Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients

Anandavadivelan, Poorna; Brismar, Torkel B.; Nilsson, Magnus; Johar, Asif; Martin, Lena

doi:10.1016/j.clnu.2015.05.011

Cited by 154 publications

(137 citation statements)

References 46 publications

(74 reference statements)

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“…The original hypothesis was investigated using several different studies with different chemotherapy drugs and in individuals with different cancer types (31,36) . In a recently published paper by Anandavadivelan et al (28) , DLT was investigated in seventy-two patients receiving neo-adjuvant therapy for oesophageal cancer. Unfortunately, absolute values of muscle mass were not stratified by gender when comparing those presenting v. not presenting with DLT.…”

Section: Treatment Toxicitymentioning

confidence: 99%

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

et al. 2016

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Our understanding of body composition (BC) variability in contemporary populations has significantly increased with the use of imaging techniques. Abnormal BC such as sarcopenia (low muscle mass) and obesity (excess adipose tissue) are predictors of poorer prognosis in a variety of conditions or clinical situations. As a catabolic illness, a defining feature of cancer is muscle loss. Although the conceptual model of wasting in cancer is typically conceived as involuntary weight loss leading to low body weight, recent studies have shown that both sarcopenia and cachexia can be present with obesity. The combination of low muscle and high adipose tissue (sarcopenic obesity) is an emerging abnormal BC phenotype prevalent across the body weight, and hence BMI spectra. Sarcopenia and sarcopenic obesity in cancer are in most instances occult conditions, which have been independently associated with higher incidence of chemotherapy toxicity, shorter time to tumour progression, poorer outcomes of surgery, physical impairment and shorter survival. Although the mechanisms are yet to be fully understood, the associations with poorer clinical outcomes emphasise the value of nutritional assessment as well as the need to develop appropriate interventions to countermeasure abnormal BC. Sarcopenia and sarcopenic obesity create diverse nutritional requirements, highlighting the compelling need for a more comprehensive and differentiated understanding of energy and protein requirements in this heterogeneous population.

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Section: Treatment Toxicitymentioning

confidence: 99%

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

et al. 2016

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“…In addition, sarcopenic patients who underwent esophagectomy had significantly higher rate of respiratory complications compared to nonsarcopenic subjects, but there was no difference in the incidence of overall complications between the two groups [47][48][49]. Sarcopenia has also impact on chemotherapy outcome since decreased muscle mass is associated with dose-limiting toxicity and pathological chemotherapy response in patients receiving neoadjuvant chemotherapy [50][51][52]. Therefore, it is imperative to estimate patients' muscle mass not only preoperatively but also before the οnset of chemotherapy, bearing in mind that sarcopenia is frequently masqued by obesity making it more difficult to define patients' needs for intervention.…”

Section: Sarcopenia and Cancer Cachexiamentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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“…Furthermore, muscle wasting and low muscle mass have been linked to poorer survival and increased risk of treatment toxicity in various cancer diagnoses, including NSCLC 15, 16, 17, 18, 19. In advanced NSCLC, a recent study from our group showed that low muscle mass was a significant predictor for chemotherapy‐induced haematological toxicity 20…”

Section: Introductionmentioning

confidence: 99%

Muscle mass and association to quality of life in non‐small cell lung cancer patients

Bye

Sjøblom

Wentzel‐Larsen

et al. 2017

J cachexia sarcopenia muscle

121

137

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BackgroundCancer wasting is characterized by muscle loss and may contribute to fatigue and poor quality of life (QoL). Our aim was to investigate associations between skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) and selected QoL outcomes in advanced non‐small cell lung cancer (NSCLC) at diagnosis.MethodsBaseline data from patients with stage IIIB/IV NSCLC and performance status 0–2 enrolled in three randomized trials of first‐line chemotherapy (n = 1305) were analysed. Associations between SMI (cm2/m2) and SMD (Hounsfield units) based on computed tomography‐images at the third lumbar level and self‐reported physical function (PF), role function (RF), global QoL, fatigue, and dyspnoea were investigated by linear regression using flexible non‐linear modelling.ResultsComplete data were available for 734 patients, mean age 65 years. Mean SMI was 47.7 cm2/m2 in men (n = 420) and 39.6 cm2/m2 in women (n = 314). Low SMI values were non‐linearly associated with low PF and RF (men P = 0.016/0.020, women P = 0.004/0.012) and with low global QoL (P = 0.001) in men. Low SMI was significantly associated with high fatigue (P = 0.002) and more pain (P = 0.015), in both genders, but not with dyspnoea. All regression analyses showed poorer physical outcomes below an SMI breakpoint of about 42–45 cm2/m2 for men and 37–40 cm2/m2 for women. In both genders, poor PF and more dyspnoea were significantly associated with low SMD.ConclusionsLow muscle mass in NSCLC negatively affects the patients' PF, RF, and global QoL, possibly more so in men than in women. However, muscle mass must be below a threshold value before this effect can be detected.

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Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients

Cited by 154 publications

References 46 publications

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

Nutritional Management of Esophageal Cancer Patients

Muscle mass and association to quality of life in non‐small cell lung cancer patients

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