Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer

Awad, Sherif; Tan, Benjamin H.L.; Cui, Helen; Bhalla, Ashish; Fearon, K. C. H.; Parsons, Simon L.; Catton, James; Lobo, Dileep N.

doi:10.1016/j.clnu.2011.08.008

Cited by 234 publications

(193 citation statements)

References 15 publications

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“…This finding could suggest that the amount of oral intake had less influence on the loss of skeletal muscle than adjuvant chemotherapy. In addition, Awad et al [23] demonstrated a significant association of preoperative 5-FU-based chemotherapy with reductions in fat-free mass of as much as 6 % in patients with esophagogastric cancer, using the method employed in this study of analyzing transverse CT images at the third lumbar vertebral level. These combined results suggest that 5-FU might affect the loss of skeletal muscle, although the precise mechanism is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…CT scan is the gold standard for quantifying skeletal muscle mass [22], and Mourtzakis et al [18] have shown that the CT cross sectional area at L3 is strongly related to appendicular skeletal mass, a common index of sarcopenia as measured by dual-energy X-ray densitometry. CT cross-sectional area at L3 single slice was employed in many studies as a reliable method to evaluate body composition [7,10,23]. In our study, mean SMI (cm 2 /m 2 ) decreased from 46.6 to 43.6 by 1 year after surgery and ATI (cm 2 /m 2 ) decreased from 76.4 to 21.4; these declines corresponded to 6.2 % and 65.8 % reductions of the preoperative values, respectively ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

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Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

et al. 2014

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Background Skeletal muscle loss is associated with physical disability, nosocomial infections, postoperative complications, and decreased survival. Preventing the loss of skeletal muscle mass after gastrectomy may lead to improved outcomes. The aims of this study were to assess changes in skeletal muscle mass after total gastrectomy (TG) and to clarify the clinical factors affecting significant loss of skeletal muscle after TG. Patients and methods One hundred and two patients undergoing TG for primary gastric cancer underwent abdominal computed tomography before and 1 year after TG to precisely quantify postoperative changes in skeletal muscle and adipose tissue. Univariate and multivariate logistic regression analyses identified clinical factors contributing to significant loss of skeletal muscle after TG.Results At 1 year after TG, the mass of both skeletal muscle and adipose tissue was reduced by 6.20 ± 6.80 and 65.8 ± 36.1 % of the preoperative values, respectively, and 26 patients (25.5 %) showed a significant loss of skeletal muscle of more than 10 %. Adjuvant chemotherapy with S-1 for C6 months (hazard ratio 26.61, 95 % confidence interval, 3.487-203.1) was identified as the single independent risk factor for a significant loss of skeletal muscle. Conclusions Skeletal muscle loss was exacerbated by extended adjuvant chemotherapy after TG. Further research should identify appropriate nutritional interventions for maintaining skeletal muscle mass and leading to improved outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

et al. 2014

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“…In practical terms, this means that cachexia interventions should be given alongside tumour‐directed treatment. This approach has the advantage that chemotherapy‐induced muscle loss may also be reduced 11. Undertaking cachexia treatment early in the disease trajectory during chemotherapy may provide a therapeutic window where the chances to establish a clinically meaningful benefit are maximal.…”

Section: Introductionmentioning

confidence: 99%

A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer

Solheim

Laird

Balstad

et al. 2017

J cachexia sarcopenia muscle

258

279

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BackgroundCancer cachexia is a syndrome of weight loss (including muscle and fat), anorexia, and decreased physical function. It has been suggested that the optimal treatment for cachexia should be a multimodal intervention. The primary aim of this study was to examine the feasibility and safety of a multimodal intervention (n‐3 polyunsaturated fatty acid nutritional supplements, exercise, and anti‐inflammatory medication: celecoxib) for cancer cachexia in patients with incurable lung or pancreatic cancer, undergoing chemotherapy.MethodsPatients receiving two cycles of standard chemotherapy were randomized to either the multimodal cachexia intervention or standard care. Primary outcome measures were feasibility assessed by recruitment, attrition, and compliance with intervention (>50% of components in >50% of patients). Key secondary outcomes were change in weight, muscle mass, physical activity, safety, and survival.ResultsThree hundred and ninety‐nine were screened resulting in 46 patients recruited (11.5%). Twenty five patients were randomized to the treatment and 21 as controls. Forty‐one completed the study (attrition rate 11%). Compliance to the individual components of the intervention was 76% for celecoxib, 60% for exercise, and 48% for nutritional supplements. As expected from the sample size, there was no statistically significant effect on physical activity or muscle mass. There were no intervention‐related Serious Adverse Events and survival was similar between the groups.ConclusionsA multimodal cachexia intervention is feasible and safe in patients with incurable lung or pancreatic cancer; however, compliance to nutritional supplements was suboptimal. A phase III study is now underway to assess fully the effect of the intervention.

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“…Malnutrition is associated with increased morbidity and mortality after gastric cancer surgery [7] . It is highly important to thoroughly screen patients for malnutrition as interventions can be done to preoperatively improve nutritional status and subsequently neo-adjuvant therapies potentially further compromising the nutritional and metabolic status [31] . Questionnaires are subjective methods to assess nutritional status and therefore methods to objectively measure a patient's condition might improve outcomes.…”

Section: Nutritional Statusmentioning

confidence: 99%

Improving the outcomes in gastric cancer surgery

Tegels¹,

Maat²,

Hulsewé³

et al. 2014

WJG

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Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer

Cited by 234 publications

References 15 publications

Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer

Improving the outcomes in gastric cancer surgery

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