Body Composition in Pediatric Solid Tumors: State of the Science and Future Directions

Abstract

Sarcopenia (severe skeletal muscle wasting) and sarcopenic obesity (skeletal muscle wasting in the setting of excess fat) have been increasingly recognized as important prognostic indicators in adult oncology. Unfavorable changes in lean and adipose tissue masses manifest early in therapy and are associated with altered chemotherapy metabolism as well as increased treatment-related morbidity and mortality. Existing literature addresses the role of body composition in children with hematologic malignancies; however, data is lacking among solid tumor patients. Advances in imaging techniques for quantification of tissue compartments potentiate further investigation in this highly understudied area of pediatric oncology. The following review presents an in-depth discussion of body composition analysis and its potential role in the care of pediatric solid tumor patients. Integration of body tissue measurement into standard practice has broad clinical implications and may improve quality of life and treatment outcomes in this at-risk population.

Skeletal muscle and adipose tissue changes in the first phase of treatment of pediatric solid tumors

“…There is a developing body of evidence indicating that nutritional status may impact treatment outcomes, including tolerance to chemotherapy, infection rates, prognosis, and quality of life, among pediatric solid tumor patients 1 . In recent years, body composition, as a result of nutritional balance in conjunction with effects of the underlying disease, has been increasingly recognized as an important factor in both adult and pediatric cancer outcomes 2 . Sarcopenia and sarcopenic obesity have consistently demonstrated an adverse relationship with treatment‐related complications, morbidity, and survival in the adult solid tumor population 3–10 .…”

“…Anthropometric measures such as body mass index (BMI), skin fold thickness, and mid‐upper arm or waist‐circumference, are easily obtained and often relied upon in the clinical setting 2 . However, the utility of these modalities is limited due to their variability 13 .…”

“…Moreover, BMI does not distinguish between lean mass and adiposity, 3,15 and may even be inaccurate in patients with significant tumor burden; a clinical picture more likely in solid tumors. Use of advanced imaging techniques like computed tomography (CT) and magnetic resonance imaging (MRI) has enabled practitioners to accurately discern and quantify lean and adipose tissue compartments, and to further investigate their role in cancer outcomes 2 . The utility of single‐slice CT images for body composition analysis, particularly at the vertebral level of L3, has been validated as an indicator of whole‐body tissue measurements in adult oncology literature 7,18 .…”

“…1 In recent years, body composition, as a result of nutritional balance in conjunction with effects of the underlying disease, has been increasingly recognized as an important factor in both adult and pediatric cancer outcomes. 2 Sarcopenia and sarcopenic obesity have consistently demonstrated an adverse relationship with treatment-related complications, morbidity, and survival in the adult solid tumor population. [3][4][5][6][7][8][9][10] Body composition studies in pediatrics are limited, and current literature largely focuses on hematologic malignancies.…”

Potential Molecular Players of the Tumor Microenvironment in Extracranial Pediatric Solid Tumors

“…In extracranial pediatric solid tumors, comprehensive molecular profiling studies have detected potentially actionable targets in 46–60.9% of patients [ 7 ]. In some cases, identifying genomic alterations has guided targeted therapy selection [ 8 ]. Most pediatric malignancies are treated as part of cooperative treatment-optimizing trials based on national and international collaboration.…”