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Temporalis muscle width as a measure of sarcopenia correlates with overall survival in patients with newly diagnosed glioblastoma

  • : Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Sarcopenia has been shown to correlate with poor oncologic outcomes, but the optimal method to evaluate sarcopenia and its use as a prognostic tool in glioblastoma multiforme (GBM) remain unclear. We developed a method to reproducibly quantify sarcopenia using the temporalis muscle and correlated sarcopenia with overall survival (OS) in GBM patients.

Methods

We measured the temporalis muscle width (TMW) on the postoperative radiotherapy CT simulation scan of 87 newly diagnosed GBM patients from 2011 to 2016. All patients successfully completed standard of care radiotherapy to a dose of 6000 cGy in 30 fractions with concurrent temozolomide without treatment breaks. TMW was measured bilaterally on four axial CT slices defined by bony orbit anatomy: orbit ceiling, superior quarter (equidistant between orbit and mid-orbit), mid-orbit, and inferior quarter (equidistant between mid-orbit and orbit floor). For analysis, TMW was dichotomized to either wide or narrow TMW by the median TMW and correlated with OS using Cox regression models.

Results

TMW at the orbit inferior quarter significantly correlated with OS. Median OS for wide TMW (> 1.583 cm) was greater than that of narrow TMW: 28.3 mo vs. 22.2 mo (HR (wide/narrow) = 0.42, 95% CI = (0.22, 0.82), p = 0.01), controlling for resection type and MGMT methylation. This effect was pronounced especially in the following patient subsets: females (HR (wide/narrow) = 0.26, 95% CI = (0.07, 0.92), p = 0.04) and patients without MGMT methylation (HR = 0.35, 95% CI = (0.15, 0.81), p = 0.01).

Conclusion

Our results suggest sarcopenia and TMW correlate with GBM OS. Prospective validation of sarcopenia is needed to evaluate its potential in determining optimal patient treatment.

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Author notes

  1. Kristin Hsieh and Mark E. Hwang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, Level B, New York, NY, 10032, USA

    Kristin Hsieh, Mark E. Hwang, Gabrielle Estevez-Inoa, Akshay V. Save, Anurag Saraf, Catherine S. Spina, Simon K. Cheng, Tony J. C. Wang & Cheng-Chia Wu

  2. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 622 West 168th Street, Level B, New York, NY, 10032, USA

    Simon K. Cheng, Tony J. C. Wang & Cheng-Chia Wu

  3. Department of Neurological Surgery, Columbia University Medical Center, 622 West 168th Street, Level B, New York, NY, 10032, USA

    Tony J. C. Wang

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  1. Kristin Hsieh
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Corresponding authors

Correspondence to Tony J. C. Wang or Cheng-Chia Wu.

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Conflict of interest

Dr. Tony J. C. Wang reports personal fees and non-financial support from AbbVie, personal fees from AstraZeneca, personal fees and non-financial support from Elekta, personal fees and non-financial support from Merck, personal fees from Doximity, personal fees from Wolters Kluwer, personal fees and non-financial support from Novocure, personal fees and non-financial support from RTOG foundation, personal fees from Cancer Panels, outside thesubmitted work.

The remaining authors (Kristin Hsieh, Mark Hwang, Gabrielle Estevez-Inoa, Akshay Save, Anurag Saraf, Catherine Spina, Simon Cheng, Cheng-Chia Wu) declare no conflicts of interest.

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Informed consent was obtained from all patients for being included in this retrospective study.

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Hsieh, K., Hwang, M.E., Estevez-Inoa, G. et al. Temporalis muscle width as a measure of sarcopenia correlates with overall survival in patients with newly diagnosed glioblastoma. J Radiat Oncol 8, 379–387 (2019). https://doi.org/10.1007/s13566-019-00408-9

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  • DOI: https://doi.org/10.1007/s13566-019-00408-9

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