Abstract
Purpose
Sarcopenia is associated with reduced survival in cancer. Currently, data on sarcopenia at presentation and muscle loss throughout treatment are unknown in patients receiving chemoradiation therapy (CRT) for non-small cell lung cancer (NSCLC). This study evaluated skeletal muscle changes in NSCLC patients receiving CRT and relationship with survival.
Methods
Secondary analysis of 41 patients with NSCLC treated with CRT assessed for skeletal muscle area and muscle density by computed tomography pre-treatment and 3 months post-treatment. Images at week 4 of treatment were available for 32 (78%) patients. Linear mixed models were applied to determine changes in skeletal muscle over time and related to overall survival using Kaplan-Meier plots.
Results
Muscle area and muscle density decreased significantly by week 4 of CRT (− 6.6 cm2, 95% CI − 9.7 to − 3.1, p < 0.001; − 1.3 HU, 95% CI − 1.9 to − 0.64, p < 0.001, respectively), with minimal change between week 4 of CRT and 3 months post-CRT follow-up (− 0.2 cm2, 95% CI − 3.6–3.1, p = 0.91; − 0.27, 95% CI − 0.91–0.36, p = 0.36, respectively). Sarcopenia was present in 25 (61%) and sarcopenic obesity in 6 (14%) of patients prior to CRT, but not associated with poorer survival. Median survival was shorter in patients with low muscle density prior to treatment although not statistically significant (25 months + 8.3 vs 53 months + 13.0, log-rank p = 0.17).
Conclusion
Significant loss of muscle area and muscle density occurs in NSCLC patients early during CRT. A high proportion of patients are sarcopenic prior to CRT; however, this was not significantly associated with poorer survival.
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Acknowledgements
The authors would like to thank Jason Callahan and Nick Hardcastle for their technical support and Gavin Abbott for his statistical support
Statement of authorship
NK participated in the design of the study, performed the statistical analysis, interpretation of results and drafted the manuscript. JB participated in data collection, interpretation of results and writing the manuscript. SE participated in the design of the study, interpretation of results and writing the manuscript.
Funding
This work was supported by a National Health and Medical Research Council New Investigator Project Grant (APP1003895) and a Victorian Cancer Agency Tumour Stream Research Grant (both SJE).
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Approval to conduct the study was granted by the Institutional Research and Ethics committees (ACTRN 12611001283965), all patients provided written, informed consent.
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The authors declare that they have no conflict of interest.
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Kiss, N., Beraldo, J. & Everitt, S. Early Skeletal Muscle Loss in Non-Small Cell Lung Cancer Patients Receiving Chemoradiation and Relationship to Survival. Support Care Cancer 27, 2657–2664 (2019). https://doi.org/10.1007/s00520-018-4563-9
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DOI: https://doi.org/10.1007/s00520-018-4563-9