Poor treatment tolerance in head and neck cancer patients with low muscle mass

Mascarella, Marco A.; Patel, Terral; Vendra, Varun; Gardiner, Lauren; Kergoat, Marie‐Jeanne; Kubik, Mark W.; Solari, Mario G.; Snyderman, Carl H.; Traylor, Katie; Ferris, Robert L.; Kim, Seungwon; Duvvuri, Umamaheswar; Sridharan, Shaum

doi:10.1002/hed.26978

Cited by 13 publications

(12 citation statements)

References 37 publications

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“…The pooled frequency of PORT delay > 6 weeks was 48.6% (95% CI, 41.4‐55.9) (Figure 2). 3,16,19,22,23,52‐55,57‐61 The pooled frequency of PORT delay was unchanged in the sensitivity meta‐analysis excluding the NCDB study (pooled delay frequency = 48.0; 95% CI, 39.2‐56.8; Supplemental Figure S3, available online).…”

Section: Resultsmentioning

confidence: 99%

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

Duckett,

Kassir,

Nguyen

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveInitiating postoperative radiotherapy (PORT) within 6 weeks (42 days) of surgery is the first and only Commission on Cancer (CoC) approved quality metric for head and neck squamous cell carcinoma (HNSCC). No study has systematically reviewed nor synthesized the literature to establish national benchmarks for delays in starting PORT.Data SourcesFollowing Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines, we performed a systematic review of PubMed, Scopus, and CINAHL.Review MethodsStudies that described time‐to‐PORT or PORT delays in patients with HNSCC treated in the United States after 2003 were included. Meta‐analysis of proportions and continuous measures was performed on nonoverlapping datasets to examine the pooled frequency of PORT delays and time‐to‐PORT.ResultsThirty‐six studies were included in the systematic review and 14 in the meta‐analysis. Most studies utilized single‐institution (n = 17; 47.2%) or cancer registry (n = 16; 44.4%) data. Twenty‐five studies (69.4%) defined PORT delay as >6 weeks after surgery (the definition utilized by the CoC and National Comprehensive Cancer Network Guidelines), whereas 4 (11.1%) defined PORT delay as a time interval other than >6 weeks, and 7 (19.4%) characterized time‐to‐PORT without defining delay. Meta‐analysis revealed that 48.6% (95% confidence interval [CI], 41.4‐55.9) of patients started PORT > 6 weeks after surgery. Median and mean time‐to‐PORT were 45.8 (95% CI, 42.4‐51.4 days) and 47.4 days (95% CI, 43.4‐51.4 days), respectively.ConclusionDelays in initiating guideline‐adherent PORT occur in approximately half of patients with HNSCC. These meta‐analytic data can be used to set national benchmarks and assess progress in reducing delays.

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Section: Resultsmentioning

confidence: 99%

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

Duckett,

Kassir,

Nguyen

et al. 2023

Otolaryngol.--head neck surg.

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“…44 Agreement was also not investigated. Selected muscle analysis, that is, not all muscles in a chosen axial slice, has been used in other cancer studies, 37,[45][46][47][48] and the heterogeneity of chosen muscles makes direct comparison between studies difficult.…”

Section: Discussionmentioning

confidence: 99%

The use of the second thoracic vertebral landmark for skeletal muscle assessment and computed tomography‐defined sarcopenia evaluation in patients with head and neck cancer

et al. 2023

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Background:The cross-sectional area (CSA) of skeletal muscle (SM) at the third lumbar vertebra (L3) is used to determine computed tomography (CT)defined sarcopenia. We investigated the feasibility of SM assessment at the second thoracic vertebra (T2) in patients with head and neck cancer (HNC). Methods: Diagnostic PET-CT scans were used to develop a prediction model for L3-CSA using T2-CSA. Effectiveness of the model and cancer-specific survival (CSS) were investigated.Results: Scans of 111 patients (85% male) were evaluated. The predictive formula: L3-CSA (cm 2 ) = 174.15 + [0.212 Â T2-CSA (cm 2 )] -[40.032 Â sex] -[0.928 Â age (years)] + [0.285 Â weight (kg)] had good correlation r = 0.796, ICC = 0.882 (p < 0.001). SM index (SMI) mean difference (bias) was À3.6% (SD 10.2, 95% CI À8.7% to 1.3%). Sensitivity (82.8%), specificity (78.2%), with moderate agreement (ƙ = 0.540, p < 0.001). Worse 5-year CSS with lower quartile T2-SMI (51%, p = 0.003).

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“…Chargi et al found skeletal muscle mass-derived sarcopenia to be significantly associated with dose-limiting toxicities of cisplatin for concomitant chemoradiation [ 24 ]. Similarly, Ganju et al described a significantly increased risk for treatment interruptions in sarcopenic HNSCC patients undergoing radiotherapy, and poor treatment tolerance in sarcopenic patients has also been reported for surgical approaches [ 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia as a Prognostic Marker in Elderly Head and Neck Squamous Cell Carcinoma Patients Undergoing (Chemo-)Radiation

Haehl

Alvino

Rühle

et al. 2022

Cancers

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Sarcopenia is associated with reduced survival and increased toxicity in malignant diseases. The prevalence of sarcopenia increases with age and is an important cause of functional decline. We analyzed sarcopenia and sarcopenia dynamics in elderly head-and-neck squamous cell carcinoma (HNSCC) patients undergoing (chemo)radiation. Skeletal muscle mass of 280 elderly HNSCC-patients (>65 yrs) receiving curative (chemo)radiation was manually outlined and quantified on CT scans at the level of the C3 (C3MA). Cross-sectional muscle area at L3 (L3MA) was calculated and normalized to height (L3MI). Frequency distributions of clinical parameters as well as overall survival (OS), progression-free survival (PFS) and locoregional control (LRC) were calculated regarding sarcopenia. Calculated L3MA correlated with pretherapeutic hemoglobin-levels (ρ = 0.280) bodyweight (ρ = 0.702) and inversely with patient-age (ρ = −0.290). Sarcopenic patients featured larger tumors (T3/4 69.0% vs. 52.8%, p < 0.001), a higher burden of comorbidity (age-adjusted Charlson Comorbidity Index 4.8 vs. 4.2, p = 0.015) and more severe chronic toxicities (CTCAE grade 3/4 24.0% vs. 11.8%, p = 0.022). OS was significantly deteriorated in sarcopenic patients with a median of 23 vs. 91 months (logrank p = 0.002) (HR 1.79, CI 1.22–2.60, p = 0.003) and sarcopenia remained an independent prognostic factor for reduced OS in the multivariate analysis (HR 1.64, CI 1.07–2.52, p = 0.023). After therapy, 33% of previously non-sarcopenic patients developed sarcopenia, while 97% of pre-treatment sarcopenic remained sarcopenic. Median bodyweight decreased by 6.8%, whereas median calculated L3MA decreased by 2.4%. In contrast to pretherapeutic, post-therapeutic sarcopenia is no prognosticator for reduced OS. Pretherapeutic sarcopenia is a significant prognostic factor in elderly HNSCC patients undergoing (chemo-)radiation and should be considered in pretherapeutic decision-making. Its role as a predictive marker for tailored supportive interventions merits further prospective evaluation.

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Poor treatment tolerance in head and neck cancer patients with low muscle mass

Cited by 13 publications

References 37 publications

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

The use of the second thoracic vertebral landmark for skeletal muscle assessment and computed tomography‐defined sarcopenia evaluation in patients with head and neck cancer

Sarcopenia as a Prognostic Marker in Elderly Head and Neck Squamous Cell Carcinoma Patients Undergoing (Chemo-)Radiation

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