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Older cancer patients receiving radiotherapy: a systematic review for the role of sarcopenia in treatment outcomes

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Abstract

Background

Previous studies have evaluated the prognostic effects of sarcopenia in cancer patients receiving various treatments, including chemotherapy and surgery, but few studies have focused on radiotherapy (RT).

Aims

We aimed to investigate the prevalence of sarcopenia and the relationship between sarcopenia and outcomes in older cancer patients who underwent RT without chemotherapy.

Methods

A systematic review of the literature was conducted in Pubmed/Medline and Cochrane databases in September 2021. We used the search terms and medical subject heading terms “sarcopenia,” “low muscle mass (LMM),” “low muscle strength,” “LMM and low muscle strength,” “LMM and low muscle strength and low physical performance,” and “RT.” Outcomes were overall survival (OS), progression-free survival, non-cancer death, cancer death, disease-specific survival, local failure-free survival, distant failure-free survival, and RT-related toxicities.

Results

Among 460 studies, 8 studies were eligible for inclusion. The prevalence of sarcopenia was between 42.8% and 72%. Sarcopenia was not associated with OS or OS at 3 years in seven studies in which it was defined as the presence of LMM, while it was related in one study, in which it was defined as the concomitant presence of LMM and muscle strength/function.

Discussion

There was heterogeneity between the studies because there was diversity in their inclusion criteria, definition and assessment methods used for detection of sarcopenia, considered cutoffs for low muscle mass and strength, cross-sectional locations on imaging to assess muscle mass and included covariates. The discrepancy in the results of the studies may also result from the variations in diagnoses, sample sizes, and treatment modalities. The low number of included studies and a small number of patients in each study limited generalizability.

Conclusions

Sarcopenia may be a prognostic factor, especially in OS when low muscle strength/function is integrated into its definition. We suggest that clinicians focus on muscle strength/function while considering sarcopenia and its association with cancer and RT-related outcomes.

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Authors and Affiliations

  1. Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34093, Istanbul, Turkey

    Nezahat Muge Catikkas & Gulistan Bahat

  2. Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

    Zumrut Bahat

  3. Department of Public Health, Istanbul Medical School, Istanbul University, Capa, 34093, Istanbul, Turkey

    Meryem Merve Oren

  4. Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey

    Gulistan Bahat

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  1. Nezahat Muge Catikkas
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NMC: conceptualization, methodology, writing—original draft preparation, writing—review and editing. ZB: writing—original draft preparation, data curation, review and editing. MMO: formal analysis, data curation. GB: conceptualization, methodology, writing—original draft preparation, writing—review a editing, supervision.

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Correspondence to Gulistan Bahat.

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Catikkas, N.M., Bahat, Z., Oren, M.M. et al. Older cancer patients receiving radiotherapy: a systematic review for the role of sarcopenia in treatment outcomes. Aging Clin Exp Res 34, 1747–1759 (2022). https://doi.org/10.1007/s40520-022-02085-0

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