Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses

Abstract

BackgroundSarcopenia (SP) is defined as the quantitative and functional impairment of skeletal muscles. SP is commonly related to older age and is frequent in patients with cancer. To provide an overview of SP in patients treated with radiotherapy (RT) and to evaluate the current evidence, we analyzed the available systematic reviews and meta-analyses.MethodsReviews were identified using PubMed, Scopus, and Cochrane library databases, without date restriction. Only systematic reviews and meta-analyses on the prognostic impact of SP and on any treatments aimed at reducing SP effect, in patients undergoing RT, were included in this review. The analyses not separately reporting the results in patients treated with RT were excluded. The quality assessment was performed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews).ResultsFrom the 84 papers identified, five reviews met the inclusion criteria with four reports mainly including non-randomized trials. Three reviews on the effect of SP showed a significantly negative impact on overall survival in patients undergoing RT and/or chemoradiation for H&N cancers (HR: 1.63-2.07). Two reviews on interventional studies showed the possibility of 1) improving physical functions through nutritional and physical interventions and 2) avoiding muscle wasting by means of sufficient protein intake. The quality assessment of the included review showed that two and three analyses are classifiable as having low and moderate overall confidence rating, respectively.ConclusionsThe analyzed reviews uniformly confirmed the negative impact of SP in patients with H&N tumors undergoing RT and the possibility of improving muscle mass and function through nutritional and physical interventions. These results justify further research on this topic based on a more uniform SP definition and on a complete evaluation of the potentially confounding parameters.

Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study—AFRAID Project)

“…In this study, we extended the investigation to include body composition-related parameters such as BMI, SP, and SO. These parameters have gained attention in recent years as potential prognostic factors in cancer treatment, including cervical cancer [ 11 , 12 ]. Previous studies have explored the impact of SP on outcomes in LACC patients undergoing CRT.…”

“…To improve the accuracy of outcome predictions and enable treatment customization based on prognostic profiles, recent studies have explored the use of various body composition-related parameters in cancer patients. In particular, there is a growing awareness of the impact of parameters such as body mass index (BMI), sarcopenia (SP), and sarcopenic obesity (SO) in cancer patients undergoing RT [11,12]. Also, in LACC, several studies have explored the impact of SP in patients treated with CRT.…”

Everything You Always Wanted to Know about Sarcopenia but Were Afraid to Ask: A Quick Guide for Radiation Oncologists (impAct oF saRcopeniA In raDiotherapy: The AFRAID Project)

“…Most of the current evidence on the impact of SP in patients undergoing RT comes from analyses on patients with head and neck tumors [ 5 , 59 ]. However, several studies reported a significantly negative impact of SP on overall survival not only in patients undergoing RT for head and neck cancers [ 25 , 60 , 61 , 62 , 63 ], but also in the esophagus [ 64 ], rectum [ 65 ], pancreas [ 66 ], cervix [ 67 ], and lung [ 68 ] tumors.…”

“…In particular, attention to SP has grown in the field of radiotherapy (RT), given the evidence of the significant impact of SP on the prognosis of RT-treated patients, and the possibility of preventing and at least partially treating this syndrome [ 5 ]. In fact, only in 2020 and 2021, 114 papers were registered on PubMed including seven systematic reviews on RT and SP [ 6 ].…”

Body Composition as a Predictor of the Survival in Anal Cancer

“…On the other hand, the value of body composition parameters as biomarkers in cancer management has been evaluated in different studies [ 10 , 11 ]. These include sarcopenia, defined as progressive skeletal muscle wasting [ 12 ], which could reflect a state of cachexia and has emerged as a prognostic tool in multiple tumor sites [ 13 ]. Other parameters reflecting the body composition, including body mass index (BMI), visceral adipose tissue abdominal (VAT), subcutaneous abdominal adipose tissue (SAT), and visceral-to-subcutaneous fat ratio (VSR) have been also discussed as prognostic factors and predictors for the treatment-related toxicities in different solid tumors [ 14 , 15 ].…”