Concurrent Chemoradiotherapy Induces Body Composition Changes in Locally Advanced Head and Neck Squamous Cell Carcinoma: Comparison between Oral Cavity and Non-Oral Cavity Cancer

Abstract

Few prospective cohort trials have evaluated the difference in treatment-interval total body composition (TBC) changes assessed by dual-energy X-ray absorptiometry (DXA) between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC) receiving concurrent chemoradiotherapy (CCRT): oral cavity cancer with adjuvant CCRT (OCC) and non-oral cavity with primary CCRT (NOCC). This study prospectively recruited patients with LAHNSCC. Clinicopathological variables, blood nutritional/inflammatory markers, CCRT-related factors, and TBC data assessed by DXA before and after treatment were collected. Multivariate linear regression analysis identified the factors associated with treatment-interval changes in body composition parameters, including lean body mass (LBM), total fat mass (TFM), and bone mineral content (BMC). A total of 127 patients (OCC (n = 69) and NOCC (n = 58)) were eligible. Body composition parameters were progressively lost during CCRT in both subgroups. Extremities lost more muscle mass than the trunk for LBM, whereas the trunk lost more fat mass than the extremities for TFM. BMC loss preferentially occurred in the trunk region. Different factors were independently correlated with the interval changes of each body composition parameter for both OCC and NOCC subgroups, particularly mean daily calorie intake for LBM and TFM loss, and total lymphocyte count for BMC loss. In conclusion, treatment-interval TBC changes and related contributing factors differ between the OCC and NOCC subgroups.

Inflammation Status and Body Composition Predict Two-Year Mortality of Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma under Provision of Recommended Energy Intake during Concurrent Chemoradiotherapy

“…To address these uncertainties, in the current study, we adopted calorie supply programs recommended by academic societies for patients with LAHNSCC undergoing CCRT and found that the change in TBM during CCRT correlated with that in certain NIBs (OCC Factor 3 correlated with Δplatelet count, and NOCC Factor 3 correlated with Δalbumin and ΔCRP). In addition, the mean daily calorie intake during CCRT was associated with changes in TBM and TBF, which is compatible with our previous observation [ 35 ]. Finally, we showed that the treatment interval change in TBM (OCC Factor 3) independently contributed to the 2-year mortality rate.…”

“…Dual-energy X-ray absorptiometry (DXA) can be used to appropriately evaluate the status of three major components of TBC: lean body mass (LBM), total fat mass (TFM), and total body bone mineral content at the time of cancer diagnosis and during treatment [ 7 , 18 , 28 , 29 , 30 ]. In accordance with findings from other reports [ 7 , 25 , 31 , 32 , 33 , 34 ], we observed that the LBM and TFM assessed using DXA were significantly decreased among patients with LAHNSCC during CCRT [ 35 , 36 ]. Furthermore, a low pretreatment muscle mass is associated with increased treatment-related toxicity, early treatment failure, and recurrence-free survival among patients with LAHNSCC [ 35 , 36 , 37 ].…”

“…In accordance with findings from other reports [ 7 , 25 , 31 , 32 , 33 , 34 ], we observed that the LBM and TFM assessed using DXA were significantly decreased among patients with LAHNSCC during CCRT [ 35 , 36 ]. Furthermore, a low pretreatment muscle mass is associated with increased treatment-related toxicity, early treatment failure, and recurrence-free survival among patients with LAHNSCC [ 35 , 36 , 37 ]. However, it remains unclear whether NIBs or DXA-derived parameters could affect the prognostic outcomes of patients provided the recommended daily calorie intake during the CCRT course.…”

Treatment-Interval Changes in Serum Levels of Albumin and Histidine Correlated with Treatment Interruption in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma Completing Chemoradiotherapy under Recommended Calorie and Protein Provision

“…Alterations in total body composition (TBC), assessed by dual-energy X-ray absorptiometry (DXA), are commonly observed in cancer patients in response to various physiological and pathological stimuli, such as aging, sex, intercurrent illness, metabolic disturbance, and therapy; therefore, they can appropriately reflect the status of nutritional and inflammatory changes caused by cancer or treatment. We observed a significant loss in lean body muscle (LBM) and total fat mass (TFM) in patients with LAHNSCC during CCRT [39,40]. Additionally, the pretreatment level and treatment-interval changes in TBC are associated with increased treatment-related toxicity, early treatment failure, recurrence-free survival, and two-year mortality rate among LAHNSCC patients undergoing CCRT [39][40][41][42].…”

“…We observed a significant loss in lean body muscle (LBM) and total fat mass (TFM) in patients with LAHNSCC during CCRT [39,40]. Additionally, the pretreatment level and treatment-interval changes in TBC are associated with increased treatment-related toxicity, early treatment failure, recurrence-free survival, and two-year mortality rate among LAHNSCC patients undergoing CCRT [39][40][41][42]. Therefore, further research is needed to investigate the effect of TBC changes on treatment interruption in patients with LAHNSCC undergoing CCRT.…”