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Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy. Radiat Oncol 2019; 14:166. [PMID: 31511012 PMCID: PMC6739918 DOI: 10.1186/s13014-019-1372-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023] Open
Abstract
Background Sarcopenia, the critical depletion of skeletal muscle mass, is an independent prognostic factor in several tumor entities for treatment-related toxicity and survival. In esophageal cancer, there have been conflicting results regarding the value of sarcopenia as prognostic factor, which may be attributed to the heterogeneous patient populations and the retrospective nature of previous studies. The aim of our study was therefore to determine the impact of sarcopenia on prospectively collected specific outcomes in a subgroup of patients treated within the phase III study SAKK 75/08 with trimodality therapy (induction chemotherapy, radiochemotherapy and surgery) for locally advanced esophageal cancer. Methods Sarcopenia was assessed by skeletal muscle index at the 3rd lumbar vertebra (L3) in cross-sectional computed tomography scans before induction chemotherapy, before radiochemotherapy and after neoadjuvant therapy in a subgroup of 61 patients from four centers in Switzerland. Sarcopenia was determined by previously established cut-off values (Martin et al., PMID: 23530101) and correlated with prospectively collected outcomes including treatment-related toxicity, postoperative morbidity, treatment feasibility and survival. Results Using the published cut-off values, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9% during neoadjuvant therapy (p < 0.001). Feasibility of neoadjuvant therapy and surgery was not different in initially sarcopenic and non-sarcopenic patients. We observed in sarcopenic patients significantly increased grade ≥ 3 toxicities during chemoradiation (83.3% vs 52.4%, p = 0.04) and a non-significant trend towards increased postoperative complications (66.7% vs 42.9%, p = 0.16). No difference in survival according to sarcopenia could be observed in this small study population. Conclusions Trimodality therapy in locally advanced esophageal cancer is feasible in selected patients with sarcopenia. Neoadjuvant chemoradiation increased the percentage of sarcopenia. Sarcopenic patients are at higher risk for increased toxicity during neoadjuvant radiochemotherapy and showed a non-significant trend to more postoperative morbidity.
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Antoun S, Bayar MA, Dyevre V, Lanoy E, Smolenschi C, Ducreux M. No evidence for changes in skeletal muscle mass or weight during first-line chemotherapy for metastatic colorectal cancer. BMC Cancer 2019; 19:847. [PMID: 31462288 PMCID: PMC6714393 DOI: 10.1186/s12885-019-6086-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 08/23/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Studies over the past 10 years strongly support an association between skeletal muscle mass (SMM) depletion and outcome in metastatic colorectal cancer (mCRC). Factors influencing SMM changes over time are, however, poorly studied. We analyzed the impact of SMM on overall survival and chemotherapy toxicities in mCRC patients treated with first-line chemotherapy. Changes in weight and body composition were evaluated during follow-up. METHODS Patients enrolled in the randomized phase II ACCORD trial comparing two chemotherapy regimens were screened. Body composition parameters (SMM, adipose tissue) were assessed prospectively with computed tomography (CT) imaging, and toxicities were recorded. Mixed models were used to assess weight and BC changes during 4 months of treatment follow-up. RESULTS Among 145 patients included in ACCORD, 76 had available baseline CT scans and were included in the current study. Mean age was 60.6 ± 10.0 years, 50% were women, 82% had colon cancer, and 62% had two or more metastatic sites. At baseline, 49% had lost at least 5% of their initial weight, including 26% who had lost more than 10%; 53% had SMM depletion. In this homogenous cohort, there were no statistically significant associations between SMM depletion and overall survival, progression-free survival or chemotherapy toxicity. There were no decreases in weight or SMM during follow-up. Weight and SMM changes were not influenced by diarrhea either grade 3-4 or any grade (reported in 74% of patients). For patients with weight loss ≥10% at baseline, SMM increased significantly after 4 months of follow-up and after disease stabilization following chemotherapy (P = 0.008). CONCLUSIONS In a homogenous mCRC cohort, SMM depletion was not associated with survival or chemotherapy toxicity. Despite most patient experiencing diarrhea, no changes in weight or SMM were found during 4 months of follow-up. However, hypotheses deriving from our exploratory study have to be tested in further larger sample size studies. TRIAL REGISTRATION Clinicaltrials.gov NCT00423696 (2011).
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Affiliation(s)
- Sami Antoun
- Medical Emergency Unit in Oncology, Gustave Roussy Cancer Campus, 94800, Villejuif, France.
| | - Mohamed Amine Bayar
- Department of Biostatics and Epidemiology, Gustave Roussy Cancer Campus, 94800, Villejuif, France.,CESP, Faculté de Médecine, Université Paris Sud, INSERM, Université Paris Saclay, 94805, Villejuif, France
| | - Valérie Dyevre
- Department of Biostatics and Epidemiology, Gustave Roussy Cancer Campus, 94800, Villejuif, France
| | - Emilie Lanoy
- Department of Biostatics and Epidemiology, Gustave Roussy Cancer Campus, 94800, Villejuif, France
| | - Cristina Smolenschi
- Department Medical Oncology, Gustave Roussy Cancer Campu, 94800, Villejuif, France
| | - Michel Ducreux
- Department Medical Oncology, Gustave Roussy Cancer Campu, 94800, Villejuif, France
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Kurk S, Peeters P, Stellato R, Dorresteijn B, de Jong P, Jourdan M, Creemers G, Erdkamp F, de Jongh F, Kint P, Simkens L, Tanis B, Tjin‐A‐Ton M, Van Der Velden A, Punt C, Koopman M, May A. Skeletal muscle mass loss and dose-limiting toxicities in metastatic colorectal cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:803-813. [PMID: 31094083 PMCID: PMC6711417 DOI: 10.1002/jcsm.12436] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/21/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that severe skeletal muscle index (SMI) loss (sarcopenia) is associated with poor overall survival in metastatic colorectal cancer patients, but its mechanisms are unknown. We recently found, using data of the randomized phase 3 CAIRO3 study, that SMI loss was related with shorter time to disease progression and overall survival during first-line maintenance treatment with capecitabine + bevacizumab (CAP-B) or observation and during more intensive capecitabine + oxaliplatin + bevacizumab (CAPOX-B) reintroduction treatment. As a potential risk factor for reduced survival, we explored whether sarcopenia and SMI loss were associated with dose-limiting toxicities (DLTs) during CAP-B and CAPOX-B. METHODS Sarcopenia status and SMI loss were assessed by using consecutive computed tomography scans. DLTs were defined as any dose delay/reduction/discontinuation of systemic treatment because of reported CTCAE (version 3.0) toxicities at the start or during treatment. Poisson regression models were used to study whether sarcopenia and body mass index (BMI) at the start of treatment and SMI and BMI loss during treatment were associated with DLTs. RESULTS One hundred eighty-two patients (mean age 63.0 ± 8.8 years, 37% female) received CAP-B, and 232 patients (mean age 63.0 ± 9.0 years, 34% female) received CAPOX-B. At the start of CAP-B and CAPOX-B, 54% and 46% of patients were sarcopenic, respectively. Mean BMI was lower in sarcopenic patients, although patients were on average still overweight (sarcopenic vs. non-sarcopenic at the start of CAP-B 25.0 ± 3.9 vs. 26.7 ± 4.1 and CAPOX-B 25.8 ± 3.8 vs. 27.1 ± 3.8 kg/m2 ). Sarcopenia at the start of CAP-B was not associated with DLTs [relative risk 0.87 (95% confidence interval 0.64-1.19)], whereas patients with >2% SMI loss had a significantly higher risk of DLTs [1.29 (1.01-1.66)]. At the start of subsequent CAPOX-B, 25% of patients received a dose reduction, and the risk of dose reduction was significantly higher for patients with preceding SMI loss [1.78 (1.06-3.01)] or sarcopenia [1.75 (1.08-2.86)]. After the received dose reductions, sarcopenia or SMI loss was not significantly associated with a higher risk of DLTs during CAPOX-B [sarcopenia vs. non-sarcopenic: 0.86 (0.69-1.08) and SMI loss vs. stable/gain: 0.83 (0.65-1.07)]. In contrast, BMI (loss) at the start or during either treatment was not associated with an increased risk of DLTs. CONCLUSIONS In this large longitudinal study in metastatic colorectal cancer patients during palliative systemic treatment, sarcopenia and/or muscle loss was associated with an increased risk of DLTs. BMI was not associated with DLTs and could not detect sarcopenia or SMI loss. Prospective (randomized) studies should reveal whether normalizing chemotherapeutic doses to muscle mass or muscle mass preservation (by exercise and nutritional interventions) increases chemotherapeutic tolerance and improves survival.
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Affiliation(s)
- Sophie Kurk
- Department of Medical Oncology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Petra Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Rebecca Stellato
- Department of Statistics, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - B. Dorresteijn
- Danone Nutricia ResearchNutricia Advanced Medical NutritionUtrechtThe Netherlands
| | - Pim de Jong
- Department of Radiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Marion Jourdan
- Danone Nutricia ResearchNutricia Advanced Medical NutritionUtrechtThe Netherlands
| | - Geert‐Jan Creemers
- Department of Medical OncologyCatharina HospitalEindhovenThe Netherlands
| | - Frans Erdkamp
- Department of Medical OncologyZuyderland HospitalSittard‐GeleenThe Netherlands
| | - Felix de Jongh
- Department of Internal Medicine and Medical OncologyIkazia HospitalRotterdamThe Netherlands
| | - Peter Kint
- Department of RadiologyAmphia HospitalBredaThe Netherlands
| | - Lieke Simkens
- Department of Medical OncologyMaxima Medical CenterEindhovenThe Netherlands
| | - Bea Tanis
- Department of Medical OncologyGroenehart HospitalGoudaThe Netherlands
| | - Manuel Tjin‐A‐Ton
- Department of Medical OncologyRivierenland HospitalTielThe Netherlands
| | | | - Cornelis Punt
- Department of Medical Oncology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Anne May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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Cotogni P, Pedrazzoli P, De Waele E, Aprile G, Farina G, Stragliotto S, De Lorenzo F, Caccialanza R. Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes? J Cancer 2019; 10:4318-4325. [PMID: 31413751 PMCID: PMC6691712 DOI: 10.7150/jca.31611] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/26/2019] [Indexed: 01/06/2023] Open
Abstract
One of the challenges during chemotherapy and radiotherapy is to complete the planned cycles and doses without dose-limiting toxicity. Growing evidence clearly demonstrates the relationship between dose-limiting toxicity and low muscle mass. Moreover, malnutrition leads to low performance status, impaired quality of life, unplanned hospital admissions, and reduced survival. In the past, the lack of clear and authoritative recommendations and guidelines has meant that oncologists have not always fully appreciated the importance of nutritional therapy in patients receiving anticancer treatments. Therefore, collaboration between oncologists and clinical nutrition specialists needs to be urgently improved. Recent guidelines from scientific societies and practical recommendations by inter-society consensus documents can be summarized as follows: 1) timely nutritional therapy should be carefully considered if patients undergoing anticancer treatments are malnourished or at risk of malnutrition due to inadequate oral intake; 2) if oral intake is inadequate despite counseling and oral nutritional supplements, supplemental enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition should be considered; 3) home artificial nutrition should be prescribed and regularly monitored using defined protocols developed between oncologists and clinical nutrition specialists; 4) appropriate nutritional management in the context of simultaneous care should become a guaranteed right for all patients with cancer. The purpose of this review is to provide oncologists with an overview of the aims and current evidence about nutrition in oncology, together with updated practical and concise recommendations on the application of nutritional therapy in cancer patients receiving chemoradiotherapy.
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Affiliation(s)
- Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Elisabeth De Waele
- Intensive Care Unit and Department of Nutrition, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Gabriella Farina
- Department of Oncology, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Moderate Exercise Improves Experimental Cancer Cachexia by Modulating the Redox Homeostasis. Cancers (Basel) 2019; 11:cancers11030285. [PMID: 30823492 PMCID: PMC6468783 DOI: 10.3390/cancers11030285] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 12/19/2022] Open
Abstract
Cachexia is a debilitating syndrome that complicates the management of cancer patients. Muscle wasting, one of the main features of cachexia, is associated with hyper-activation of protein degradative pathways and altered mitochondrial function that could both result from impaired redox homeostasis. This study aimed to investigate the contribution of oxidative stress to cancer-induced cachexia in the presence or in the absence of moderate exercise training. Mice bearing the colon C26 carcinoma, either sedentary or exercised, were used. The former showed muscle wasting and redox imbalance, with the activation of an antioxidant response and with upregulation of markers of proteasome-dependent protein degradation and autophagy. Moderate exercise was able to relieve muscle wasting and prevented the loss of muscle strength; such a pattern was associated with reduced levels of Reactive Oxygen Species (ROS), carbonylated proteins and markers of autophagy and with improved antioxidant capacity. The muscle of sedentary tumor hosts also showed increased levels of molecular markers of mitophagy and reduced mitochondrial mass. Conversely, exercise in the C26 hosts led to increased mitochondrial mass. In conclusion, moderate exercise could be an effective non-pharmacological approach to prevent muscle wasting in cancer patients, decreasing muscle protein catabolism and oxidative stress and preserving mitochondria.
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56
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Sealy MJ, Dechaphunkul T, van der Schans CP, Krijnen WP, Roodenburg JLN, Walker J, Jager-Wittenaar H, Baracos VE. Low muscle mass is associated with early termination of chemotherapy related to toxicity in patients with head and neck cancer. Clin Nutr 2019; 39:501-509. [PMID: 30846324 DOI: 10.1016/j.clnu.2019.02.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS We studied whether low pre-treatment muscle mass, measured with CT at thoracic (T4) or lumbar level (L3) associates with early termination of chemotherapy related to toxicity in head and neck cancer (HNC) patients. METHODS This was a retrospective chart and image review. Adult HNC patients treated with (surgery and) platinum-based chemo-radiotherapy were included if a pre-treatment CT scan at T4 or L3 level was available. Muscle mass was evaluated by assessment of skeletal muscle index (SMI; cm2/m2). T4 and L3 SMI measurements were corrected for deviation from their respective means and were merged into one score for SMI difference (cm2/m2). All cases were assessed for presence of toxicity-related unplanned early termination of chemotherapy ('early termination'). Univariate and multivariate logistic regression models were used to investigate associations between pooled SMI and early termination. RESULTS 213 patients (age: 57.9 ± 10.3 y, male: 77%, T4 image: 45%) were included. A significant association between SMI as a continuous variable and early termination was found, both in the univariate analysis (p = 0.007, OR = 0.96 [0.94-0.99]) and the multivariate analysis (p = 0.021, OR 0.96 [0.92-0.99]). The multivariate models identified potential associations with type of chemotherapy, presence of co-morbidity, a combination of (former) smoking and alcohol consumption, and sex. CONCLUSION Lower muscle mass was robustly associated with higher odds of early termination of chemotherapy in HNC patients. Further prospective studies are required to tailor the care for patients with low muscle mass and to avoid early termination of chemotherapy.
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Affiliation(s)
- Martine J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Tanadech Dechaphunkul
- Department of Oncology, University of Alberta, Edmonton, AB, Canada; Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand.
| | - Cees P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; Department of Rehabilitation Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands; Department of Health Psychology Research, University of Groningen, University Medical Center, Groningen, the Netherlands.
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; Johan Bernoulli Institute for Mathematics and Computer Science, University of Groningen, Groningen, the Netherlands.
| | - Jan L N Roodenburg
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - John Walker
- Department of Oncology, University of Alberta, Edmonton, AB, Canada.
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Vickie E Baracos
- Department of Oncology, University of Alberta, Edmonton, AB, Canada.
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Freckelton J, Croagh D, Holt DQ, Fox A, Wong R, Lee M, Moore GT. Body Composition Adjusted Dosing of Gemcitabine-Nab-Paclitaxel in Pancreatic Cancer Does Not Predict Toxicity Compared to Body Surface Area Dosing. Nutr Cancer 2019; 71:624-628. [DOI: 10.1080/01635581.2018.1542011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Julia Freckelton
- School of Clinical Sciences, Department of Surgery, Monash Health, Monash University, Clayton, Victoria, Australia
| | - Daniel Croagh
- School of Clinical Sciences, Department of Surgery, Monash Health, Monash University, Clayton, Victoria, Australia
| | - Darcy Quinn Holt
- Clinical Nutrition and Metabolism Unit, Monash Health, Clayton, Victoria, Australia
| | - Adrian Fox
- Department of Medicine, Nursing & Health Science, Monash University, Clayton, Victoria, Australia
- Department of Surgery, Eastern Health, Clayton, Victoria, Australia
| | - Rachel Wong
- Department of Medicine, Nursing & Health Science, Monash University, Clayton, Victoria, Australia
- Department of Oncology, Eastern Health, Clayton, Victoria, Australia
| | - Margaret Lee
- Department of Medicine, Nursing & Health Science, Monash University, Clayton, Victoria, Australia
- Department of Oncology, Eastern Health, Clayton, Victoria, Australia
| | - Gregory Thomas Moore
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia
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Dijksterhuis WPM, Pruijt MJ, van der Woude SO, Klaassen R, Kurk SA, van Oijen MGH, van Laarhoven HWM. Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy. J Cachexia Sarcopenia Muscle 2019; 10:199-206. [PMID: 30666831 PMCID: PMC6438339 DOI: 10.1002/jcsm.12371] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/05/2018] [Accepted: 11/03/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Palliative systemic treatment in patients with advanced or metastatic esophagogastric cancer may result in improved overall survival and quality of life but can also lead to considerable toxicity. In various cancer types, severe muscle mass depletion (sarcopenia) and poor muscle strength are associated with decreased survival and increased chemotherapy-related toxicity. The aim of this study is to determine the impact of body composition on survival and chemotherapy toxicity in esophagogastric cancer patients treated with first-line palliative chemotherapy. METHODS A total of 88 patients with advanced esophagogastric cancer treated with standard first-line palliative systemic therapy consisting of capecitabine and oxaliplatin (CapOx) between January 2010 and February 2017 were included. Skeletal muscle index (SMI), reflecting muscle mass, and skeletal muscle density (SMD), associated with muscle strength, were measured using pre-treatment of all patients and evaluation computed tomography scans after three treatment cycles of 65 patients and were used to determine sarcopenia and sarcopenic obesity (i.e. sarcopenia and body mass index >25 kg/m2 ). The associations between body composition (SMI, SMD, sarcopenia, and sarcopenic obesity) and survival and toxicity were assessed using univariable and multivariable Cox and logistic regression analyses, respectively. RESULTS Of 88 patients, 75% was male, and median age was 63 (interquartile range 56-69) years. The majority of patients had an adenocarcinoma (83%). Before start of treatment, 49% of the patients were sarcopenic, and 20% had sarcopenic obesity. Low SMD was observed in 50% of patients. During three cycles CapOx, SMI significantly decreased, with a median decrease of 4% (interquartile range -8.6--0.4). Median progression-free and overall survival were 6.9 and 10.1 months. SMI, SMD, sarcopenia, and sarcopenic obesity (both pre-treatment and after three cycles) were neither associated with progression-free nor overall survival. Pre-treatment SMD was independently associated with grade 3-4 toxicity (odds ratio 0.94; 95% confidence interval 0.89-1.00) and sarcopenic obesity with grade 2-4 neuropathy (odds ratio 3.82; 95% confidence interval 1.20-12.18). CONCLUSIONS Sarcopenia was not associated with survival or treatment-related toxicity in advanced esophagogastric cancer patients treated with CapOx. Pre-treatment sarcopenic obesity was independently associated with the occurrence of grade 2-4 neurotoxicity and skeletal muscle density with grade 3-4 toxicity.
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Affiliation(s)
- Willemieke P M Dijksterhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten J Pruijt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie O van der Woude
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Remy Klaassen
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie A Kurk
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Martijn G H van Oijen
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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A window beneath the skin: how computed tomography assessment of body composition can assist in the identification of hidden wasting conditions in oncology that profoundly impact outcomes. Proc Nutr Soc 2019; 77:135-151. [PMID: 29745361 DOI: 10.1017/s0029665118000046] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Advancements in image-based technologies and body composition research over the past decade has led to increased understanding of the importance of muscle abnormalities, such as low muscle mass (sarcopenia), and more recently low muscle attenuation (MA), as important prognostic indicators of unfavourable outcomes in patients with cancer. Muscle abnormalities can be highly prevalent in patients with cancer (ranging between 10 and 90 %), depending on the cohort under investigation and diagnostic criteria used. Importantly, both low muscle mass and low MA have been associated with poorer tolerance to chemotherapy, increased risk of post-operative infectious and non-infectious complications, increased length of hospital stay and poorer survival in patients with cancer. Studies have shown that systemic antineoplastic treatment can exacerbate losses in muscle mass and MA, with reported loss of skeletal muscle between 3 and 5 % per 100 d, which are increased exponentially with progressive disease and proximity to death. At present, no effective medical intervention to improve muscle mass and MA exists. Most research to date has focused on treating muscle depletion as part of the cachexia syndrome using nutritional, exercise and pharmacological interventions; however, these single-agent therapies have not provided promising results. Rehabilitation care to modify body composition, either increasing muscle mass and/or MA should be conducted, and its respective impact on oncology outcomes explored. Although the optimal timing and treatment strategy for preventing or delaying the development of muscle abnormalities are yet to be determined, multimodal interventions initiated early in the disease trajectory appear to hold the most promise.
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Zhang S, Tan S, Jiang Y, Xi Q, Meng Q, Zhuang Q, Han Y, Sui X, Wu G. Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: A prospective cohort study. Clin Nutr 2018; 38:2881-2888. [PMID: 30630709 DOI: 10.1016/j.clnu.2018.12.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Sarcopenia has been widely recognized as an important predictor of poor outcomes in patients with cancer after surgery, but the controversy remains, and its impact on surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer is poorly described. The aim of this study was to evaluate the prognostic impact of sarcopenia on surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer. METHODS Six thousand four hundred and forty-seven consecutive patients who underwent abdominal surgery for digestive tract cancer in our institution were prospectively included. Sarcopenia was defined as skeletal muscle index below the lowest sex-specific quartile using computed tomography scan at L3 before surgery. The surgical and oncologic outcomes were recorded, and univariate and multivariate analyses were performed. RESULTS Sarcopenia was present in 1638 of 6447 patients (25.4%) with digestive tract cancer before surgery based on the diagnostic cut-off values (43.13 cm2/m2 for men and 37.81 cm2/m2 for women). The incidence of postoperative total and pulmonary complications, and 30-day readmission were significantly higher in sarcopenic group than in nonsarcopenic group (37.4% vs 12.9%, P < 0.001; 3.1% vs 2.1%, P = 0.026; 1.1% vs 0.4%, P = 0.003, respectively). The postoperative hospital stay was significantly longer in sarcopenic patients (9.42 ± 3.40 vs 8.51 ± 3.17 days, P < 0.001). There were significantly more patients receiving postoperative chemotherapy or radiotherapy in sarcopenic group than in nonsarcopenic group (73.1% vs 69.2%, P = 0.003; 10.6% vs 8.8%, P = 0.038, respectively), and patients with sarcopenia had significantly more chemotherapy modifications including delay, dose reduction, or termination (48.5% vs 44.2%, P = 0.018). In addition, during the follow-up period, sarcopenic patients had significantly lower rate of overall survival and disease-free survival than nonsarcopenic patients (53.9% vs 69.3%, P = 0.002; 36.8% vs 59.7%, P = 0.000, respectively). In multivariate analysis, sarcopenia was found to be a risk factor for postoperative complications [odds ratio (OR) = 5.418, 95% confidence interval (CI) = 2.986-9.828, P < 0.001], and was an unfavorable prognostic factor for poor overall survival [hazard ratio (HR) = 0.649, 95% CI = 0.426-0.991, P = 0.045] and disease-free survival (HR = 0.514, 95% CI = 0.348-0.757, P = 0.001). CONCLUSIONS Sarcopenia could be used as a strong and independent prognostic factor for poor surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer. Identification of preoperative sarcopenia in digestive surgery for cancer and targeted approaches may improve its negative outcomes.
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Affiliation(s)
- Shuze Zhang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Jiang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiulei Xi
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingyang Meng
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiulin Zhuang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yusong Han
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiangyu Sui
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guohao Wu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Rimar KJ, Glaser AP, Kundu S, Schaeffer EM, Meeks J, Psutka SP. Changes in Lean Muscle Mass Associated with Neoadjuvant Platinum-Based Chemotherapy in Patients with Muscle Invasive Bladder Cancer. Bladder Cancer 2018; 4:411-418. [PMID: 30417052 PMCID: PMC6218112 DOI: 10.3233/blc-180188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Baseline sarcopenia or severe lean muscle deficiency is independently associated with increased mortality after cystectomy for muscle-invasive urothelial carcinoma of the bladder (MIUC). The impact of chemotherapy on muscle mass in MIUC patients remains undefined Objectives: To describe preoperative changes in body composition in MIUC patients receiving platinum-based neoadjuvant chemotherapy (NC). Methods: Patients with cT2-4 N0-1 M0 UC of the bladder who received NC were identified. Lumbar skeletal muscle index (SMI, cm2/m2), visceral adipose index (VAI, cm2/m2), and the subcutaneous and intramuscular adipose index (SAI, cm2/m2) were calculated using validated methodology (cross sectional area of skeletal muscle/height2 at L3) from measurement of soft tissue areas on pre- (pre-NC) and post-NC (post-NC) computed tomography. Patients were classified as sarcopenic according to consensus definitions: Male: SMI <55 cm2/m2, Female: SMI <38.5 cm2/m2. Pre-NC and post-NC median body mass index (BMI kg/m2), SMI, and adipose indices were compared. Results: The study cohort consisted of 26 patients, with a median age 70 years, including 7 females (27%). Chemotherapy regimens included dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (31%), gemcitabine/cisplatin (62%) and gemcitabine/carboplatin (3.8%) with a median of 3.5 (range 2–6) cycles. Median pre- and post-NC BMI were 27.1 kg/m2 and 27.2 kg/m2 (p = 0.36). Median pre- and post-NC SMI were 49.1 cm2/m2 and 44.5 (p < 0.001) respectively. Median percent change in SMI was –6.4% (range –30% to 10%). Pre-NC, 18 (69%) patients were sarcopenic vs. 21 (81%, p = 0.002) post-NC. Median time between initiation of chemotherapy and cystectomy was 110 days. Conclusions: We observed a significant decrease in lean muscle mass among MIUC patients treated with platinum-based NC prior to cystectomy, with an associated increase in the prevalence of sarcopenia. Patients undergoing NC may benefit from pre-habilitative interventions to mitigate lean muscle loss prior to cystectomy.
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Affiliation(s)
- Kalen J Rimar
- Department of Urology, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Alexander P Glaser
- Department of Urology, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Shilajit Kundu
- Department of Urology, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Joshua Meeks
- Department of Urology, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
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62
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van den Berg MMGA, Kok DE, Posthuma L, Kamps L, Kelfkens CS, Buist N, Geenen M, Haringhuizen A, Heijns JB, van Lieshout RHMA, Los M, Sommeijer DW, Timmer-Bonte JNH, de Kruif ATCM, van Laarhoven HWM, Kampman E, Winkels RM. Body composition is associated with risk of toxicity-induced modifications of treatment in women with stage I-IIIB breast cancer receiving chemotherapy. Breast Cancer Res Treat 2018; 173:475-481. [PMID: 30353244 PMCID: PMC6394786 DOI: 10.1007/s10549-018-5014-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
Purpose Initial dose of chemotherapy is planned based on body surface area, which does not take body composition into account. We studied the association between fat mass (kg and relative to total body weight) as well as lean mass (kg and relative to total body weight) and toxicity-induced modifications of treatment in breast cancer patients receiving chemotherapy. Methods In an observational study among 172 breast cancer patients (stage I–IIIB) in the Netherlands, we assessed body composition using dual-energy X-ray scans. Information on toxicity-induced modifications of treatment, defined as dose reductions, cycle delays, regimen switches, or premature termination of chemotherapy, was abstracted from medical records. Adjusted hazard ratios and 95% confidence intervals (95% CI) were calculated to assess associations between body composition and the risk of toxicity-induced modifications of treatment. Results In total, 95 out of 172 (55%) patients experienced toxicity-induced modifications of treatment. Higher absolute and relative fat mass were associated with higher risk of these modifications (HR 1.14 per 5 kg; 95% CI 1.04–1.25 and HR 1.21 per 5%; 95% CI 1.05–1.38, respectively). A higher relative lean mass was associated with a lower risk of modifications (HR 0.83 per 5%; 95% CI 0.72–0.96). There was no association between absolute lean mass and risk of toxicity-induced modifications of treatment. Conclusions A higher absolute and a higher relative fat mass was associated with an increased risk of toxicity-induced modifications of treatment. Absolute lean mass was not associated with risk of these treatment modifications, while higher relative lean mass associated with lower risk of modifications. These data suggest that total fat mass importantly determines the risk of toxicities during chemotherapy in breast cancer patients. Electronic supplementary material The online version of this article (10.1007/s10549-018-5014-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maaike M G A van den Berg
- Division of Human Nutrition and Health, Wageningen University & Research, PO Box 17, 6700 AA, Wageningen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, PO Box 17, 6700 AA, Wageningen, The Netherlands.
| | - Liesbeth Posthuma
- Division of Human Nutrition and Health, Wageningen University & Research, PO Box 17, 6700 AA, Wageningen, The Netherlands
| | - Lisette Kamps
- Division of Human Nutrition and Health, Wageningen University & Research, PO Box 17, 6700 AA, Wageningen, The Netherlands
| | - Celine S Kelfkens
- Division of Human Nutrition and Health, Wageningen University & Research, PO Box 17, 6700 AA, Wageningen, The Netherlands
| | | | - Maud Geenen
- Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands
| | | | | | | | - Maartje Los
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | | | | | | | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, PO Box 17, 6700 AA, Wageningen, The Netherlands
| | - Renate M Winkels
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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63
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Parker NH, Ngo-Huang A, Lee RE, O'Connor DP, Basen-Engquist KM, Petzel MQB, Wang X, Xiao L, Fogelman DR, Schadler KL, Simpson RJ, Fleming JB, Lee JE, Varadhachary GR, Sahai SK, Katz MHG. Physical activity and exercise during preoperative pancreatic cancer treatment. Support Care Cancer 2018; 27:2275-2284. [PMID: 30334105 DOI: 10.1007/s00520-018-4493-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Guidelines recommend exercise to cancer survivors, but limited data exists regarding exercise among patients undergoing preoperative cancer treatment. We examined differences in weekly self-reported exercise and accelerometer-measured physical activity among participants in a home-based exercise program administered during preoperative treatment for pancreatic cancer. METHODS Participants were encouraged to perform at least 60 min/week of moderate-intensity aerobic exercise and at least 60 min/week of full-body strengthening exercises concurrent with chemotherapy, chemoradiation therapy or both sequentially and received resistance equipment, program instruction, and biweekly follow-up calls to encourage adherence. Self-reported aerobic and strengthening exercise minutes were measured using daily logs, and physical activity was measured objectively using accelerometers. RESULTS Fifty participants (48% female, mean age 66 ± 8 years) participated for an average of 16 ± 9 preoperative weeks. Participants reported overall means of 126 ± 83 weekly minutes of aerobic exercise and 39 ± 33 weekly minutes of strengthening exercise in daily logs. Participants performed 158.7 ± 146.7 weekly minutes of accelerometer-measured moderate-to-vigorous physical activity. There were no significant differences in exercise or physical activity between treatment phases. CONCLUSIONS These findings suggest that it is feasible to target the entire preoperative course for exercise prescription. Although participants exceeded aerobic exercise recommendations on average, we observed low strengthening exercise adherence and wide variability in self-reported exercise and accelerometer physical activity variables. These findings suggest that additional support, including program adaptations, may be necessary to overcome barriers to exercise or improve motivation when prescribing exercise in this clinical scenario.
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Affiliation(s)
- Nathan H Parker
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, CPB 3.3278, PO Box 301439, Houston, TX, 77030-1439, USA.
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca E Lee
- College of Nursing and Health Innovation, Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Karen M Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, CPB 3.3278, PO Box 301439, Houston, TX, 77030-1439, USA
| | - Maria Q B Petzel
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David R Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keri L Schadler
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard J Simpson
- Department of Nutritional Sciences, The University of Arizona Cancer Center, Phoenix, AZ, USA
| | - Jason B Fleming
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gauri R Varadhachary
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunil K Sahai
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Cotogni P, Monge T, Fadda M, De Francesco A. Bioelectrical impedance analysis for monitoring cancer patients receiving chemotherapy and home parenteral nutrition. BMC Cancer 2018; 18:990. [PMID: 30332998 PMCID: PMC6192128 DOI: 10.1186/s12885-018-4904-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/04/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Home parenteral nutrition (HPN) can improve survival, quality of life, nutritional and functional status in cancer patients. Bioelectrical impedance analysis (BIA) is a non-invasive, validated method to assess body composition. The objective of this prospective single-arm study was to investigate the impact of HPN in advanced cancer patients receiving chemotherapy assessed by BIA, clinical and laboratory measures. METHODS Adult malnourished cancer outpatients with solid tumors receiving anticancer treatments who were candidates for daily HPN were enrolled. Patients were assessed at baseline (T0), 60 (T1) and 90 days (T2) after HPN start. Assessments included anthropometric and clinical-oncological characteristics, performance status, inflammatory response and Patient-Generated Subjective Global Assessment (PG-SGA). RESULTS Sixty-five advanced cancer patients were enrolled. Median overall survival was 317 days. Body weight, BMI, oral calorie and protein intake increased over time (P < 0.01). At T2 the proportion of well-nourished patients, Karnofsky performance status and modified Glasgow prognostic score were improved (P < 0.01), total body water was reduced (P = 0.04), and fat mass increased (P = 0.04). Reactance, resistance and phase angle were significantly associated with survival at T0, T1, and T2, respectively. At T2, PG-SGA category A was a predictor of survival (P < 0.0001). CONCLUSIONS After 90 days of HPN, patients experienced significantly improved nutritional status, performance status, prognostic score and some BIA measures. HPN may be an important therapy in oncology patients receiving chemotherapy. Longitudinal use of BIA may help track the effects of HPN and disease progression, potentially contributing to optimal global patient management.
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Affiliation(s)
- Paolo Cotogni
- Department of Anaesthesia and Intensive Care, Pain Management and Palliative Care, S. Giovanni Battista Hospital, University of Turin, C.so Bramante 88, 10126 Turin, Italy
- Unit of Parenteral Nutrition in Oncology, S. Giovanni Battista Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Taira Monge
- Unit of Parenteral Nutrition in Oncology, S. Giovanni Battista Hospital, C.so Bramante 88, 10126 Turin, Italy
- Clinical Nutrition, S. Giovanni Battista Hospital, C.so Bramante 88, 10126 Turin, Italy
| | - Maurizio Fadda
- Clinical Nutrition, S. Giovanni Battista Hospital, C.so Bramante 88, 10126 Turin, Italy
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Botsen D, Ordan MA, Barbe C, Mazza C, Perrier M, Moreau J, Brasseur M, Renard Y, Taillière B, Slimano F, Bertin E, Bouché O. Dynapenia could predict chemotherapy-induced dose-limiting neurotoxicity in digestive cancer patients. BMC Cancer 2018; 18:955. [PMID: 30286724 PMCID: PMC6172807 DOI: 10.1186/s12885-018-4860-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background FIGHTDIGO study showed the feasibility and acceptability of handgrip strength (HGS) measure in routine in 201 consecutive patients with digestive cancer treated with ambulatory chemotherapy. The present study focuses on the second aim of FIGHTDIGO study: the relationships between pre-therapeutic dynapenia and chemotherapy-induced Dose-Limiting Toxicities (DLT). Methods In this ancillary prospective study, DLT were analyzed in a sub-group of 45 chemotherapy-naive patients. Two bilateral consecutive measures of HGS were performed with a Jamar dynamometer before the first cycle of chemotherapy. Dynapenia was defined as HGS < 30 kg (men) and < 20 kg (women). DLT and/or Dose-Limiting Neurotoxicity (DLN) were defined as any toxicity leading to dose reduction, treatment delays or permanent treatment discontinuation. Results Two-thirds of chemotherapies were potentially neurotoxic (n = 31 [68.7%]) and 22 patients (48.9%) received FOLFOX (5FU, leucovorin plus oxaliplatin) regimen chemotherapy. Eleven patients (24.4%) had pre-therapeutic dynapenia. The median number of chemotherapy cycles was 10 with a median follow-up of 167 days. Twenty-two patients experienced DLT (48.9%). There was no significant association between pre-therapeutic dynapenia and DLT (p = 0.62). Nineteen patients (42.2%) experienced DLN. In multivariate analysis, dynapenia and tumoral location (stomach, biliary tract or small intestine) were independent risk factors for DLN (HR = 3.5 [1.3; 9.8]; p = 0.02 and HR = 3.6 [1.3; 10.0]; p = 0.01, respectively). Conclusions Digestive cancer patients with pre-therapeutic dynapenia seemed to experience more DLN. HGS routine measurement may be a way to screen patients with frailty marker (dynapenia) who would require chemotherapy dose adjustment and adapted physical activity programs. Trial registration NCT02797197 June 13, 2016 retrospectively registered.
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Affiliation(s)
- Damien Botsen
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France.
| | - Marie-Amélie Ordan
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Coralie Barbe
- Clinical Research Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Camille Mazza
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Marine Perrier
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Johanna Moreau
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France.,Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Mathilde Brasseur
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France.,Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Yohann Renard
- Department of General and Digestive Surgery, Reims University Hospital, Reims, France
| | - Barbara Taillière
- Artificial Nutrition Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Florian Slimano
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Eric Bertin
- Department of Nutrition, Endocrinology, and Diabetology, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
| | - Olivier Bouché
- Ambulatory Cancer Unit, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France.,Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Robert Debré Hospital, rue du Général Koenig, 51100, Reims, France
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Cespedes Feliciano EM, Avrutin E, Caan BJ, Boroian A, Mourtzakis M. Screening for low muscularity in colorectal cancer patients: a valid, clinic-friendly approach that predicts mortality. J Cachexia Sarcopenia Muscle 2018; 9:898-908. [PMID: 30066490 PMCID: PMC6204585 DOI: 10.1002/jcsm.12317] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Low skeletal muscle quantified using computed tomography (CT) scans is associated with morbidity and mortality among cancer patients. However, existing methods to assess skeletal muscle from CT are time-consuming, expensive, and require training. Clinic-friendly tools to screen for low skeletal muscle in cancer patients are urgently needed. METHODS We included 807 scans from non-metastatic colorectal cancer patients. With the digital ruler available in most radiological software, we implemented an abbreviated method to assess skeletal muscle area at the third lumbar vertebra (L3), which consisted of assessing the height and width of the psoas and paraspinal muscles and computing their combined 'linear area' in centimetres squared (cm2 ). A subset of CT scans was assessed twice by two analysts to compute intra-rater and inter-rater reliability. We derived cut-points for 'low' linear area using optimal stratification and then calculated the sensitivity and specificity of these cut-points relative to standard methods (total L3 cross-sectional area assessed with Slice-O-Matic research software). We further evaluated the association of low linear area with death from any cause after colorectal cancer diagnosis in Cox proportional hazards models adjusting for demographics, smoking, body mass index category, and tumour characteristics. RESULTS The linear area was highly correlated with total cross-sectional area assessed using standard methods [r = 0.92; 95% confidence interval (CI): 0.91, 0.93] overall and within subgroups defined by age, sex, and body mass index group. Intra-rater and inter-rater reliability were equally high (both intra-class correlations = 0.98). Cut-points for low linear area were sensitive (0.75; 95% CI: 0.70, 0.80) and specific (0.77; 95% CI: 0.73, 0.80) for identifying low skeletal muscle relative to the standard of total L3 cross-sectional area. The hazard ratio and 95% CI for death associated with a low linear area were hazard ratio = 1.66; 95% CI: 1.22, 2.25. CONCLUSIONS Clinic-friendly methods that assess linear area from CT scans are an accurate screening tool to identify low skeletal muscle among non-metastatic colorectal cancer patients. These linear measures are associated with mortality after colorectal cancer, suggesting they could be clinically useful both to improve prognostication and to provide a practical screening tool to identify cancer patients who require nutrition or exercise intervention.
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Affiliation(s)
| | - Egor Avrutin
- Department of KinesiologyUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Northern California200 Broadway, 5th FloorOaklandCAUSA
| | - Adam Boroian
- Division of ResearchKaiser Permanente Northern California200 Broadway, 5th FloorOaklandCAUSA
| | - Marina Mourtzakis
- Department of KinesiologyUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
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Trestini I, Carbognin L, Monteverdi S, Zanelli S, De Toma A, Bonaiuto C, Nortilli R, Fiorio E, Pilotto S, Di Maio M, Gasbarrini A, Scambia G, Tortora G, Bria E. Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer. Crit Rev Oncol Hematol 2018; 129:54-66. [DOI: 10.1016/j.critrevonc.2018.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023] Open
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Nishigori T, Tsunoda S, Obama K, Hisamori S, Hashimoto K, Itatani Y, Okada K, Sakai Y. Optimal Cutoff Values of Skeletal Muscle Index to Define Sarcopenia for Prediction of Survival in Patients with Advanced Gastric Cancer. Ann Surg Oncol 2018; 25:3596-3603. [PMID: 30167910 DOI: 10.1245/s10434-018-6728-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sarcopenia, characterized by loss of skeletal muscle mass, is recognized as a prognostic factor in patients with gastric cancer. However, wide variability exists in the cutoff values of muscle mass for defining sarcopenia across previous studies, and the best cutoff values to predict survival remain unknown. This study aimed to determine the optimal cutoff values for sarcopenia to predict survival in patients with advanced gastric cancer. PATIENTS AND METHODS Patients with clinical stage II/III gastric cancer who underwent gastrectomy at Kyoto University Hospital were included in the study. The cross-sectional area of skeletal muscle at the third lumbar vertebra level was measured using preoperative computed tomography scan. The skeletal muscle index (SMI) was calculated by dividing the area by height in meters squared. Five sex-specific cutoffs of SMI, which were significantly associated with prognosis in patients with gastric and nongastric cancers, were examined as a threshold to define sarcopenia. RESULTS In the 177 eligible patients, the five cutoffs of SMI resulted in an incidence of sarcopenia between 6 (3%) and 114 (64%). The 5-year overall survival was 48% in patients with sarcopenia based on the cutoffs reported by Martin et al., compared with 68% in those without sarcopenia (p = 0.013). A multivariate regression model demonstrated that sarcopenia based on the cutoffs was significantly associated with overall survival (hazard ratio 2.00, 95% confidence interval 1.24-3.24, p = 0.005). CONCLUSIONS The cutoff values reported by Martin et al. were optimal to predict survival in patients with advanced gastric cancer.
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Affiliation(s)
- Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyoichi Hashimoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiro Itatani
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuyuki Okada
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Landre T, Maillard E, Taleb C, Ghebriou D, Guetz GD, Zelek L, Aparicio T. Impact of the addition of bevacizumab, oxaliplatin, or irinotecan to fluoropyrimidin in the first-line treatment of metastatic colorectal cancer in elderly patients. Int J Colorectal Dis 2018; 33:1125-1130. [PMID: 29680896 DOI: 10.1007/s00384-018-3053-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The clinical benefit of double-front-line therapy (including oxaliplatin or irinotecan or bevacizumab plus 5-fluorouracil (5FU) or capecitabine) compared to monotherapy (5FU or capecitabine) in elderly (> 70 years) patients with metastatic colorectal cancer (MCRC) is controversial. We performed a meta-analysis of published randomized studies. MATERIALS AND METHODS The selection of the studies was carried out using PubMed with the following keywords: "metastatic colorectal cancer," "elderly," "oxaliplatin," "irinotecan," "bevacizumab," "survival." The efficacy endpoints were overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) with their 95% confidence intervals (CIs) were collected from the studies and pooled. By convention, an HR < 1 was a result in favor of biotherapy. RESULTS This meta-analysis (MA) included ten studies: three assessing irinotecan (FFCD 2001-02, CAIRO, and an already published MA by Folprecht), three assessing oxaliplatin (FOCUS2, FFCD 2000-05, and a published study by De Gramont), and four assessing bevacizumab (PRODIGE-20, AVEX, AGITG-MAX, and "AVF2192g" by Kabbinavar). Our MA included 1652 patients (62% of men). Concerning age, we chose a cut-off of 70 years or a cut-off of 75 years, corresponding to the available data for each study. The performance index (PS) was 0-1 for about 90% of patients, with the exception of FFCD 2001-02 and FOCUS2 which included 30% of patients with PS2. Overall, the addition of bevacizumab to fluoropyrimidin statistically improves both OS and PFS (HR = 0.78; CI 0.63-0.96 and HR = 0.55; CI 0.44-0.67, respectively). The addition of oxaliplatin did not statistically improve OS (= 0.99; CI 0.85-1.17) but improves PFS (HR = 0.81; CI 0.67-0.97) as well as the addition of irinotecan (HR = 1.01; CI 0.84-1.22 and HR = 0.82; CI 0.68-1.00, respectively). CONCLUSION In previously untreated elderly patients with MCRC, the addition of bevacizumab to fluoropyrimidin appears more effective in terms of OS or PFS than the addition of oxaliplatin or irinotecan.
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Affiliation(s)
- Thierry Landre
- Geriatric Oncology Coordination Unit - UCOG 93, APHP, René Muret Hospital, HUPSSD - Université Paris 13, Sevran, France. .,FRancilian Oncogeriatric Group (FROG), Argenteuil, France.
| | - Emilie Maillard
- Department of Biostatistics, Fédération Française de Cancérologie Digestive, Dijon, France
| | - Chérifa Taleb
- Geriatric Oncology Coordination Unit - UCOG 93, APHP, René Muret Hospital, HUPSSD - Université Paris 13, Sevran, France.,Oncology Department, APHP, Avicenne Hospital, HUPSSD - Université Paris 13, Bobigny, France
| | - Djamel Ghebriou
- FRancilian Oncogeriatric Group (FROG), Argenteuil, France.,Department of Oncology, APHP, Tenon Hospital, Paris, France
| | - Gaetan Des Guetz
- Oncology Department, APHP, Avicenne Hospital, HUPSSD - Université Paris 13, Bobigny, France
| | - Laurent Zelek
- Geriatric Oncology Coordination Unit - UCOG 93, APHP, René Muret Hospital, HUPSSD - Université Paris 13, Sevran, France.,Oncology Department, APHP, Avicenne Hospital, HUPSSD - Université Paris 13, Bobigny, France
| | - Thomas Aparicio
- Department of Biostatistics, Fédération Française de Cancérologie Digestive, Dijon, France.,Gastroenterology Department, CHU Saint Louis, APHP, Université Paris 7, Sorbonne Paris Cité, Paris, France
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70
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Lomma C, Ransom D. Chemotherapy dosing and toxicity in a patient with muscular dystrophy. Cancer Rep (Hoboken) 2018; 1:e1106. [PMID: 32721099 DOI: 10.1002/cnr2.1106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Chemotherapy dosing has traditionally been based on a body surface area (BSA) calculation despite BSA dosing being problematic in a number of conditions, such as renal failure, liver failure, obesity, and sarcopenia. This case highlights another condition in which BSA dosing is problematic. CASE A 57-year-old man with limb-girdle muscular dystrophy presents with stage IIA inoperable squamous cell carcinoma of the lung. He is treated with chemotherapy and radiotherapy with curative intent but develops significant chemotherapy related toxicity affecting chemotherapy scheduling and dosing. Later, his cancer progresses, and he is commenced on palliative chemotherapy resulting in further significant chemotherapy toxicity. CONCLUSION Sarcopenia is known to increase risk of chemotherapy toxicity. This case postulates that changes in muscle mass seen in muscular dystrophy increases risk of chemotherapy toxicity, similar to sarcopenia.
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Affiliation(s)
- Chris Lomma
- Medical Oncology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Ransom
- Medical Oncology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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71
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Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin Nutr 2018; 38:1053-1060. [PMID: 30025745 DOI: 10.1016/j.clnu.2018.06.982] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Preservation of lean body mass is an important cancer care objective. The capacity for prehabilitation interventions to modulate the lean body mass (LBM) of colorectal cancer patients before and after surgery is unknown. METHODS A pooled analysis of two randomized controlled trials of trimodal prehabilitation vs. trimodal rehabilitation at a single university-affiliated tertiary center employing Enhanced Recovery After Surgery (ERAS) care was conducted. The prehabilitation interventions included exercise, nutrition, and anxiety-reduction elements that began approximately four weeks before surgery and continued for eight weeks after surgery. The rehabilitation interventions were identical to the prehabilitation interventions but were initiated only after surgery. Body composition, measured using multifrequency bioelectrical impedance analysis, was recorded at baseline, pre-surgery, 4 and 8 weeks after surgery. The primary outcome was change in LBM before and after colorectal surgery for cancer. A mixed effects regression model was used to estimate changes in body mass and body composition over time controlling for age, sex, baseline body mass index (BMI), baseline six-minute walk test (6MWT), and postoperative compliance to the interventions. NCT02586701 &NCT01356264. RESULTS Pooled data included 76 patients who followed prehabilitation and 63 patients who followed rehabilitation (n = 139). Neither group experienced changes in preoperative LBM. Compared to rehabilitated patients, prehabilitated patients had significantly more absolute and relative LBM at four and eight-weeks post-surgery in models controlling for age, sex, baseline BMI, baseline 6MWT, and compliance to the postoperative intervention. CONCLUSION Trimodal prehabilitation attenuated the post-surgical LBM loss compared to the loss observed in patients who received the rehabilitation intervention. Patients who receive neither intervention (i.e., standard of care) would be likely to lose more LBM. Offering a prehabilitation program to colorectal cancer patients awaiting resection is a useful strategy to mitigate the impact of the surgical stress response on lean tissue in an ERAS setting, and, in turn, might have a positive impact on the cancer care course. CLINICAL TRIAL REGISTRATION NCT02586701 &NCT01356264 (clinicaltrials.gov).
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72
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Padgett LS, Asher A, Cheville A. The Intersection of Rehabilitation and Palliative Care: Patients With Advanced Cancer in the Inpatient Rehabilitation Setting. Rehabil Nurs 2018; 43:219-228. [DOI: 10.1097/rnj.0000000000000171] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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73
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Zheng ZF, Lu J, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Zheng CH, Huang CM, Li P. Preoperative skeletal muscle index vs the controlling nutritional status score: Which is a better objective predictor of long-term survival for gastric cancer patients after radical gastrectomy? Cancer Med 2018; 7:3537-3547. [PMID: 29953752 PMCID: PMC6089186 DOI: 10.1002/cam4.1548] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 12/21/2022] Open
Abstract
Skeletal muscle index (SMI) and the controlling nutritional status (CONUT) score are useful for evaluating nutritional status, which is closely associated with cancer prognosis. This study compared the prognostic value of these indicators in patients with gastric cancer (GC) after radical gastrectomy (RG). We retrospectively enrolled 532 patients between 2010 and 2011. SMI was measured via CT images to determine low SMI. The CONUT score was calculated based on serum albumin, total lymphocyte count, and cholesterol. Patients were grouped according to SMI and the CONUT score based on previous research. Spearman's correlation coefficient, the Kaplan-Meier method, and Cox regression were used. There was no significant correlation between SMI and the CONUT score. Five-year overall survival (OS) and recurrence-free survival (RFS) in patients with low SMI were significantly worse than those in patients with high SMI (P < .001). The normal nutrition group had better OS and RFS than did the light and moderate or severe malnutrition groups (P < .05), but the OS and RFS were not significantly different between the light and moderate or severe malnutrition groups (P = .726). Univariate analysis showed that SMI and the CONUT score were associated with OS and RFS, but only SMI remained prognostic in multivariate analysis. Preoperative SMI based on CT images is a more objective predictor than the CONUT score of long-term survival in GC after RG, but this finding must be confirmed by prospective trials.
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Affiliation(s)
- Zhi-Fang Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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Antonelli G, Gigante E, Iavarone M, Begini P, Sangiovanni A, Iannicelli E, Biondetti P, Pellicelli AM, Miglioresi L, Marchetti P, Lampertico P, Marignani M. Sarcopenia is associated with reduced survival in patients with advanced hepatocellular carcinoma undergoing sorafenib treatment. United European Gastroenterol J 2018; 6:1039-1048. [PMID: 30228892 DOI: 10.1177/2050640618781188] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/13/2018] [Indexed: 12/21/2022] Open
Abstract
Background Sarcopenia has been associated with poor outcomes in patients with cirrhosis and solid tumours. Objective Analyse the influence of sarcopenia on survival and treatment duration in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib. Methods We conducted a multicentre, retrospective study on 96 patients with advanced HCC treated with sorafenib, all with available abdominal computed tomography (CT) scan within 30 days from treatment start. Anthropometric, laboratory, treatment and follow-up data were collected. Sarcopenia was defined by reduced skeletal muscle index calculated from an L3 section CT image. Results Sarcopenia was present in 49% of patients. Patients were divided into two groups according to sarcopenia: age was significantly higher in the sarcopenic group (SG) (66 years (31-87) versus 72 years (30-84), p = 0.04], with no difference in other baseline characteristics. The SG showed shorter overall survival (OS) (39 (95% confidence interval (CI) 26-50) versus 61 (95% CI 47-77) weeks (p = 0,01)) and shorter time on treatment (12.3 (95% CI 8-19) versus 25.9 (95% CI 15-33) weeks (p = 0.0044)). At multivariate analysis, sarcopenia was independently associated to reduced OS (p = 0.03) and reduced time on treatment (p = 0.001). Conclusion Sarcopenia is present in almost half of patients with advanced HCC, and is associated with reduced survival and reduced duration of oral chemotherapy.
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Affiliation(s)
- Giulio Antonelli
- Digestive and Liver Disease Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Elia Gigante
- Digestive and Liver Disease Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Iavarone
- A. M. and A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Paola Begini
- Digestive and Liver Disease Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelo Sangiovanni
- A. M. and A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Elsa Iannicelli
- Radiology Unit, Sant'Andrea University Hospital, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Piero Biondetti
- Division of Radiology, Fondazione IRCCS Cà Granda Maggiore Hospital, Milan, Italy
| | | | | | - Paolo Marchetti
- Oncology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pietro Lampertico
- A. M. and A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Massimo Marignani
- Digestive and Liver Disease Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
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Body Composition in Relation to Clinical Outcomes in Renal Cell Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2018; 4:420-434. [DOI: 10.1016/j.euf.2016.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/24/2016] [Accepted: 11/16/2016] [Indexed: 11/19/2022]
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76
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Low dietary energy intake is associated with sarcopenia in cancer survivors: An analysis based on the Korean National Health and Nutrition Examination Survey 2008–2011. Nutr Res 2018; 53:15-22. [DOI: 10.1016/j.nutres.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/07/2017] [Accepted: 01/19/2018] [Indexed: 12/16/2022]
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77
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Ohtaka A, Aoki H, Nagata M, Kanayama M, Shimizu F, Ide H, Tsujimura A, Horie S. Sarcopenia is a poor prognostic factor of castration-resistant prostate cancer treated with docetaxel therapy. Prostate Int 2018; 7:9-14. [PMID: 30937292 PMCID: PMC6424678 DOI: 10.1016/j.prnil.2018.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/20/2018] [Accepted: 04/19/2018] [Indexed: 12/25/2022] Open
Abstract
Background Sarcopenia is a geriatric syndrome that is characterized by the gradual muscle loss and frailty in the elderly. Meanwhile, the prevalence of prostate cancer is on the rise worldwide. Mainstay treatments for metastatic prostate cancer are androgen-deprivation therapy and taxane-based chemotherapy. Owing to the indolent nature of prostate cancer, these treatments tend to be long-lasting, giving rise to the problem of tolerance to the treatments. Especially given the fact that long-term chemotherapy is closely associated with muscle loss, we aimed to elucidate the correlation between chemotherapy and sarcopenia in the clinical setting. Materials and methods This study was a retrospective study. Participants with castration-resistant prostate cancer were recruited from November 2009 to September 2015.Participants were recruited at two hospitals, Juntendo and Teikyo University Hospital, Tokyo, Japan.Participants were 77 Japanese males with castration-resistant prostate cancer who underwent docetaxel chemotherapy.Sarcopenia was defined as L3-psoas muscle index < 5.7 cm2/m2. We statistically investigated whether the existence of sarcopenia has an impact on the survival time, and identified potential covariates that affect it. Results Out of 77 patients, 26 patients (34%) were diagnosed as sarcopenia. Analysis showed that sarcopenia is independently associated with mortality risk (hazards ratio = 2.74, P = 0.0055). Sarcopenic patients showed significant decrease in body mass index, pretreatment hemoglobin, C-related protein, and L3-psoas muscle index as compared with nonsarcopenic patients. The median observation period was 499 days (330-790). Thirty-five patients (45%) died of prostate cancer during that period. Sarcopenic patients showed significantly shorter survival time after the initiation of docetaxel treatments (P = 0.0055). Conclusion Sarcopenia is an independent predictive factor for a poor tolerance to docetaxel treatment. Given that cessation of the treatment leads to death from the disease, our study identified sarcopenia as an independent factor that raises mortality risk.
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Affiliation(s)
- Ayako Ohtaka
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Aoki
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Masayoshi Nagata
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Mayuko Kanayama
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Fumitaka Shimizu
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Prevalence of malnutrition in adult patients previously treated with allogeneic hematopoietic stem-cell transplantation. Clin Nutr 2018; 37:739-745. [DOI: 10.1016/j.clnu.2017.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 12/16/2022]
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79
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Rossi S, Di Noia V, Tonetti L, Strippoli A, Basso M, Schinzari G, Cassano A, Leone A, Barone C, D'Argento E. Does sarcopenia affect outcome in patients with non-small-cell lung cancer harboring EGFR mutations? Future Oncol 2018. [PMID: 29528255 DOI: 10.2217/fon-2017-0499] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIM To evaluate gefitinib outcomes in EGFR-mutated non-small-cell lung cancer (NSCLC) patients harboring EGFR mutations, according to their sarcopenia status. PATIENTS & METHODS We retrospectively evaluated 33 patients with advanced NSCLC and EGFR mutations (exon 19 or 21), dividing them into sarcopenic patients, with low skeletal muscle index ≤39 cm2/m2 for women and ≤55 cm2/m2 for men, and nonsarcopenic patients. RESULTS Sarcopenia does not affect response to gefitinib treatment in EGFR mutated NSCLC patients, even if it is a bad prognostic indicator for overall survival (p = 0.035). CONCLUSION Early recognition of sarcopenia is beneficial for prevention of cancer cachexia and detection of patients at potential risk of serious adverse events. Gefitinib dosage should be reduced and modulated in sarcopenic patients.
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Affiliation(s)
- Sabrina Rossi
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Vincenzo Di Noia
- Polo Scienze Oncologiche ed Ematologiche, UOC di Oncologia Medica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
| | - Laura Tonetti
- Polo Scienze delle Immagini, di Laboratorio ed Infettivologiche, Instituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonia Strippoli
- Polo Scienze Oncologiche ed Ematologiche, UOC di Oncologia Medica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
| | - Michele Basso
- Polo Scienze Oncologiche ed Ematologiche, UOC di Oncologia Medica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Schinzari
- Polo Scienze Oncologiche ed Ematologiche, UOC di Oncologia Medica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandra Cassano
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Antonio Leone
- Polo Scienze delle Immagini, di Laboratorio ed Infettivologiche, Instituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
| | - Carlo Barone
- Polo Scienze Oncologiche ed Ematologiche, UOC di Oncologia Medica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ettore D'Argento
- Polo Scienze Oncologiche ed Ematologiche, UOC di Oncologia Medica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli - Largo Francesco Vito 1, 00168 Rome, Italy
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Deluche E, Leobon S, Desport JC, Venat-Bouvet L, Usseglio J, Tubiana-Mathieu N. Impact of body composition on outcome in patients with early breast cancer. Support Care Cancer 2018; 26:861-868. [PMID: 28948392 PMCID: PMC5785600 DOI: 10.1007/s00520-017-3902-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE We investigated the impact of body composition on outcomes of patients with early breast cancer. Skeletal muscle mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and muscle fat infiltration or inter-muscular adipose tissue areas (IMAT), obtained by computed tomography (CT), were assessed. METHODS A total of 119 female patients who had breast cancer were included in this retrospective study. The total skeletal muscle and fat tissue areas were evaluated in two adjacent axial slices obtained at the third lumbar vertebra by CT used for disease staging. The women were assigned to either a sarcopenia or non-sarcopenia group based on their skeletal muscle index (cut-off 41.0 cm2/m2). They also were classified into high and low VAT/SAT ratio groups and assigned to either the high or low IMAT index group. The association of the body composition parameters and prognosis was statistically analyzed. RESULTS Among the 119 evaluable patients, 58 were sarcopenic (48.8%), 55 (46.2%) had a high VAT/SAT ratio, and 62 (52.1%) had a high IMAT index. Median follow-up was 52.4 months. Multivariate analysis revealed sarcopenia and IMAT index as independent prognostic factors for disease-free survival (p = 0.02 and p = 0.04, respectively) and overall survival (p = 0.05 and p = 0.02, respectively). BMI was not significantly associated with disease-free survival, but a trend was observed (p = 0.09). CONCLUSIONS Sarcopenia and IMAT index are independent prognostic factors in early breast cancer; therefore, assessing body composition could be a simple and useful approach to integrate into patient management.
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Affiliation(s)
- Elise Deluche
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | | | - Laurence Venat-Bouvet
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Julie Usseglio
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Nicole Tubiana-Mathieu
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
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Aredes MA, Garcez MR, Chaves GV. Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical cancer. Nutr Diet 2018; 75:263-270. [PMID: 29464856 DOI: 10.1111/1747-0080.12414] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/21/2017] [Accepted: 01/16/2018] [Indexed: 01/06/2023]
Abstract
AIM Assess the influence of chemoradiotherapy on the nutritional status, functional capacity and quality of life (QoL), associating these indicators at baseline with toxicity and interruption of oncologic treatment in women with cervical cancer. METHODS Prospective cohort study performed on 49 women diagnosed with cervical cancer, who underwent treatment between August 2015 and January 2016. For data collection, two appointments were conducted by the lead researcher: the first occurred the day before the first chemotherapy session (T0) and the other at the end of chemotherapy session (T1). Nutritional status was measured by anthropometry (weight, height, mid-upper arm circumference and triceps skinfold thickness) and computed tomography (skeletal muscle index-SMI), functional capacity by handgrip strength (HGS) and Karnofsky Performance Status (KPS), and application of QoL questionnaire (EORTC QLQ-C30). RESULTS The average age was 45 ± 13.8 years and 81.6% of the women were diagnosed in stages II and III. There was significant reduction in HGS, KPS and QoL between T0 and T1, in addition to a significant QoL reduction according to worsening nutritional status. The interruption of chemotherapy was significantly associated with the variables of nutritional status assessed at baseline. Women who interrupted treatment due to acute toxicity also had a significant lower median SMI than those who concluded the treatment and 83% of these patients presented cachexia. CONCLUSIONS Chemoradiotherapy treatment in patients with cervical cancer had changed negative nutritional parameters, function capacity and QoL, and poor nutritional status at baseline was associated with chemotherapy interruption.
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Affiliation(s)
- Mariah A Aredes
- Nutrition Department, Brazilian National Cancer Institute-INCA, Rio de Janeiro, Brazil
| | - Marcelly R Garcez
- Nutrition Department, Brazilian National Cancer Institute-INCA, Rio de Janeiro, Brazil
| | - Gabriela V Chaves
- Post-Graduate Program in Oncology, Brazilian National Cancer Institute-INCA, Rio de Janeiro, Brazil
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Abstract
The majority of PCs present as advanced disease, and treatment goals are for prolongation of life and palliation of the symptoms. Oncologists rely on our radiology colleagues to provide information on the extent of disease and the effectiveness of our treatment. The stakes rise in those patients where the disease has seemingly not spread and who might be treated with a goal of cure. For this subset of patients, medical oncologists and surgeons require as precise a radiologic description as possible in order to most accurately characterize the extent of the disease, in turn informing us as to the likelihood of a successful surgery and potential cure. In this paper, we review the fine points of imaging that distinguish resectable from borderline or unresectable patients, explain the principles of neoadjuvant and adjuvant therapy for pancreatic cancer, highlight some of the novel therapies now being pioneered in pancreatic cancer, and review radiologic features important for palliative care in patients with these tumors.
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Abstract
OBJECTIVE The purpose of this study was to evaluate the relationship between sarcopenia and overall and progression-free survival in patients with colorectal cancer. MATERIALS AND METHODS This study was retrospective and complied with HIPAA. Patients with colorectal cancer who underwent CT at the time of and 6-18 months after diagnosis were included. Patients were followed for at least 5 years after diagnosis. Skeletal muscle index (SMI) and mean muscle attenuation of the psoas and paraspinal muscles at the L4 level determined the degree of sarcopenia. Composite measurements combining psoas and paraspinal muscles (total muscle) were also obtained. Univariate and multivariate Cox proportional hazard analysis was performed to evaluate the association between survival and changes in SMI and changes in attenuation. Kaplan-Meier analysis was also performed. RESULTS A total of 101 patients were included (mean age ± SD, 63.7 ± 13.7 years; 68 men, 33 women). The hazard ratios for overall survival were 2.27, 1.68, and 1.54 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (all p < 0.05). The hazard ratios for overall survival were 1.14, 1.18, and 1.24 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (all p < 0.05). The hazard ratios for progression-free survival were 1.33, 1.41, and 1.23 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (not statistically significant). The hazard ratios for progression-free survival were 1.10, 1.21, and 1.23 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (p < 0.05). Kaplan-Meier analysis showed significant differences in overall and progression-free survival based on sex-specific quartiles of muscle quantity and quality. CONCLUSION Progressive sarcopenia after diagnosis of colorectal cancer has a significant negative prognostic association with overall and progression-free survival.
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Abstract
The cancer anorexia cachexia syndrome is a systemic metabolic disorder characterized by the catabolism of stored nutrients in skeletal muscle and adipose tissue that is particularly prevalent in nonsmall cell lung cancer (NSCLC). Loss of skeletal muscle results in functional impairments and increased mortality. The aim of the present study was to characterize the changes in systemic metabolism in a genetically engineered mouse model of NSCLC. We show that a portion of these animals develop loss of skeletal muscle, loss of adipose tissue, and increased inflammatory markers mirroring the human cachexia syndrome. Using noncachexic and fasted animals as controls, we report a unique cachexia metabolite phenotype that includes the loss of peroxisome proliferator-activated receptor-α (PPARα) -dependent ketone production by the liver. In this setting, glucocorticoid levels rise and correlate with skeletal muscle degradation and hepatic markers of gluconeogenesis. Restoring ketone production using the PPARα agonist, fenofibrate, prevents the loss of skeletal muscle mass and body weight. These results demonstrate how targeting hepatic metabolism can prevent muscle wasting in lung cancer, and provide evidence for a therapeutic strategy.
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85
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Vigano A, Kasvis P, Di Tomasso J, Gillis C, Kilgour R, Carli F. Pearls of optimizing nutrition and physical performance of older adults undergoing cancer therapy. J Geriatr Oncol 2017; 8:428-436. [DOI: 10.1016/j.jgo.2017.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/14/2017] [Accepted: 08/23/2017] [Indexed: 01/07/2023]
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86
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Ongaro E, Buoro V, Cinausero M, Caccialanza R, Turri A, Fanotto V, Basile D, Vitale MG, Ermacora P, Cardellino GG, Nicoletti L, Fornaro L, Casadei-Gardini A, Aprile G. Sarcopenia in gastric cancer: when the loss costs too much. Gastric Cancer 2017; 20:563-572. [PMID: 28477106 DOI: 10.1007/s10120-017-0722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/23/2017] [Indexed: 02/07/2023]
Abstract
Sarcopenia is a complex syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Malignancy is a major determinant of sarcopenia, and gastric cancer (GC) is among the most common causes of this phenomenon. As sarcopenia is a well-recognized poor prognostic feature in GC and has been associated with worse tolerance of surgical and medical treatments, members of the multidisciplinary team should be aware of the clinical relevance, pathogenic mechanisms, and potential treatments for this syndrome. The importance of sarcopenia is often underestimated in everyday practice and clinical trials, particularly among elderly or fragile patients. As treatment options are improving in all disease stages, deeper knowledge and greater attention to the metabolic balance in GC patients could further increase the benefit of novel therapeutic strategies and dramatically impact on quality of life. In this review, we describe the role of sarcopenia in different phases of GC progression. Our aim is to provide oncologists and surgeons dealing with GC patients with a useful tool for comprehensive assessment and timely management of this potentially life-threatening condition.
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Affiliation(s)
- Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Vanessa Buoro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turri
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Debora Basile
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Paola Ermacora
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Laura Nicoletti
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Lorenzo Fornaro
- Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, FC, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy.
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy.
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Comparison of Prognostic Impact between the Child-Pugh Score and Skeletal Muscle Mass for Patients with Liver Cirrhosis. Nutrients 2017; 9:nu9060595. [PMID: 28604642 PMCID: PMC5490574 DOI: 10.3390/nu9060595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 02/06/2023] Open
Abstract
AIMS To investigate the influence of skeletal muscle mass index (SMI) as determined by bioimpedance analysis (BIA) (appendicular skeletal muscle mass/(height)²) on survival by comparing the Child-Pugh score in patients with liver cirrhosis (LC, n = 383, average age = 65.2 years). PATIENTS AND METHODS In terms of comparison of the effects of SMI and other markers on survival, we used time-dependent receiver operating characteristics (ROC) analysis. RESULTS The average SMI for male was 7.4 cm²/m² whereas that for female was 6.0 cm²/m² (p < 0.0001). As for the Child-Pugh score, five points were in the majority, both in males (51.7%, (106/205)) and females (44.9%, (80/178)). For both genders, the survival curve was well stratified according to SMI (p < 0.0001 for males and p = 0.0056 for females). In the multivariate analysis for survival, SMI and Child-Pugh scores were found to be significant both in males and females. In time-dependent ROC analyses, all area under the ROCs (AUROCs) for SMI in each time point were higher than those for Child-Pugh scores in males, while in females AUROCs for Child-Pugh scores at each time point were higher than those for SMI. CONCLUSION SMI using BIA can be helpful for predicting outcomes, at least in male LC patients.
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88
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Atlan P, Bayar MA, Lanoy E, Besse B, Planchard D, Ramon J, Raynard B, Antoun S. Factors which modulate the rates of skeletal muscle mass loss in non-small cell lung cancer patients: a pilot study. Support Care Cancer 2017; 25:3365-3373. [PMID: 28593463 DOI: 10.1007/s00520-017-3755-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/16/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Advanced non-small cell lung cancer (NSCLC) is associated with weight loss which may reflect skeletal muscle mass (SMM) and/or total adipose tissue (TAT) depletion. This study aimed to describe changes in body composition (BC) parameters and to identify the factors unrelated to the tumor which modulate them. METHODS SMM, TAT, and the proportion of SMM to SMM + TAT were assessed with computed tomography. Estimates of each BC parameter at follow-up initiation and across time were derived from a mixed linear model of repeated measurements with a random intercept and a random slope. The same models were used to assess the independent effect of gender, age, body mass index (BMI), and initial values on changes in each BC parameter. RESULTS Sixty-four patients with stage III or IV NSCLC were reviewed. The mean ± SD decreases in body weight and SMM were respectively 59 ± 3 g/week (P < 0.03) and 7 mm2/m2/week (P = 0.0003). During follow-up, no changes were identified in TAT nor in muscle density or in the proportion of SMM to SMM + TAT, estimated at 37 ± 2% at baseline. SMM loss was influenced by initial BMI (P < 0.0001) and SMM values (P = 0.0002): the higher the initial BMI or SMM values, the greater the loss observed. Weight loss was greater when the initial weight was heavier (P < 0.0001). CONCLUSION Our results demonstrate that SMM wasting in NSCLC is lower when initial SMM and BMI values are low. These exploratory findings after our attempt to better understand the intrinsic factors associated with muscle mass depletion need to be confirmed in larger studies.
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Affiliation(s)
- Philippe Atlan
- Département Interdisciplinaire de Soins de Support, Gustave-Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France.
| | - Mohamed Amine Bayar
- Service de Biostatistique et d'Epidémiologie, Gustave-Roussy, Université Paris-Saclay, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94805, Villejuif, France
| | - Emilie Lanoy
- Service de Biostatistique et d'Epidémiologie, Gustave-Roussy, Université Paris-Saclay, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94805, Villejuif, France
| | - Benjamin Besse
- Département d'Oncologie Médicale, Gustave-Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - David Planchard
- Département d'Oncologie Médicale, Gustave-Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Jordy Ramon
- Département d'Oncologie Médicale, Gustave-Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Bruno Raynard
- Département Interdisciplinaire de Soins de Support, Gustave-Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Sami Antoun
- Département Ambulatoire, Gustave-Roussy, Université Paris-Saclay, F-94805, Villejuif, France
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Mocellin MC, Camargo CDQ, Fabre MEDS, Trindade EBSDM. Fish oil effects on quality of life, body weight and free fat mass change in gastrointestinal cancer patients undergoing chemotherapy: A triple blind, randomized clinical trial. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.01.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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90
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van Vugt JLA, Levolger S, Gharbharan A, Koek M, Niessen WJ, Burger JWA, Willemsen SP, de Bruin RWF, IJzermans JNM. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle 2017; 8:285-297. [PMID: 27897414 PMCID: PMC5697014 DOI: 10.1002/jcsm.12158] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/01/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The association between body composition (e.g. sarcopenia or visceral obesity) and treatment outcomes, such as survival, using single-slice computed tomography (CT)-based measurements has recently been studied in various patient groups. These studies have been conducted with different software programmes, each with their specific characteristics, of which the inter-observer, intra-observer, and inter-software correlation are unknown. Therefore, a comparative study was performed. METHODS Fifty abdominal CT scans were randomly selected from 50 different patients and independently assessed by two observers. Cross-sectional muscle area (CSMA, i.e. rectus abdominis, oblique and transverse abdominal muscles, paraspinal muscles, and the psoas muscle), visceral adipose tissue area (VAT), and subcutaneous adipose tissue area (SAT) were segmented by using standard Hounsfield unit ranges and computed for regions of interest. The inter-software, intra-observer, and inter-observer agreement for CSMA, VAT, and SAT measurements using FatSeg, OsiriX, ImageJ, and sliceOmatic were calculated using intra-class correlation coefficients (ICCs) and Bland-Altman analyses. Cohen's κ was calculated for the agreement of sarcopenia and visceral obesity assessment. The Jaccard similarity coefficient was used to compare the similarity and diversity of measurements. RESULTS Bland-Altman analyses and ICC indicated that the CSMA, VAT, and SAT measurements between the different software programmes were highly comparable (ICC 0.979-1.000, P < 0.001). All programmes adequately distinguished between the presence or absence of sarcopenia (κ = 0.88-0.96 for one observer and all κ = 1.00 for all comparisons of the other observer) and visceral obesity (all κ = 1.00). Furthermore, excellent intra-observer (ICC 0.999-1.000, P < 0.001) and inter-observer (ICC 0.998-0.999, P < 0.001) agreement for all software programmes were found. Accordingly, excellent Jaccard similarity coefficients were found for all comparisons (mean ≥ 0.964). CONCLUSIONS FatSeg, OsiriX, ImageJ, and sliceOmatic showed an excellent agreement for CSMA, VAT, and SAT measurements on abdominal CT scans. Furthermore, excellent inter-observer and intra-observer agreement were achieved. Therefore, results of studies using these different software programmes can reliably be compared.
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Affiliation(s)
- Jeroen L A van Vugt
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Stef Levolger
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Arvind Gharbharan
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Marcel Koek
- Department of Radiology and Medical Informatics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Wiro J Niessen
- Department of Radiology and Medical Informatics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.,Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Jacobus W A Burger
- Department of Surgical Oncology, Erasmus MC - Daniel den Hoed Cancer Institute, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ron W F de Bruin
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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91
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The impact of body composition parameters on ipilimumab toxicity and survival in patients with metastatic melanoma. Br J Cancer 2017; 116:310-317. [PMID: 28072766 PMCID: PMC5294486 DOI: 10.1038/bjc.2016.431] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/28/2016] [Accepted: 12/05/2016] [Indexed: 01/06/2023] Open
Abstract
Background: Body composition is an important predictor of drug toxicity and outcome. Ipilimumab (Ipi), a monoclonal antibody used to treat metastatic melanoma, has specific toxicities. No validated biomarkers that predict Ipi toxicity and efficacy exist. Also, the impact of Ipi on body composition has not been established. Methods: Patients with metastatic melanoma treated with Ipi between 2009 and 2015 were included. Body composition was assessed by computed tomography at baseline and after four cycles of Ipi. Sarcopenia and low muscle attenuation (MA) were defined using published cut-points. All adverse events (AEs) and immune-related AEs (irAEs) were recorded (Common Terminology Criteria For Adverse Event V.4.0). Results: Eighty-four patients were included in this study (62% male, median age 54 years). At baseline, 24% were sarcopenic and 33% had low MA. On multivariate analysis, sarcopenia and low MA were significantly associated with high-grade AEs (OR=5.34, 95% CI: 1.15–24.88, P=0.033; OR=5.23, 95% CI: 1.41–19.30, P=0.013, respectively), and low MA was associated with high-grade irAEs (OR=3.57, 95% CI: 1.09–11.77, P=0.036). Longitudinal analysis (n=59) revealed significant reductions in skeletal muscle area (SMA), total body fat-free mass, fat mass (all P<0.001) and MA (P=0.030). Mean reduction in SMA was 3.3%/100 days (95% CI: −4.48 to −1.79%, P<0.001). A loss of SMA ⩾7.5%/100 days (highest quartile) was a significant predictor of overall survival in multivariable Cox regression analysis (HR: 2.1, 95% CI: 1.02–4.56, P=0.046). Conclusions: Patients with sarcopenia and low MA are more likely to experience severe treatment-related toxicity to Ipi. Loss of muscle during treatment was predictive of worse survival. Treatments to increase muscle mass and influence outcome warrant further investigation.
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92
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Hopkins BD, Goncalves MD, Cantley LC. Obesity and Cancer Mechanisms: Cancer Metabolism. J Clin Oncol 2016; 34:4277-4283. [PMID: 27903152 DOI: 10.1200/jco.2016.67.9712] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity is a risk factor for cancer development and is associated with poor prognosis in multiple tumor types. The positive energy balance linked with obesity induces a variety of systemic changes including altered levels of insulin, insulin-like growth factor-1, leptin, adiponectin, steroid hormones, and cytokines. Each of these factors alters the nutritional milieu and has the potential to create an environment that favors tumor initiation and progression. Although the complete ramifications of obesity as it relates to cancer are still unclear, there is convincing evidence that reducing the magnitude of the systemic hormonal and inflammatory changes has significant clinical benefits. This review will examine the changes that occur in the obese state and review the biologic mechanisms that connect these changes to increased cancer risk. Understanding the metabolic changes that occur in obese individuals may also help to elucidate more effective treatment options for these patients when they develop cancer. Moving forward, targeted clinical trials examining the effects of behavioral modifications such as reduced carbohydrate intake, caloric restriction, structured exercise, and/or pharmacologic interventions such as the use of metformin, in obese populations may help to reduce their cancer risk.
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Affiliation(s)
- Benjamin D Hopkins
- All authors: Meyer Cancer Center, Weill Cornell Medical College, New York, NY
| | - Marcus D Goncalves
- All authors: Meyer Cancer Center, Weill Cornell Medical College, New York, NY
| | - Lewis C Cantley
- All authors: Meyer Cancer Center, Weill Cornell Medical College, New York, NY
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93
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Détection et évaluation de la dénutrition en oncologie : quels sont les outils, pour quel type de cancer et dans quels buts ? Bull Cancer 2016; 103:776-85. [DOI: 10.1016/j.bulcan.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 01/06/2023]
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94
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Kazemi-Bajestani SMR, Mazurak VC, Baracos V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes. Semin Cell Dev Biol 2016; 54:2-10. [DOI: 10.1016/j.semcdb.2015.09.001] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 01/06/2023]
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95
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Psutka SP, Boorjian SA, Moynagh MR, Schmit GD, Costello BA, Thompson RH, Stewart-Merrill SB, Lohse CM, Cheville JC, Leibovich BC, Tollefson MK. Decreased Skeletal Muscle Mass is Associated with an Increased Risk of Mortality after Radical Nephrectomy for Localized Renal Cell Cancer. J Urol 2016; 195:270-6. [DOI: 10.1016/j.juro.2015.08.072] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 01/12/2023]
Affiliation(s)
| | | | | | | | - Brian A. Costello
- Division of Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Christine M. Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc 2016; 75:199-211. [PMID: 26786393 DOI: 10.1017/s002966511500419x] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.
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97
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Abstract
PURPOSE OF REVIEW Preventing unintentional weight and muscle loss is of crucial importance to maintain the condition and well-being of patients with cancer, improve treatment response and tolerance, and prolong survival. Anabolic resistance might explain why some cancer patients do not respond to nutritional intervention, but does recent evidence actually support this? We will discuss recent literature that casts doubt on attenuated anabolic potential in cancer. RECENT FINDINGS Although anabolic resistance was observed in the past, more recent studies have shown that advanced cancer patients have an anabolic potential after intake of high-quality proteins. Furthermore, a consistent linear relationship is observed in cancer between (essential) amino acid availability from the diet and net protein gain. The studied cancer patients, however, were often characterized by a normal or obese body weight, following the trend in the general population, and mild systemic inflammation. Factors like recent chemotherapy, surgery, or cachexia do not seem to attenuate the anabolic potential to feeding. SUMMARY Cancer patients have a normal anabolic potential which relates to the amount of essential amino acids in the meal. It remains to be determined if this is also the case in weak cancer patients with a short life expectancy and high systemic inflammation.
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Affiliation(s)
- Mariëlle P K J Engelen
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
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Hsu T, Chen R, Lin SCX, Djalalov S, Horgan A, Le LW, Leighl N. Pilot of three objective markers of physical health and chemotherapy toxicity in older adults. ACTA ACUST UNITED AC 2015; 22:385-91. [PMID: 26715870 DOI: 10.3747/co.22.2623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patient function is a key part of the clinical decision to offer chemotherapy and has, in earlier studies, been associated with chemotherapy toxicity. Objective testing might be more accurate than patient-reported or physician-assessed physical function, and thus might be a stronger predictor of chemotherapy toxicity in older adults. METHODS Patients, 70 years of age and older, with thoracic or colorectal cancer were recruited. Three physical tests were performed before commencement of a new line of chemotherapy: grip strength, 4-m walk test, and the Timed Up and Go (tug). Our pilot study explored the association between those tests and chemotherapy toxicity. RESULTS The 24 patients recruited had a median age of 74.5 years (range: 70-84 years), and 54.2% had an Eastern Cooperative Oncology Group performance status of 0 or 1. Median score on the Charlson comorbidity index was 1 (range: 0-4). Almost two thirds had metastatic disease, 70% were chemonaïve, and 83.3% were about to receive polychemotherapy. Patients had a mean tug of 13.2 ± 5.7 s and a mean gait speed of 0.74 ± 0.24 m/s; 50% had a grip strength test in the lowest 20th percentile. Grades 3-5 chemotherapy toxicities occurred in 34.7% of the patients; two thirds required a dose reduction or delay; and one third discontinued chemotherapy because of toxicity. Hospitalization attributable to chemotherapy was uncommon (12.5%). A trend toward increased severe chemotherapy toxicity with slower gait speed was observed (p = 0.049). CONCLUSIONS Abnormalities in objective markers of physical function are common in older adults with cancer, even in those deemed fit for chemotherapy. However, those abnormalities were not associated with an increased likelihood of chemotherapy toxicity in the population included in this small pilot study.
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Affiliation(s)
- T Hsu
- University of Toronto, Toronto, ON
| | - R Chen
- University of Toronto, Toronto, ON
| | - S C X Lin
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - S Djalalov
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A Horgan
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - L W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - N Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
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Moryoussef F, Dhooge M, Volet J, Barbe C, Brezault C, Hoeffel C, Coriat R, Bouché O. Reversible sarcopenia in patients with gastrointestinal stromal tumor treated with imatinib. J Cachexia Sarcopenia Muscle 2015; 6:343-50. [PMID: 26673372 PMCID: PMC4670743 DOI: 10.1002/jcsm.12047] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 04/13/2015] [Accepted: 04/23/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Imatinib is a long-term, oral, targeted therapy for high-risk resected and advanced gastrointestinal stromal tumours (GIST). It is known that sarcopenia affects prognosis and treatment tolerance in patients with various solid cancers. We analysed lumbar skeletal muscle index changes in imatinib-treated GIST patients. Imatinib tolerance was also assessed to evaluate the influence of pre-treatment sarcopenia. METHODS Thirty-one patients with advanced (n = 16) or high-risk resected (n = 15) GIST treated with imatinib (400 mg/day) were analysed retrospectively. Lumbar skeletal muscle indexes were evaluated on computed tomography images obtained before starting imatinib for all patients and at 6 months for those initially sarcopenic. Sarcopenia was defined using consensual cutoffs. Imatinib-induced toxicities were assessed after 3 months of administration. RESULTS Twelve (38.7%) of the 31 patients were sarcopenic, including one unassessable at 6 months. Seven (63.6%) of the 11 assessable sarcopenic patients became non-sarcopenic after 6 months of imatinib. Pre-treatment sarcopenia was not associated with grades 3-4 toxicities, but the mean number of all-grade toxicities per sarcopenic patient was significantly higher for those non-sarcopenic (4.1 vs. 1.7, respectively, p < 0.01) after 3 months of treatment. Grades 1-2 anaemia and grades 1-2 fatigue were more frequent for sarcopenic than non-sarcopenic patients (83% vs. 26%, P < 0.01 and 42% vs. 5%, P = 0.02, respectively). CONCLUSIONS Sarcopenia is reversible in some GIST patients treated with imatinib. Pre-imatinib sarcopenia is predictive of non-severe toxicities, particularly anaemia and fatigue.
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Affiliation(s)
- Frédérick Moryoussef
- Department of Gastro-Enterology and Digestive Oncology, CHU Reims, Hôpital Robert-Debré 51092, Reims, France
| | - Marion Dhooge
- Department of Gastro-Enterology, Cochin Teaching Hospital, AP-HP, Université´ Paris Descartes Sorbonne Paris Cite, Paris, France
| | - Julien Volet
- Department of Gastro-Enterology and Digestive Oncology, CHU Reims, Hôpital Robert-Debré 51092, Reims, France
| | - Coralie Barbe
- Department of Gastro-Enterology, Cochin Teaching Hospital, AP-HP, Université´ Paris Descartes Sorbonne Paris Cite, Paris, France ; Clinical Research Unit, CHU Reims, Hôpital Robert-Debré 51092, Reims, France
| | - Catherine Brezault
- Department of Gastro-Enterology, Cochin Teaching Hospital, AP-HP, Université´ Paris Descartes Sorbonne Paris Cite, Paris, France
| | - Christine Hoeffel
- Department of Radiology, CHU Reims, Hôpital Robert-Debré 51092, Reims, France
| | - Romain Coriat
- Department of Gastro-Enterology, Cochin Teaching Hospital, AP-HP, Université´ Paris Descartes Sorbonne Paris Cite, Paris, France
| | - Olivier Bouché
- Department of Gastro-Enterology and Digestive Oncology, CHU Reims, Hôpital Robert-Debré 51092, Reims, France
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Berger J, Bunout D, Barrera G, de la Maza MP, Henriquez S, Leiva L, Hirsch S. Rectus femoris (RF) ultrasound for the assessment of muscle mass in older people. Arch Gerontol Geriatr 2015; 61:33-8. [DOI: 10.1016/j.archger.2015.03.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/21/2015] [Accepted: 03/25/2015] [Indexed: 12/30/2022]
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