S Levolger1, M G van Vledder2, W J Alberda3, C Verhoef3, R W F de Bruin2, J N M IJzermans2, J W Burger3. 1. Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands. Electronic address: s.levolger@erasmusmc.nl. 2. Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands. 3. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Abstract
BACKGROUND & AIMS: Neoadjuvant chemoradiotherapy (NACRT) has increased local control in locally advanced rectal cancer. Reduced skeletal muscle mass (sarcopenia), or ongoing muscle wasting, is associated with decreased survival in cancer. This study aims to assess the change in body composition during NACRT and its impact on outcome using computed tomography (CT) imaging in locally advanced rectal cancer (LARC) patients. METHODS: LARC patients treated with NACRT were selected from a prospectively maintained database and retrospectively analyzed. One-hundred twenty-two patients who received treatment between 2004 and 2012 with available diagnostic CT imaging obtained before and after NACRT were identified. Cross-sectional areas for skeletal muscle was determined, and subsequently normalized for patient height. Differences between skeletal muscle areas before and after NACRT were computed, and their influence on overall and disease-free survival was assessed. RESULTS: A wide distribution in change of body composition was observed. Loss of skeletal muscle mass during chemoradiotherapy was independently associated with disease-free survival (HR0.971; 95% CI: 0.946-0.996; p = 0.025) and distant metastasis-free survival (HR0.942; 95% CI: 0.898-0.988; p = 0.013). No relation was observed with overall survival in the current cohort. CONCLUSIONS: Loss of skeletal muscle mass during NACRT in rectal cancer patients is an independent prognostic factor for disease-free survival and distant metastasis-free survival following curative intent resection.
BACKGROUND & AIMS: Neoadjuvant chemoradiotherapy (NACRT) has increased local control in locally advanced rectal cancer. Reduced skeletal muscle mass (sarcopenia), or ongoing muscle wasting, is associated with decreased survival in cancer. This study aims to assess the change in body composition during NACRT and its impact on outcome using computed tomography (CT) imaging in locally advanced rectal cancer (LARC) patients. METHODS: LARC patients treated with NACRT were selected from a prospectively maintained database and retrospectively analyzed. One-hundred twenty-two patients who received treatment between 2004 and 2012 with available diagnostic CT imaging obtained before and after NACRT were identified. Cross-sectional areas for skeletal muscle was determined, and subsequently normalized for patient height. Differences between skeletal muscle areas before and after NACRT were computed, and their influence on overall and disease-free survival was assessed. RESULTS: A wide distribution in change of body composition was observed. Loss of skeletal muscle mass during chemoradiotherapy was independently associated with disease-free survival (HR0.971; 95% CI: 0.946-0.996; p = 0.025) and distant metastasis-free survival (HR0.942; 95% CI: 0.898-0.988; p = 0.013). No relation was observed with overall survival in the current cohort. CONCLUSIONS: Loss of skeletal muscle mass during NACRT in rectal cancerpatients is an independent prognostic factor for disease-free survival and distant metastasis-free survival following curative intent resection.
Authors: Jeroen L A van Vugt; Stefan Buettner; Stef Levolger; Robert R J Coebergh van den Braak; Mustafa Suker; Marcia P Gaspersz; Ron W F de Bruin; Cornelis Verhoef; Casper H C van Eijck; Niek Bossche; Bas Groot Koerkamp; Jan N M IJzermans Journal: PLoS One Date: 2017-10-31 Impact factor: 3.240
Authors: S Levolger; E A C Wiemer; J L A van Vugt; S A Huisman; M G van Vledder; S van Damme-van Engel; G Ambagtsheer; J N M IJzermans; R W F de Bruin Journal: Sci Rep Date: 2019-07-08 Impact factor: 4.379
Authors: Jan M van Rees; Eva Visser; Jeroen L A van Vugt; Joost Rothbarth; Cornelis Verhoef; Victorien M T van Verschuer Journal: BJS Open Date: 2021-09-06