Prevalence and clinical significance of cancer cachexia based on time from treatment in advanced-stage head and neck squamous cell carcinoma

Kwon, Minsu; Kim, Rock Bum; Roh, Jong–Lyel; Lee, Sangwook; Kim, Sung‐Bae; Choi, Seung‐Ho; Nam, Soon Yuhl; Kim, Sang Yoon

doi:10.1002/hed.24672

Cited by 43 publications

(39 citation statements)

References 22 publications

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“…The present study also showed that pretreatment muscle wasting is an independent prognostic factor for OS in LAHNSCC patients. Kaplan–Meier and Cox regression analyses showed a significantly worse OS in patients with pretreatment muscle wasting, which is consistent with previous studies …”

Section: Discussionsupporting

confidence: 92%

“…In this Dutch patient cohort, an FFMI < P 10 was found in 29% ( n = 40/137) of the patients at the start of CRT, which is slightly higher than reported in present literature . Kwon et al reported a much lower pretreatment incidence of cachexia in Korean patients, namely, 6.1% ( n = 22/361) . These differences can probably partially be explained by the different diagnostic criteria that were used for muscle wasting and cachexia .…”

Section: Discussioncontrasting

confidence: 59%

“…Kaplan-Meier and Cox regression analyses showed a significantly worse OS in patients with pretreatment muscle wasting, which is consistent with previous studies. 25,26,[41][42][43][44][45] This study is the first to evaluate the effect of different body 'wasting' profiles in LAHNSCC on OS and the risk of misleading information when relying only on BMI. Although the sample size of the subgroups is small, Figure 1 suggests that a low BMI does not necessarily mean that patients are malnourished, nor that they are at risk for malnutrition-related therapeutic consequences.…”

Section: Discussionmentioning

confidence: 99%

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Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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Background Chemoradiation or bioradiation treatment (CRT/BRT) of locally advanced head and neck squamous cell carcinoma (LAHNSCC) comes with high toxicity rates, often leading to temporary tube feeding (TF) dependency. Cachexia is a common problem in LAHNSCC. Yet changes in body composition and muscle weakness during CRT/BRT are underexplored. Strong evidence on the effect of TF on body composition during treatment is lacking. The aim of this cohort study was to assess (i) the relationship of fat‐free mass index (FFMI) and handgrip strength (HGS) with CRT/BRT toxicity and outcome, (ii) body composition in patients treated with chemoradiation (cisplatin) vs. bioradiation (cetuximab), and (iii) the effect of the current TF regime on body composition and muscle strength. Methods Locally advanced head and neck squamous cell carcinoma patients treated with CRT/BRT between January 2013 and December 2016 were included (n = 137). Baseline measurements of body composition (bioelectrical impedance analysis) and HGS were performed. Toxicity grades (Common Terminology Criteria for Adverse Events) were scored. In a subset of 69 patients, weight loss, body composition, and HGS were additionally assessed during and after CRT/BRT. TF was initiated according to the Dutch guidelines for malnutrition. Results In this cohort (68% male, mean age 59 ± 8 years), the incidence of baseline muscle wasting, defined as FFMI < P10, was 29%. Muscle wasting was present in 23 of 100 (23%) chemoradiation patients and 17 of 37 (46%) bioradiation patients (P = 0.009). Muscle‐wasted patients required more unplanned hospitalizations during CRT (P = 0.035). In the chemoradiation subset, dose‐limiting toxicity was significantly higher in wasted vs. non‐wasted patients (57% vs. 25%, P = 0.004). Median follow‐up was 32 months. Multivariate Cox regression analysis identified muscle wasting as independent unfavourable prognostic factor for overall survival [hazard ratio 2.1 (95% CI 1.1–4.1), P = 0.022] and cisplatin as favourable prognostic factor [hazard ratio 0.3 (95% CI 0.2–0.6), P = 0.001]. Weight and HGS significantly decreased during CRT/BRT, −3.7 ± 3.5 kg (P < 0.001) and −3.1 ± 6.0 kg (P < 0.001), respectively. Sixty‐four per cent of the patients required TF 21 days (range 0–59) after CRT/BRT initiation. Total weight loss during CRT/BRT was significantly (P = 0.007) higher in the total oral diet group (5.5 ± 3.7 kg) compared with the TF group (3.0 ± 3.2 kg). Loss of FFM and HGS was similar in both groups. Conclusions In LAHNSCC patients undergoing CRT/BRT, FFMI < P10 is an unfavourable prognostic factor for overall survival, treatment toxicity, and tolerance. Patients experience significant weight and FFM loss during treatment. Current TF regime attenuates weight loss but does not overcome loss of muscle mass and function during therapy. Future interventions should consider nutritional intake and additional strategies specifically targeting metabolism, loss of muscle mass, and function.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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“…Up to over 50% of advanced head and neck cancer (HNC) patients present to their initial clinic visit in this catabolic state . Many present with a several month history of dysphagia or odynophagia related to the location of their tumor or an enlarging neck mass.…”

Section: Introductionmentioning

confidence: 99%

“…6,[8][9][10] Up to over 50% of advanced head and neck cancer (HNC) patients present to their initial clinic visit in this catabolic state. [11][12][13][14] Many present with a several month history of dysphagia or odynophagia related to the location of their tumor or an enlarging neck mass. Other social factors common to this population, such as alcohol abuse, further complicate their nutritional status.…”

Section: Introductionmentioning

confidence: 99%

Does perioperative oxandrolone improve nutritional status in patients with cachexia related to head and neck carcinoma?

Osmolak

Klatt-Cromwell

Price

et al. 2019

Laryngoscope Investig Oto

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Background Cancer cachexia affects up to over 50% of advanced head and neck cancer (HNC) patients. To date, the potential utility of anabolic steroids in perioperative cachectic HNC patients has not been determined. Methods Retrospective review of pre‐ and post‐oxandrolone administration prealbumin levels in 18 perioperative HNC patients between October 2007 and October 2014 at a tertiary academic medical center. Results The median pretreatment prealbumin was 88.5 mg/L. The median post‐treatment prealbumin was 227 mg/L. The median interval improvement of the prealbumin level was 131.5 mg/L. The median differences between the pretreatment and post‐treatment prealbumin levels were found to be statistically significant ( P < .001). Subjective improvement in wound healing was also observed. Conclusions Perioperative administration of oxandrolone resulted in objective improvements in prealbumin levels and subjective improvements in surgical wounds. Oxandrolone administered 10 mg twice daily (BID) for 10 days may be a useful adjunct in the perioperative care of nutritionally deficient HNC patients who are at risk for or have demonstrated impaired wound healing. Level of Evidence 3

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Postoperative consequences of cancer cachexia after head and neck free flap reconstruction

et al. 2022

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Background Cachexia is detrimental for patients with head and neck cancer (HNC). However, postoperative consequences of HNC cachexia remain unknown. Methods A 2014–2019 retrospective review was performed of adults undergoing aerodigestive HNC resection with free tissue reconstruction. Propensity score matching using inverse probability of treatment weighting (IPTW) of cachectic and control groups was employed to adjust for covariate imbalances followed by binary logistic regression on postoperative outcomes. Results Out of 252 total patients, 135 (53.6%) had cancer cachexia. The cohort was predominantly white (94.4%) males (65.1%) aged 61.5 ± 11.5 years with stage III–IV (84.1%) malignancy of the oral cavity (66.3%). After matching cohort pre‐ and intra‐operative covariates using IPTW, cancer cachexia remained a strong, significant predictor of serious National Surgical Quality Improvement Program (NSQIP) complications (OR [95%CI] = 3.84 [1.80–8.21]) and major Clavien‐Dindo complications (OR [95%CI] = 3.00 [1.18–7.60]). Conclusions Cancer cachexia is associated with worse HNC free flap reconstruction outcomes.

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Prevalence and clinical significance of cancer cachexia based on time from treatment in advanced-stage head and neck squamous cell carcinoma

Abstract: Cachexia prevalence at 6 and 12 months after treatment for HNSCC indicates a higher chance of recurrence, NCHE, and death. © 2016 Wiley Periodicals, Inc. Head Neck 39: 716-723, 2017.

Cited by 43 publications

References 22 publications

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Does perioperative oxandrolone improve nutritional status in patients with cachexia related to head and neck carcinoma?

Postoperative consequences of cancer cachexia after head and neck free flap reconstruction

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