Quantitative body mass characterization before and after head and neck cancer radiotherapy: A challenge of height-weight formulae using computed tomography measurement

Chamchod, Sasikarn; Fuller, Clifton D.; Mohamed, A.S.R.; Grossberg, Aaron J.; Messer, Jay A.; Heukelom, J.; Gunn, G. Brandon; Kantor, Michael; Eichelberger, Hillary; Garden, Adam S.; Rosenthal, David I.

doi:10.1016/j.oraloncology.2016.08.012

Cited by 31 publications

(48 citation statements)

References 28 publications

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“…Prevalence of sarcopenia in our cohort is 48.2% and thus in line with previous published prevalence. CT‐derived sarcopenia has been previously related to chemotherapy dose‐limiting toxicity and worsened survival and is aggravated trough (chemo)radiotherapy in HNC patients . However, despite being a significant problem, other associations of CT‐determined sarcopenia in HNC patients are underreported in literature.…”

Section: Discussionmentioning

confidence: 99%

“…CT-derived sarcopenia has been previously related to chemotherapy dose-limiting toxicity and worsened survival and is aggravated trough (chemo)radiotherapy in HNC patients. 19,27,29,30 However, despite being a significant problem, other associations Figure 3 Scatterplots for skeletal muscle index and frailty scores. The figure illustrates the correlation of skeletal muscle index and frailty scores for both G8 (A) and GFI (B), with corresponding cut-off values for frailty (≤14 and ≥4, respectively).…”

Section: Discussionmentioning

confidence: 99%

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CT‐measured skeletal muscle mass used to assess frailty in patients with head and neck cancer

Zwart

Hoorn

Ooijen

et al. 2019

J cachexia sarcopenia muscle

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Background Skeletal muscle depletion or sarcopenia is related to multiple adverse clinical outcome. However, frailty questionnaires are currently applied in the daily practice to identify patients who are potentially (un)suitable for treatment but are time consuming and straining for patients and the clinician. Screening for sarcopenia in patients with head and neck cancer (HNC) could be a promising fast biomarker for frailty. Our objective was to quantify sarcopenia with pre‐treatment low skeletal muscle mass from routinely obtained neck computed tomography scans at level of third cervical vertebra in patients diagnosed with HNC and evaluate its association with frailty. Methods A total of 112 HNC patients with Stages III and IV disease were included from a prospective databiobank. The amount of skeletal muscle mass was retrospectively defined using the skeletal muscle index (SMI). Correlation analysis between SMI and continuous frailty data and the observer agreement were analysed with Pearson's r correlation coefficients. Sarcopenia was present when SMI felt below previously published non‐gender specific thresholds (<43.2 cm2/m2). Frailty was evaluated by Geriatrics 8 (G8), Groningen Frailty Indicator, Timed Up and Go test, and Malnutrition Universal Screening Tool. A univariate and multivariate logistic regression analysis was performed for all patients and men separately to obtain odds ratios (ORs) and 95% confidence intervals (95% CIs). Results The cohort included 82 men (73%) and 30 women (27%), with a total mean age of 63 (±9) years. The observer agreement for cross‐sectional measurements was excellent for both intra‐observer variability (r = 0.99, P < 0.001) and inter‐observer variability (r = 0.98, P < 0.001). SMI correlated best with G8 frailty score (r = 0.38, P < 0.001) and did not differ per gender. Sarcopenia was present in 54 (48%) patients, whereof 25 (46%) men and 29 (54%) women. Prevalence of frailty was between 5% and 54% depending on the used screening tool. The multivariate regression analysis for all patients and men separately isolated the G8 questionnaire as the only independent variable associated with sarcopenia (OR 0.76, 95% CI 0.66–0.89, P < 0.001 and OR 0.76, 95% CI 0.66–0.88, P < 0.001, respectively). Conclusions This is the first study that demonstrates that sarcopenia is independently associated with frailty based on the G8 questionnaire in HNC patients. These results suggest that in the future, screening for sarcopenia on routinely obtained neck computed tomography scans may replace time consuming frailty questionnaires and help to select the (un)suitable patients for therapy, which is highly clinically relevant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

CT‐measured skeletal muscle mass used to assess frailty in patients with head and neck cancer

Zwart

Hoorn

Ooijen

et al. 2019

J cachexia sarcopenia muscle

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“…Underestimation of FM and BF % by BIA versus DXA has been reported elsewhere (43). Our LM difference of ~2kg falls under the ±5kg deemed 'clinically acceptable' for such comparisons (30).…”

Section: Dxa Vs Hume Formulamentioning

confidence: 65%

“…In cancer patients, the Hume formula was the only acceptable height-and weight-based formula to adequately approximate LM against a CT; the James and Boer formulas were deemed inaccurate. The LM difference of 1.8kg was deemed clinically acceptable (defined as ±5kg) (30). Consequently, our difference of ~3.5kg can also be considered acceptable.…”

Section: Dxa Vs Hume Formulamentioning

confidence: 82%

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Anthropometry-based Equations to Estimate Body Composition: A Suitable Alternative in Renal Transplant Recipients and Patients With Nondialysis Dependent Kidney Disease?

Wilkinson

Richler-Potts

Nixon

et al. 2019

Journal of Renal Nutrition

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Our results demonstrate, in RTR and NDD-CKD patients, that the Hume formula, whose estimation of body composition is based only upon height, body mass, age, and sex, may reliably predict the same parameters obtained by DXA. In addition, BIA also provided similar estimates versus DXA. Thus, the Hume formula and BIA could provide simple and inexpensive means to estimate body composition in renal disease.

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Prognostic Indication of Sarcopenia for Wound Complication After Total Laryngectomy

Achim

Bash

Mowery

et al. 2017

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Postoperative wound complications after total laryngectomy (TL) increase hospital stay, costs, and delay adjuvant therapy when indicated. Recently, sarcopenia has been identified as a predictor of postoperative complications in patients undergoing major surgery but has not been assessed in head and neck surgery patients. OBJECTIVE To determine the incidence of sarcopenia in patients with squamous cell carcinoma (SCC) undergoing TL and evaluate its association with the development of postoperative wound complications. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical chart review of 70 patients with SCC who underwent TL with cross-sectional abdominal imaging obtained preoperatively from 2004 to 2016 in a tertiary care hospital. Patients were determined to have sarcopenia present if the skeletal muscle index was calculated to be less than 38.5 cm 2 /m 2 for women and 52.4 cm 2 /m 2 for men. Demographic data included age, sex, smoking history, Charlson Comorbidity Index (CCI) score, prior radiation history, tumor stage, body mass index (BMI), and preoperative albumin levels. MAIN OUTCOMES AND MEASURES Measurements of abdominal wall and paraspinal musculature at the cross-sectional L3 vertebral body were performed, normalized for height, and compared with previously defined sex-specific cutoff values to identify sarcopenia. Postoperative complications including all complications, wound-related complications, and pharyngo-cutaneous fistula (PCF) were determined. RESULTS Sarcopenia was identified preoperatively in 54 (77%) patients. There was not a significant difference between the sarcopenia group and the nonsarcopenia group for any data except BMI (Cohen d = 1; 95% CI, 0.41-1.57) and preoperative albumin levels (Cohen d = 0.69; 95% CI, 0.11-1.25). Of 70 patients, 13 (24%) in the sarcopenia group developed a PCF compared with 0 (0%) without sarcopenia (OR, 1.32; 95% CI, 1.13-1.53). Similarly, 35 (50%) patients in the sarcopenia group developed a wound complication compared with 2 (13%) in the nonsarcopenia group (OR, 7.54; 95% CI, 1.56-36.4). On univariate analysis, sarcopenia was the only predictive factor of any complication (OR, 6.53; 95% CI, 1.84-23.23) and any wound complication (OR, 7.54; 95% CI, 1.56-36.4). On multivariable analysis of preoperative albumin levels and preoperative sarcopenia, only sarcopenia was a significant predictor for all complications (OR, 7.96; 95% CI, 1.39-45.29). CONCLUSIONS AND RELEVANCE Sarcopenia is an independent negative prognostic indicator for the development of all complications and wound complications after TL for the treatment of SCC.

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Quantitative body mass characterization before and after head and neck cancer radiotherapy: A challenge of height-weight formulae using computed tomography measurement

Cited by 31 publications

References 28 publications

CT‐measured skeletal muscle mass used to assess frailty in patients with head and neck cancer

CT‐measured skeletal muscle mass used to assess frailty in patients with head and neck cancer

Anthropometry-based Equations to Estimate Body Composition: A Suitable Alternative in Renal Transplant Recipients and Patients With Nondialysis Dependent Kidney Disease?

Prognostic Indication of Sarcopenia for Wound Complication After Total Laryngectomy

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