Low Skeletal Muscle Mass Is a Risk Factor for Aspiration Pneumonia During Chemoradiotherapy

Abstract

Objectives This study aimed to investigate whether pretreatment skeletal muscle mass index (SMI) is a predictor for the risk of aspiration pneumonia and to explore the relationship between low SMI and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC) receiving chemoradiotherapy (CRT). Methods We retrospectively reviewed the data of patients with HNSCC who received CRT during 2010–2019. Patients received a combination of radiotherapy and cisplatin‐based chemotherapy (3 cycles of 80 mg/m2 cisplatin on days 1, 22, and 43). Aspiration pneumonia were defined as the presence of both subjective and objective symptoms. Kaplan–Meier curves were generated to analyze survival. Results Among the 159 patients, 36 (22.6%) developed aspiration pneumonia during treatment. Median SMI in patients with and without pneumonia was 12.4 cm2/m2 (9.0–20.7) and 13.6 cm2/m2 (8.1–19.7), respectively (P < .01). Multivariate logistic regression revealed that SMI was the only independent predictor of aspiration pneumonia (P = .0026). Mean OS was significantly shorter for patients with low SMI than for patients with normal SMI (66.9 months vs. 92.7 months, P = .001). Conclusion Pretreatment low SMI predicts development of aspiration pneumonia and is a strong negative prognostic predictor for OS in patients with HNSCC undergoing CRT. Supportive treatment can be provided to patients at high risk of a low SMI. This study is the first to report SMI as a prognostic predictor in HNSCC. Laryngoscope, 131:E1524–E1529, 2021

Prognostic impact of sarcopenia in patients with head and neck cancer treated with surgery or radiation: A meta-analysis

“…We screened the titles and abstracts of these studies and identified 83 potentially eligible studies. The full-text versions of these 83 studies were then inspected according to the exclusion criteria, and 18 studies involving 3,233 patients were determined to be eligible for inclusion in this study [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 1). In these 18 studies, seven investigated patients treated with surgery [17, 20, 25-27, 31, 32] and 10 investigated patients treated with RT [15, 16, 18, 19, 21-24, 29, 30].…”

“…[31] used the psoas muscle mass index, and the study by Choi et al [21] used the skeletal muscle area of the neck. The remaining 16 studies used skeletal muscle mass index (SMI), with seven [15,18,23,25,[27][28][29] and nine [16,17,19,20,22,24,26,30,32] studies measuring the muscle area at the L3 and C3 spine levels, respectively. Eight studies [16, 18, 19, 22-24, 29, 30] in the RT group and six studies [17,20,[25][26][27]31] in the surgery group reported stage distribution between stage I, II and stage III, IV disease.…”

“…In particular, the timing of sarcopenia assessment was not described or was more than 1 month before treatment in many of the studies, which resulted in a high or moderate risk of bias in the prognostic factor measurement domain. Notably, the HRs according to treatment modality were not shown in some published articles [15,17,18,22,28,29,31] and were therefore estimated from Kaplan-Meier curves. As a result, some well-designed studies were graded as having a high risk of bias in the study confounding and the statistical analysis and reporting domains (S1 Table ).…”

“…Fourth, sarcopenia may be associated with a progressive tumor status, with some studies showing advanced T and N classifications in sarcopenic patients [17,27,44]. Finally, sarcopenia increases adverse events during and after RT, including aspiration pneumonitis during CRT [22] and dose-limiting toxicity during cetuximab treatment [24]. These adverse events can lead to treatment cessation and poorer disease control [29].…”

Sarcopenia and its impact in head and neck cancer treatment

“…included wet cough, purulent sputum, and fever, and objective symptoms, e.g. increased inflammatory or consolidation on chest imaging [37]. Low SMM was also found to be predictive for the length of hospital stay and unplanned admission in HNC patients treated with (chemo)radiotherapy [38].…”