Interobserver agreement of skeletal muscle mass measurement on head and neck CT imaging at the level of the third cervical vertebra

Bril, Sandra I.; Wendrich, Anne W.; Swartz, Justin E.; Wegner, Inge; Pameijer, Frank A.; Smid, Ernst J.; Bol, Gijsbert H.; Pothen, Ajit J.; Bree, Remco de

doi:10.1007/s00405-019-05307-w

Cited by 54 publications

(60 citation statements)

References 36 publications

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“…However, abdominal imaging is not routinely available in patients with HNC, which limits its applicability in this population. Although the optimal measurement level, measurement method, or cutoff value for sarcopenia on CT imaging is still debated, a high correlation of C3 SMI with L3 SMI has been reported before . Thus, in patients with HNC, measurement on head and neck CT imaging currently appears to be the most applicable method.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia, a strong determinant for prolonged feeding tube dependency after chemoradiotherapy for head and neck cancer

et al. 2019

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Background Sarcopenia might be a relevant lead for optimization of the condition of patients with head and neck cancer (HNC) before chemoradiotherapy (CRT) to prevent long‐term functional swallowing impairment, such as feeding tube dependency. Methods Regression analyses were performed to assess the association between skeletal muscle mass index (SMI), as a measure of sarcopenia, and prolonged (>90 days) feeding tube dependency in 128 patients with HNC treated with primary CRT. Results Sixty‐one patients (48%) became prolonged feeding tube‐dependent. Lower SMI increased the risk of prolonged feeding tube dependency in multivariable analysis (risk ratio 1.08; 95% confidence interval 1.02‐1.14, P = .01) adjusted for body mass index, abnormal diet, and socioeconomic status. Conclusions Sarcopenia contributes to the risk of prolonged feeding tube dependency of patients with HNC treated with primary CRT. As sarcopenia might be a modifiable factor prior to treatment, it should be explored as a target for pretreatment patients' condition.

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Section: Discussionmentioning

confidence: 99%

Sarcopenia, a strong determinant for prolonged feeding tube dependency after chemoradiotherapy for head and neck cancer

et al. 2019

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“…Low SMM has a high prevalence in adults with cancer; in HNSCC prevalence as high as 55% has been reported [ 3 ]. SMM can be measured on a routinely performed computed tomography (CT) or magnetic resonance imaging (MRI) of the head and neck [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

The predictive and prognostic value of low skeletal muscle mass for dose-limiting toxicity and survival in head and neck cancer patients receiving concomitant cetuximab and radiotherapy

Huiskamp

Chargi

Devriese

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose This study aims to investigate the predictive value of low skeletal muscle mass (SMM) for cetuximab dose-limiting toxicity (DLT) and its prognostic value in head and neck squamous cell carcinoma (HNSCC) patients treated with concomitant cetuximab and radiotherapy. Methods Patients diagnosed with HNSCC and treated with primary or adjuvant concomitant cetuximab and radiotherapy were included. Clinical and demographic variables were retrospectively retrieved and SMM was measured at the level of the third cervical vertebra using pre-treatment diagnostic computed tomography or magnetic resonance imaging. An optimal cutoff value for low SMM was determined based on the lowest log-likelihood associated with cetuximab DLT. A multivariate linear regression model was used to determine predictive factors for cetuximab DLT. The prognostic value of low SMM for disease-free and overall survival was analyzed using Kaplan-Meier curves. Results The optimal cutoff value for low SMM as a predictor of cetuximab DLT was an LSMI ≤ 45.2 cm 2 /m 2. Of the 91 included patients, 74.7% had low SMM and 30.8% experienced cetuximab DLT. At multivariate analysis, low SMM had no predictive value for DLT (OR 0.83; 95% CI 0.27-2.56; p = 0.74). The Kaplan-Meier curve demonstrated that patients with low SMM had significantly lower overall survival (Log Rank χ 2 = 5.87; p = 0.02). Conclusion Low SMM is highly prevalent in HNSCC patients treated with concomitant cetuximab and radiotherapy. Low SMM has no predictive value for cetuximab DLT in HNSCC patients. Low SMM is probably not a prognostic factor for overall survival in highly selected HNSCC patients treated with concomitant cetuximab and radiotherapy and unfit for platin-based chemotherapy.

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“…Because there was no difference in the correlation between masticatory muscle and L3 muscle CSA between OSCC and trauma groups, our results may be deduced to both oral cancer patients and healthy individuals. Finally, even though CSA assessment at the mandibular notch and C3 level by using a single slice has proved to be one method for estimating sarcopenia, estimation of SMM by using the volume data is considered the standard [16,17,21].…”

Section: Discussionmentioning

confidence: 99%

“…Image selection and analysis of the cervical (C3) and lumbar (L3) vertebra were performed as per previously published reports [16,17,21]. CSAs of the paravertebral muscles (PVM) and the sternocleidomastoid muscles (SCM) at the C3 level were measured, and the sum of these muscles was defined as the C3 muscles.…”

Section: Methodsmentioning

confidence: 99%

“…Even though patients with HNC are prone to sarcopenic status, abdomen CT imaging or PET-CT scan are not routinely performed in patients with HNC, making the SMM measurements at the L3 level not always be applicable. Swartz et al [16] proposed that assessing C3 muscle CSA on a head and neck CT scan could be an excellent alternative to abdominal CT scans [17]. Nevertheless, neck lymphadenopathy or locally advanced disease may hinder interpretation of the C3 muscle CSA in HNC patients.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Using Masticatory Muscles to Assess Skeletal Muscle Mass in Patients with Oral Cavity Cancer

Chang

Hsu

Tsai

et al. 2019

Preprint

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Background Sarcopenia is typically assessed using abdominal computed tomography (CT) scans, which are not obtained routinely in patients with oral cavity cancer. In order to investigate the feasibility of using masticatory muscles to assess general skeletal muscle mass (SMM) in oral cancer patients, we aimed to correlate the masticatory SMM evaluated on head and neck CT-images with the SMM measurement at the level of L3 on abdominal CT-scans. Methods The abdominal and head and neck CT-scans of the oral cavity squamous cell carcinoma (OSCC, n = 54) and trauma (n = 50) patients were analyzed retrospectively. All muscles at the L3 level were delineated on abdominal CT scans, and skeletal muscles at the mandibular notch level and C3 level were delineated on head and neck CT scans. Cross-sectional area (CSA) of the muscles at the mandibular notch and C3 level were compared to skeletal muscle CSA at the L3 level using linear regression, and a multivariate linear regression model was also calculated. Results The OSCC patients had significantly smaller muscle CSA at the mandibular notch level than trauma patients (1221.4 vs. 1512.2 mm2, p = 0.006). Masticatory muscle CSA strongly predicted the L3 muscle CSA (r = 0.880, p < 0.001), and this correlation was stronger in the multivariate model including age, body weight, and sex (r = 0.898, p < 0.001). Conclusions Evaluation of the masticatory skeletal muscle mass on head and neck CT images is simple, feasible, and may be an alternative to abdominal CT scans. Assessment of masticatory muscle at mandibular notch can be performed using routinely obtained scans without additional imaging or cost. Identifying patients at risk of being sarcopenic may select oral cancer patients for nutritional intervention and appropriate treatment modality to improve their prognosis.

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Interobserver agreement of skeletal muscle mass measurement on head and neck CT imaging at the level of the third cervical vertebra

Cited by 54 publications

References 36 publications

Sarcopenia, a strong determinant for prolonged feeding tube dependency after chemoradiotherapy for head and neck cancer

Sarcopenia, a strong determinant for prolonged feeding tube dependency after chemoradiotherapy for head and neck cancer

The predictive and prognostic value of low skeletal muscle mass for dose-limiting toxicity and survival in head and neck cancer patients receiving concomitant cetuximab and radiotherapy

Feasibility of Using Masticatory Muscles to Assess Skeletal Muscle Mass in Patients with Oral Cavity Cancer

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