant across different locations of cancer, treatment modality, tumor stages and geographical region, and did not differ between univariate and multivariate HRs. Statistically significant correlations were observed between the C3 and L3 cross-sectional area, skeletal muscle mass, and skeletal muscle index. CONCLUSIONS Among patients with head and neck cancers, CT-defined sarcopenia was consistently associated with poorer survival and greater toxicity.
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Affiliation(s)
- Jin Hean Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Claire Yi Jia Lim
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lucas Tze Peng Tan
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Esther Yanxin Gao
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jamie Sin Ying Ho
- Department of Medicine, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Justina Angel Tan
- Division of Geriatric Medicine, Department of Medicine, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Li Feng Tan
- Division of Geriatric Medicine, Department of Medicine, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Benjamin Yong Qiang Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
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Yang D, Su L, Zhang L, Zhang Y, Li Y, Huang T, Huang X. Sarcopenia predicts postoperative complications in head and neck cancer: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3959-3975. [PMID: 38647686 DOI: 10.1007/s00405-024-08577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE We performed this systematic review and meta-analysis to explore the impact of preoperative sarcopenia on postoperative complication risks after head and neck cancer (HNC) surgery. METHODS We identified eligible studies by searching Ovid-MEDLINE, Ovid-Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and Scopus. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. RESULTS Twenty-one studies with a total of 3480 patients met our inclusion criteria. The presence of sarcopenia significantly increased the incidence of overall postoperative complications (OR = 1.72, 95% CI 1.23, 2.41; P = 0.002; I2 = 59%). Subgroup analyses showed a higher risk of postoperative complications in the populations in which sarcopenia was diagnosed with low L3-skeletal muscle index (L3-SMI) or low cross-sectional area of the rectus femoris, but not in the group that sarcopenia was diagnosed with low C3-SMI. Preoperative sarcopenia also substantially increased the risk of severe postoperative complications (OR = 2.26), pharyngocutaneous fistulas (OR = 2.15), free flap-related complications (OR = 1.63), and surgical site infections (OR = 1.84). We also found a tendency toward a higher incidence of wound complications and 30-day mortality in patients with sarcopenia. CONCLUSION Preoperative sarcopenia is a negative prognostic indicator for postoperative complications in patients with HNC after surgery. To reduce the incidence of postoperative complications and improve poor prognosis, further attention needs to be paid to the evaluation and management of preoperative sarcopenia.
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Affiliation(s)
- Dan Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Su
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Liying Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Biomedical Engineering, Sichuan University Library, Chengdu, 610041, Sichuan, China
| | - Yina Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tingxuan Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoli Huang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Takayama H, Yoshimura T, Suzuki H, Hirano Y, Tezuka M, Ishida T, Ishihata K, Amitani M, Amitani H, Nakamura Y, Imamura Y, Inui A, Nakamura N. Comparison between single-muscle evaluation and cross-sectional area muscle evaluation for predicting the prognosis in patients with oral squamous cell carcinoma: a retrospective cohort study. Front Oncol 2024; 14:1336284. [PMID: 38751815 PMCID: PMC11094248 DOI: 10.3389/fonc.2024.1336284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction The most effective method of assessing sarcopenia has yet to be determined, whether by single muscle or by whole muscle segmentation. The purpose of this study was to compare the prognostic value of these two methods using computed tomography (CT) images in patients with oral squamous cell carcinoma (OSCC). Materials and methods Sex- and age-adjusted Cox proportional hazards models were employed for each parameter of sarcopenia related to overall survival, disease-free survival, and disease-specific survival. Harrell's concordance index was calculated for each model to assess discriminatory power. Results In this study including 165 patients, a significant correlation was found between the CT-based assessment of individual muscles and their cross-sectional area. Single muscle assessments showed slightly higher discriminatory power in survival outcomes compared to whole muscle assessments, but the difference was not statistically significant, as indicated by overlapping confidence intervals for the C-index between assessments. To further validate our measurements, we classified patients into two groups based on intramuscular adipose tissue content (P-IMAC) of the spinous process muscle. Analysis showed that the higher the P-IMAC value, the poorer the survival outcome. Conclusion Our findings indicate a slight advantage of single-muscle over whole-muscle assessment in prognostic evaluation, but the difference between the two methods is not conclusive. Both assessment methods provide valuable prognostic information for patients with OSCC, and further studies involving larger, independent cohorts are needed to clarify the potential advantage of one method over the other in the prognostic assessment of sarcopenia in OSCC.
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Affiliation(s)
- Hirotaka Takayama
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takuya Yoshimura
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hajime Suzuki
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuka Hirano
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masahiro Tezuka
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takayuki Ishida
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kiyohide Ishihata
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Marie Amitani
- Department of Community-Based Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Haruka Amitani
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yasunori Nakamura
- Department of Oral Surgery, Kagoshima Medical Center, National Hospital Organization, Kagoshima, Japan
| | - Yasushi Imamura
- Department of Internal Medicine, Kagoshima Kouseiren Hospital, Kagoshima, Japan
| | - Akio Inui
- Pharmacological Department of Herbal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Norifumi Nakamura
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Morelli C, Formica V, Bossi P, Rofei M, Guerriero S, Riondino S, Argirò R, Pucci N, Cenci T, Savino L, Rinaldi CG, Garaci F, Orlandi A, D’Angelillo RM, Arkenau HT, Roselli M. Untailored vs. Gender- and Body-Mass-Index-Tailored Skeletal Muscle Mass Index (SMI) to Assess Sarcopenia in Advanced Head and Neck Squamous Cell Carcinoma (HNSCC). Cancers (Basel) 2023; 15:4716. [PMID: 37835410 PMCID: PMC10571960 DOI: 10.3390/cancers15194716] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Sarcopenia lasting >1 year might be considered a chronic condition in many HNSCC patients. CT-scan-derived Skeletal Muscle Mass Index (SMI) is an established surrogate of sarcopenia; yet, the cut-off reported in the literature (literature-based, lb-SMI < 43.2) is mainly based on the risk of chemoradiotherapy-induced toxicity, and the optimal value to discriminate OS is under-investigated. (2) Methods: The effect on OS of the lb-SMI cutoff was compared with an untailored OS-oriented SMI cutoff obtained in a cohort of consecutive advanced HNSCC patients treated with primary chemoradiotherapy, bio-chemotherapy or chemo-immunotherapy (cohort-specific, cs-SMI cutoff). Gender- and BMI-tailored (gt-SMI and bt-SMI) cut-offs were also evaluated. Cutoff values were identified by using the maximally selected rank statistics for OS. (3) Results: In 115 HNSCC patients, the cs-SMI cutoff was 31.50, which was lower compared to the lb-SMI reported cut-off. The optimal cut-off separately determined in females, males, overweight and non-overweight patients were 46.02, 34.37, 27.32 and 34.73, respectively. gt-SMI categorization had the highest effect on survival (p < 0.0001); its prognostic value was independent of the treatment setting or the primary location and was retained in a multivariate cox-regression analysis for OS including other HNSCC-specific prognostic factors (p = 0.0004). (4) Conclusions: A tailored SMI assessment would improve clinical management of sarcopenia in chemoradiotherapy-, bio-chemotherapy- or chemo-immunotherapy-treated HNSCC patients. Gender-based SMI could be used for prognostication in HNSCC patients.
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Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, “ASST Spedali Civili di Brescia”, University of Brescia, 25123 Brescia, Italy;
| | - Michela Rofei
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Simona Guerriero
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Renato Argirò
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Noemi Pucci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (N.P.); (F.G.)
| | - Tonia Cenci
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Luca Savino
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Carla G. Rinaldi
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00152 Rome, Italy; (C.G.R.); (R.M.D.)
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (N.P.); (F.G.)
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Rolando M. D’Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00152 Rome, Italy; (C.G.R.); (R.M.D.)
| | | | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
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Miola TM, Bitencourt AGV, Souza JDO, Kowalski LP, Gonçalves Filho J. Analysis of muscle mass by computed tomography in patients with head and neck cancer: a prospective study. Radiol Bras 2023; 56:269-274. [PMID: 38204897 PMCID: PMC10775814 DOI: 10.1590/0100-3984.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 01/12/2024] Open
Abstract
Objective To evaluate the preoperative muscle mass of patients with head and neck cancer (HNC) with computed tomography (CT), comparing the results obtained through analysis of cross-sectional areas at the level of the third lumbar vertebra (L3) with those obtained through analysis of cross-sectional areas at the levels of the third cervical and fourth thoracic vertebrae (C3 and T4, respectively). Materials and Methods A total of 63 patients with HNC were evaluated preoperatively. Using CT, we assessed muscle mass at L3, as well as at C3 and T4. Results Most (73.0%) of the patients had low muscle mass at L3, whereas 50.8% had a normal body mass index. The cross-sectional area at L3 correlated strongly with those at C3 and T4 (r = 0.831 and r = 0.763, respectively; p < 0.001 for both). In addition, the muscle mass index at L3 correlated strongly with those at C3 and T4 (r = 0.781 and r = 0.715, respectively; p < 0.001 for both). Conclusion Low muscle mass appears to be highly prevalent in patients with HNC. Measurements at C3 and T4 could represent alternative means of assessing muscle mass in such patients.
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Erul E, Guven DC, Onur MR, Yazici G, Aksoy S. Role of sarcopenia on survival and treatment-related toxicity in head and neck cancer: a narrative review of current evidence and future perspectives. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-08014-9. [PMID: 37188907 DOI: 10.1007/s00405-023-08014-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The purpose of this article is to provide an up-to-date summary of sarcopenia and its clinical implications for patients with head and neck cancer (HNC). METHODS We conducted a literature review of recent studies investigating the prevalence of sarcopenia in HNC patients, its detection using MRI or CT scans, and its association with clinical outcomes such as disease-free and overall survival time, radiotherapy-related side effects, cisplatin toxicity, and surgical complications. RESULTS Sarcopenia, characterized by low skeletal muscle mass (SMM), is a prevalent condition in HNC patients and can be effectively detected using routine MRI or CT scans. Low SMM in HNC patients is associated with increased risks of shorter disease-free and overall survival times, as well as radiotherapy-related side effects such as mucositis, dysphagia, and xerostomia. In addition, cisplatin toxicity is more severe in HNC patients with low SMM, leading to higher dose-limiting toxicity and treatment interruptions. Low SMM may also predict higher risks of surgical complications in head and neck surgery. Identifying sarcopenic patients can aid physicians in better riskstratifying HNC patients for therapeutic or nutritional interventions to improve clinical outcomes. CONCLUSIONS Sarcopenia is a significant concern for HNC patients and can impact their clinical outcomes. Routine MRI or CT scans can effectively detect low SMM in HNC patients. Identifying sarcopenic patients can aid physicians in better risk-stratifying HNC patients for therapeutic or nutritional interventions to improve clinical outcomes. Further research is needed to explore the potential of interventions to mitigate the negative effects of sarcopenia in HNC patients.
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Affiliation(s)
- Enes Erul
- Department of Internal Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
| | | | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
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10
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Vangelov B, Bauer J, Moses D, Smee R. Comparison of Skeletal Muscle Changes at Three Vertebral Levels Following Radiotherapy in Patients With Oropharyngeal Carcinoma. Nutr Cancer 2023; 75:572-581. [PMID: 36308327 DOI: 10.1080/01635581.2022.2138468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Evaluation of skeletal muscle (SM) depletion, or sarcopenia, utilizes the cross-sectional area (CSA) of computed tomography (CT) scans at the lumbar level L3. However, alternate vertebral landmarks are used in patients with head and neck cancer due to scan unavailability. Muscle changes following radiotherapy at cervical (C3) and thoracic (T2) levels were compared to L3 in patients with oropharyngeal carcinoma. Muscle density data were derived retrospectively from diagnostic PET-CT scans at C3, T2 and L3 pretreatment, and up to six months post. CSA changes were compared to L3 in scans of 33 patients (88% male, mean age 61 (SD 8.5) years). On matched pair analysis; mean L3-CSA change -12.1 cm2 (SD 9.7, 95%CI -15.5 to -8.6, and p < 0.001), T2-CSA -30.5 cm2 (SD 34.8, 95%CI -42.8 to -18.1, and p < 0.001) and C3-CSA +2.1 cm2 (SD 4.1, 95%CI 0.63 to 3.5, and p < 0.00). No difference was found in the percentage change of T2-CSA with L3-CSA (mean -2.2%, SD 10.6, 95%CI -6.0 to 1.6, and p = 0.240), however, was significantly different to C3-CSA (mean 13.2%, SD 11.6, 95%CI 9.1 to 17.3, and p < 0.001). Results suggest SM at C3 does not change proportionately and may not be a reliable representation of whole-body SM change over time.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, New South Wales, Australia.,Department of Radiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Robert Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
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11
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Prognostic Impact of Sarcopenia's Occurrence during Radiotherapy in Oropharyngeal Cancer Patients. Cancers (Basel) 2023; 15:cancers15030723. [PMID: 36765681 PMCID: PMC9913355 DOI: 10.3390/cancers15030723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
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.
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12
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Van den Broeck J, Sealy MJ, Brussaard C, Kooijman J, Jager-Wittenaar H, Scafoglieri A. The correlation of muscle quantity and quality between all vertebra levels and level L3, measured with CT: An exploratory study. Front Nutr 2023; 10:1148809. [PMID: 36908909 PMCID: PMC9996002 DOI: 10.3389/fnut.2023.1148809] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction In patients with cancer, low muscle mass has been associated with a higher risk of fatigue, poorer treatment outcomes, and mortality. To determine body composition with computed tomography (CT), measuring the muscle quantity at the level of lumbar 3 (L3) is suggested. However, in patients with cancer, CT imaging of the L3 level is not always available. Thus far, little is known about the extent to which other vertebra levels could be useful for measuring muscle status. In this study, we aimed to assess the correlation of the muscle quantity and quality between any vertebra level and L3 level in patients with various tumor localizations. Methods Two hundred-twenty Positron Emission Tomography (PET)-CT images of patients with four different tumor localizations were included: 1. head and neck (n = 34), 2. esophagus (n = 45), 3. lung (n = 54), and 4. melanoma (n = 87). From the whole body scan, 24 slices were used, i.e., one for each vertebra level. Two examiners contoured the muscles independently. After contouring, muscle quantity was estimated by calculating skeletal muscle area (SMA) and skeletal muscle index (SMI). Muscle quality was assessed by calculating muscle radiation attenuation (MRA). Pearson correlation coefficient was used to determine whether the other vertebra levels correlate with L3 level. Results For SMA, strong correlations were found between C1-C3 and L3, and C7-L5 and L3 (r = 0.72-0.95). For SMI, strong correlations were found between the levels C1-C2, C7-T5, T7-L5, and L3 (r = 0.70-0.93), respectively. For MRA, strong correlations were found between T1-L5 and L3 (r = 0.71-0.95). Discussion For muscle quantity, the correlations between the cervical, thoracic, and lumbar levels are good, except for the cervical levels in patients with esophageal cancer. For muscle quality, the correlations between the other levels and L3 are good, except for the cervical levels in patients with melanoma. If visualization of L3 on the CT scan is absent, the other thoracic and lumbar vertebra levels could serve as a proxy to measure muscle quantity and quality in patients with head and neck, esophageal, lung cancer, and melanoma, whereas the cervical levels may be less reliable as a proxy in some patient groups.
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Affiliation(s)
- Jona Van den Broeck
- Experimental Anatomy Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Martine J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Carola Brussaard
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jasmijn Kooijman
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Harriët Jager-Wittenaar
- Experimental Anatomy Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Aldo Scafoglieri
- Experimental Anatomy Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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13
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Evaluation of sarcopenia and sarcopenic obesity in patients affected by oral squamous cell carcinoma: A retrospective single-center study. J Craniomaxillofac Surg 2023; 51:7-15. [PMID: 36739189 DOI: 10.1016/j.jcms.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2022] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
This retrospective single-center study aimed to evaluate the relevance of sarcopenia and sarcopenic obesity as negative prognostic factors in patients with oral squamous cell carcinoma (OSCC). The study was performed on patients who underwent oral squamous cell carcinoma resection surgery. Patients' demographic and clinical variables were collected at diagnosis (sex, age, height, weight, comorbidities, smoke and alcohol consumption, HPV positivity, TNM-stage) and corrected for known prognostic factors (age, body mass index, TNM-stage). The Skeletal Muscle Mass (SMM) and the Cross-Sectional Area (CSA) on pre-treatment CT scans and Body Mass Index (BMI) were measured to assess sarcopenia and sarcopenic obesity correlated to overall survival (OS). Chi-square statistics were used to analyze the differences between the frequencies of each categorical variable with the presence or absence of sarcopenia and sarcopenic obesity. The cumulative overall survival was calculated by the Kaplan-Meier method, and the differences between curves were evaluated by the log-rank test. A Cox proportional hazard regression model was used for univariate and multivariate analysis of the overall survival. Within the limitations of the study, in this sample, sarcopenia did not seem to cause a statistically significant reduction in the overall survival in patients with oral squamous cell carcinoma (Log Rank χ2 = 3.67, p = 0.055; HR 0.996, 95% CI 0.732-1.354, p = 0.979), however, sarcopenic obesity showed a meaningful negative prognostic impact on it (Log Rank χ2 = 5.71, p = 0.017; HR 0.985, 95% CI 0.424-2.286, p = 0.972). Within the limitations of the study it seems that sarcopenic obesity, age, BMI, and TNM-stage are more relevant negative prognostic factors, influencing overall survival in surgically treated OSCC, than sarcopenia.
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14
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Edwards A, Hughes BGM, Brown T, Bauer J. Prevalence and Impact of Computed Tomography-Defined Sarcopenia on Survival in Patients with Human Papillomavirus-Positive Oropharyngeal Cancer: A Systematic Review. Adv Nutr 2022; 13:2433-2444. [PMID: 35876662 PMCID: PMC9776633 DOI: 10.1093/advances/nmac076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 01/29/2023] Open
Abstract
Sarcopenia is a known independent prognostic factor for decreased survival in patients with head and neck cancer; yet, its importance for the growing number of younger patients diagnosed with human papillomavirus (HPV)-positive oropharyngeal carcinoma (OPC+) has not been established. This systematic literature review aimed to determine the prevalence and impact of computed tomography (CT)-defined sarcopenia on survival outcomes for adult OPC+ patients (>18 y) undergoing any treatment modality. Prospective studies were searched using PubMed, Embase, CENTRAL, CINAHL, and Web of Science up until and including February 2022. Bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In total, 9 studies (total pooled OPC+ patients, n = 744) were identified and included in this review; 2 at low, 6 at moderate, and 1 at high risk of bias. All studies varied in sarcopenia assessment methods and skeletal muscle index threshold cutoff values. These studies demonstrated the cumulative prevalence of sarcopenia for OPC+ patients to be 42.9% (95% CI: 37.8%, 47.9%). While overall survival (3 studies, n = 253) and progression-free survival (1 study, n = 117) was lower in sarcopenic OPC+ patients, this was not statistically significant. GRADE certainty of evidence for impact of pretreatment sarcopenia on overall survival was low and progression-free survival was very low. Although these studies showed there to be a high prevalence of pretreatment sarcopenia in patients with OPC+, which may decrease survival, the impact on progression-free survival is very uncertain. Further, high-quality research utilizing consistent sarcopenia definitions and assessment methods that are conducted specifically in OPC+ is required to strengthen evidence certainty and determine if sarcopenia is an independent prognostic factor for this population.
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Affiliation(s)
| | - Brett G M Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition, Dietetics, and Food, Monash University, Melbourne, Victoria, Australia
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15
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de Bree R, Meerkerk CDA, Halmos GB, Mäkitie AA, Homma A, Rodrigo JP, López F, Takes RP, Vermorken JB, Ferlito A. Measurement of Sarcopenia in Head and Neck Cancer Patients and Its Association With Frailty. Front Oncol 2022; 12:884988. [PMID: 35651790 PMCID: PMC9150392 DOI: 10.3389/fonc.2022.884988] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
In head and neck cancer (HNC) there is a need for more personalized treatment based on risk assessment for treatment related adverse events (i.e. toxicities and complications), expected survival and quality of life. Sarcopenia, defined as a condition characterized by loss of skeletal muscle mass and function, can predict adverse outcomes in HNC patients. A review of the literature on the measurement of sarcopenia in head and neck cancer patients and its association with frailty was performed. Skeletal muscle mass (SMM) measurement only is often used to determine if sarcopenia is present or not. SMM is most often assessed by measuring skeletal muscle cross-sectional area on CT or MRI at the level of the third lumbar vertebra. As abdominal scans are not always available in HNC patients, measurement of SMM at the third cervical vertebra has been developed and is frequently used. Frailty is often defined as an age-related cumulative decline across multiple physiologic systems, with impaired homeostatic reserve and a reduced capacity of the organism to withstand stress, leading to increased risk of adverse health outcomes. There is no international standard measure of frailty and there are multiple measures of frailty. Both sarcopenia and frailty can predict adverse outcomes and can be used to identify vulnerable patients, select treatment options, adjust treatments, improve patient counselling, improve preoperative nutritional status and anticipate early on complications, length of hospital stay and discharge. Depending on the definitions used for sarcopenia and frailty, there is more or less overlap between both conditions. However, it has yet to be determined if sarcopenia and frailty can be used interchangeably or that they have additional value and should be used in combination to optimize individualized treatment in HNC patients.
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Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Christiaan D. A. Meerkerk
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Gyorgy B. Halmos
- Department of Otorhinolaryngology – Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Juan P. Rodrigo
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Fernando López
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Robert P. Takes
- Department of Otolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan B. Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium and Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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16
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Olson B, Edwards J, Degnin C, Santucci N, Buncke M, Hu J, Chen Y, Fuller CD, Geltzeiler M, Grossberg AJ, Clayburgh D. Establishment and Validation of Pre-Therapy Cervical Vertebrae Muscle Quantification as a Prognostic Marker of Sarcopenia in Patients With Head and Neck Cancer. Front Oncol 2022; 12:812159. [PMID: 35237517 PMCID: PMC8882831 DOI: 10.3389/fonc.2022.812159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
Background Sarcopenia is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging without computed tomography (CT) imaging of the abdomen or thorax. Herein, we establish sarcopenia thresholds at the C3 level and determine if C3 sarcopenia is associated with survival in patients with HNC. Methods This retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment. Measurement of cross-sectional muscle area at L3 and C3 levels was performed from CT imaging. Primary study outcome was overall survival. Results Skeletal muscle area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3 sarcopenia thresholds of 14.0 cm2/m2 (men) and 11.1 cm2/m2 (women) were best predictive of L3 sarcopenia thresholds. Applying these C3 thresholds to a cohort of patients with neck imaging alone revealed that C3 sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85). Conclusions This study identifies sarcopenia thresholds at the C3 level that best predict L3 sarcopenia in men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.
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Affiliation(s)
- Brennan Olson
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, United States
| | - Jared Edwards
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, United States
| | - Catherine Degnin
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Nicole Santucci
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Michelle Buncke
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Jeffrey Hu
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Yiyi Chen
- Seagen Inc., Bothell, WA, United States
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Aaron J. Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, OR, United States
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- *Correspondence: Daniel Clayburgh, ; Aaron J. Grossberg,
| | - Daniel Clayburgh
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR, United States
- Operative Care Division, Portland Veterans Affairs Health Care System, Portland, OR, United States
- *Correspondence: Daniel Clayburgh, ; Aaron J. Grossberg,
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17
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Sarcopenia and its impact in head and neck cancer treatment. Curr Opin Otolaryngol Head Neck Surg 2022; 30:87-93. [DOI: 10.1097/moo.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Bril SI, van Beers MA, Chargi N, Carrillo Minulina N, Smid EJ, Dankbaar JW, de Bree R. Skeletal muscle mass at C3 is a strong predictor for skeletal muscle mass at L3 in sarcopenic and non-sarcopenic patients with head and neck cancer. Oral Oncol 2021; 122:105558. [PMID: 34627078 DOI: 10.1016/j.oraloncology.2021.105558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Sandra I Bril
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - M A van Beers
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - N Chargi
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - N Carrillo Minulina
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - E J Smid
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - J W Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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