B H L Tan1, K Brammer2, N Randhawa2, N T Welch2, S L Parsons2, E J James3, J A Catton2. 1. Department of Surgery, City Hospital Campus, Nottingham University Hospitals, Nottingham NG5 1PB, UK. Electronic address: benjamintan@hotmail.co.uk. 2. Department of Surgery, City Hospital Campus, Nottingham University Hospitals, Nottingham NG5 1PB, UK. 3. Department of Oncology, City Hospital Campus, Nottingham University Hospitals, Nottingham NG5 1PB, UK.
Abstract
BACKGROUND: Patients with potentially curative oesophago-gastric cancer typically undergo neo-adjuvant chemotherapy prior to surgery. The majority of anti-cancer drugs have a narrow therapeutic index. The aim of this study was to determine if features of body composition, assessed using computed tomography (CT) scans, may be predictive of dose-limiting toxicity (DLT) in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer. The influence of sarcopenia and DLT on overall survival was also evaluated. METHODS: 89 Patients having potentially curative oesophago-gastric cancer surgery were studied. Patients studied had histologically confirmed oesophago-gastric cancer with no evidence of distant metastasis on pre-operative staging. CT scan was performed in all cases at diagnosis. DLT was defined as toxicity leading to postponement of treatment, a drug dose reduction or definitive interruption of drug administration. RESULTS: DLT occurred in 37 out of 89 patients (41.6%) undergoing chemotherapy. Sarcopenia (odds ratio, 2.95; 95% confidence interval, 1.23-7.09; p = 0.015) was associated with DLT on multivariate analysis. Median overall survival for patients who were sarcopenic was 569 days (IQ range: 357-1230 days) vs. 1013 days (IQ range: 496-1318 days) for patients who were not sarcopenic (p = 0.04). There was no significant difference in overall survival in patients who experienced DLT compared with those that did not (p = 0.665). CONCLUSIONS: Sarcopenia is a significant predictor of DLT in oesophago-gastric cancer patients undergoing neo-adjuvant chemotherapy. These results raise the potential for use of assessment of skeletal muscle mass using CT scans to predict toxicity and individualize chemotherapy dosing.
BACKGROUND:Patients with potentially curative oesophago-gastric cancer typically undergo neo-adjuvant chemotherapy prior to surgery. The majority of anti-cancer drugs have a narrow therapeutic index. The aim of this study was to determine if features of body composition, assessed using computed tomography (CT) scans, may be predictive of dose-limiting toxicity (DLT) in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer. The influence of sarcopenia and DLT on overall survival was also evaluated. METHODS: 89 Patients having potentially curative oesophago-gastric cancer surgery were studied. Patients studied had histologically confirmed oesophago-gastric cancer with no evidence of distant metastasis on pre-operative staging. CT scan was performed in all cases at diagnosis. DLT was defined as toxicity leading to postponement of treatment, a drug dose reduction or definitive interruption of drug administration. RESULTS: DLT occurred in 37 out of 89 patients (41.6%) undergoing chemotherapy. Sarcopenia (odds ratio, 2.95; 95% confidence interval, 1.23-7.09; p = 0.015) was associated with DLT on multivariate analysis. Median overall survival for patients who were sarcopenic was 569 days (IQ range: 357-1230 days) vs. 1013 days (IQ range: 496-1318 days) for patients who were not sarcopenic (p = 0.04). There was no significant difference in overall survival in patients who experienced DLT compared with those that did not (p = 0.665). CONCLUSIONS:Sarcopenia is a significant predictor of DLT in oesophago-gastric cancerpatients undergoing neo-adjuvant chemotherapy. These results raise the potential for use of assessment of skeletal muscle mass using CT scans to predict toxicity and individualize chemotherapy dosing.
Authors: Shlomit Strulov Shachar; Allison M Deal; Marc Weinberg; Grant R Williams; Kirsten A Nyrop; Karteek Popuri; Seul Ki Choi; Hyman B Muss Journal: Clin Cancer Res Date: 2017-01-31 Impact factor: 12.531
Authors: Chien-Hung Chiu; Peng Zhang; Andrew C Chang; Brian A Derstine; Brian E Ross; Binu Enchakalody; Nidhi V Shah; Stewart C Wang; Yin-Kai Chao; Jules Lin Journal: Ann Thorac Surg Date: 2019-09-21 Impact factor: 4.330
Authors: Katelin A Mirkin; Franklyn E Luke; Alexandra Gangi; Jose M Pimiento; Daniel Jeong; Christopher S Hollenbeak; Joyce Wong Journal: J Gastrointest Oncol Date: 2017-06
Authors: Lisly Chéry; Leonardo D Borregales; Bryan Fellman; Diana L Urbauer; Naveen Garg; Nathan Parker; Matthew H G Katz; Christopher G Wood; Jose A Karam Journal: Urology Date: 2017-07-10 Impact factor: 2.649
Authors: Shlomit Strulov Shachar; Allison M Deal; Marc Weinberg; Kirsten A Nyrop; Grant R Williams; Tomohiro F Nishijima; Julia M Benbow; Hyman B Muss Journal: Clin Cancer Res Date: 2016-08-03 Impact factor: 12.531
Authors: S Gérard; D Bréchemier; A Lefort; S Lozano; G Abellan Van Kan; T Filleron; L Mourey; C Bernard-Marty; M E Rougé-Bugat; V Soler; B Vellas; M Cesari; Y Rolland; L Balardy Journal: J Nutr Health Aging Date: 2016 Impact factor: 4.075