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Introduction Interstitial brachytherapy (iBT) is an effective treatment for hepatocellular carcinoma (HCC). Identification of prognostic factors is pivotal for patient selection and treatment efficacy. This study aimed to assess the impact of low skeletal muscle mass (LSMM) on overall survival (OS) and progression free survival (PFS) of iBT in patients with HCC. Methods For this single-center study we retrospectively identified 77 patients with HCC who underwent iBT between 2011 and 2018. Follow-up visits were recorded until 2020. The psoas muscle area (PMA), psoas muscle index (PMI), psoas muscle density (MD), and the skeletal muscle gauge (SMG) were assessed on the L3 level on pre-treatment cross-sectional CT-scans. Results Median overall survival was 37 months. 42 patients (54.5%) had LSMM. An AFP level of >400ng/ml (HR 5.705, 95%CI 2.228-14.606, p=0.001), BCLC stage (HR 3.230, 95%CI 0.972-10.735, p=0.026), and LSMM (HR 3.365, 95%CI 1.490-7.596, p=0.002) showed a relevant association with OS. Weighted hazard ratios were used to form a predictive risk stratification model with three groups: Patients with low-risk (median OS 62 months), intermediate-risk (median OS 31 months), and high-risk (median OS 9 months). The model showed a good prediction of one-year mortality, with an AUC of 0.71. Higher Muscle density was associated with better PFS (HR 0.920, 95%CI 0.881-0.962, p<0.001). Conclusion In patients undergoing interstitial brachytherapy for hepatocellular carcinoma, low skeletal muscle mass is associated with worse overall survival. A risk stratification model based on LSMM, AFP > 400 ng/ml, and BCLC stage successfully predicted patient mortality. The model may support and enhance patient selection.

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Purpose Several studies report an association of sarcopenia with survival in oncologic patients. The aim of this study is to assess the influence of sarcopenia on overall survival (OS) in patients with colorectal liver metastases undergoing interstitial brachytherapy (iBT) Methods We identified 144 patients with colorectal liver metastases from our database from 2014–2017. Computed tomography (CT) chest scans at the L3 level were retrospectively analyzed. Psoas muscle area (PMA), psoas muscle index (PMI), and skeletal muscle gauge (SMG) were measured on the CT scan before treatment. Parameters were associated with overall survival. Results 116 patients were included. Median overall survival was 27 months. Median PMA was 13.79 cm2, median PMI 4.51 cm2/m2. Neither PMA (HR 1.036, 95 % CI 0.996–1.078, p = 0.080), PMI (HR 1.068, 95 % CI 0.922–1.238, p = 0.382), nor SMG (HR 1.00, 95 % CI 0.998–1.003, p = 0.955) were significantly associated with overall survival. Conclusion Sarcopenic patients undergoing iBT for colorectal liver metastases did not show decreased overall survival. If confirmed by comparative studies, sarcopenia may serve as a biomarker for treatment decision in patients with CRLM. Key points: Sarcopenia is not a risk factor for survival in patients with CLRM undergoing iBT. Citation Format