Maria I van Rijn-Dekker1, Lisa van den Bosch1, Johanna G M van den Hoek1, Hendrik P Bijl1, Evert S M van Aken1, Anouk van der Hoorn2, Sjoukje F Oosting3, Gyorgy B Halmos4, Max J H Witjes5, Hans P van der Laan1, Johannes A Langendijk1, Roel J H M Steenbakkers6. 1. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. 2. Department of Radiology, University of Groningen, University Medical Center Groningen, The Netherlands. 3. Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. 4. Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands. 5. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands. 6. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: r.steenbakkers@umcg.nl.
Abstract
BACKGROUND AND PURPOSE: Sarcopenia is emerging as an adverse prognostic factor for survival and complication risk in cancer patients. This study aims to determine the impact of sarcopenia on survival and late toxicity in a large cohort of head and neck squamous cell carcinoma (HNSCC) patients treated with definitive (chemo)radiotherapy ((C)RT). MATERIALS AND METHODS: HNSCC patients treated with definitive (C)RT from January 2007 to June 2016 were included. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using skeletal muscles at level C3. The impact of sarcopenia on overall survival (OS) and disease-free survival (DFS) was evaluated using the Kaplan-Meier method. Multivariable association models were developed to assess the impact of sarcopenia on late toxicity. RESULTS: The study population was composed of 750 HNSCC patients. Cut-off values for sarcopenia were set at SMI < 42.4 cm2/m2 (men) and <30.6 cm2/m2 (women) corresponding lowest gender specific quartile. Sarcopenic patients had significantly poorer survival rates, especially those with lower performance status and locally advanced disease. In oropharyngeal cancer patients, survival was more determined by p16 status than by sarcopenia. In multivariable analysis, sarcopenia was associated with worse OS (HR 0.72, p = 0.012) and DFS (HR 0.67, p = 0.001). In multivariable association models, sarcopenia was associated with physician-rated xerostomia six months after treatment (OR 1.65, p = 0.027) and physician-rated dysphagia six and twelve months after treatment (OR 2.02, p = 0.012 and 2.51, p = 0.003, respectively). CONCLUSION: Sarcopenia in HNSCC patients receiving definitive (C)RT is an independent prognostic factor for worse survival outcomes and is associated with physician-rated toxicity.
BACKGROUND AND PURPOSE: Sarcopenia is emerging as an adverse prognostic factor for survival and complication risk in cancer patients. This study aims to determine the impact of sarcopenia on survival and late toxicity in a large cohort of head and neck squamous cell carcinoma (HNSCC) patients treated with definitive (chemo)radiotherapy ((C)RT). MATERIALS AND METHODS: HNSCC patients treated with definitive (C)RT from January 2007 to June 2016 were included. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using skeletal muscles at level C3. The impact of sarcopenia on overall survival (OS) and disease-free survival (DFS) was evaluated using the Kaplan-Meier method. Multivariable association models were developed to assess the impact of sarcopenia on late toxicity. RESULTS: The study population was composed of 750 HNSCC patients. Cut-off values for sarcopenia were set at SMI < 42.4 cm2/m2 (men) and <30.6 cm2/m2 (women) corresponding lowest gender specific quartile. Sarcopenic patients had significantly poorer survival rates, especially those with lower performance status and locally advanced disease. In oropharyngeal cancer patients, survival was more determined by p16 status than by sarcopenia. In multivariable analysis, sarcopenia was associated with worse OS (HR 0.72, p = 0.012) and DFS (HR 0.67, p = 0.001). In multivariable association models, sarcopenia was associated with physician-rated xerostomia six months after treatment (OR 1.65, p = 0.027) and physician-rated dysphagia six and twelve months after treatment (OR 2.02, p = 0.012 and 2.51, p = 0.003, respectively). CONCLUSION: Sarcopenia in HNSCC patients receiving definitive (C)RT is an independent prognostic factor for worse survival outcomes and is associated with physician-rated toxicity.
Authors: Lorena Arribas; Maria Plana; Miren Taberna; Maria Sospedra; Noelia Vilariño; Marc Oliva; Natalia Pallarés; Ana Regina González Tampán; Luis Miguel Del Rio; Ricard Mesia; Vickie Baracos Journal: Front Oncol Date: 2021-06-25 Impact factor: 6.244