Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy

Radiation Oncology

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[1] 0000 0000 8587 8621, grid.413354.4, Department of Radiation Oncology, Luzerner Kantonsspital, Luzern, Switzerland;0000 0001 0697 1703, grid.452288.1, Department of Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland;0000 0001 0697 1703, grid.452288.1, Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland;0000 0001 0726 5157, grid.5734.5, Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland;0000 0001 1955 3199, grid.476782.8, Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland;0000 0001 2294 4705, grid.413349.8, Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland;0000 0004 0478 9977, grid.412004.3, University Hospital Zurich, Zurich, Switzerland;0000 0004 0479 0855, grid.411656.1, Department of Radiation Oncology, Inselspital Bern, Bern, Switzerland;0000 0004 1937 0642, grid.6612.3, Department of Medical Oncology and Hematology, Kantonsspital St. Gallen and University of Basel, Basel, Switzerland;grid.17089.37, Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada;

关键词: Sarcopenia;    Esophageal cancer;    Resectable;    Locally advanced;    Radiotherapy;    Radiochemotherapy;    Cetuximab;   

DOI  :  10.1186/s13014-019-1372-3

来源: publisher

【 摘 要 】

BackgroundSarcopenia, the critical depletion of skeletal muscle mass, is an independent prognostic factor in several tumor entities for treatment-related toxicity and survival. In esophageal cancer, there have been conflicting results regarding the value of sarcopenia as prognostic factor, which may be attributed to the heterogeneous patient populations and the retrospective nature of previous studies. The aim of our study was therefore to determine the impact of sarcopenia on prospectively collected specific outcomes in a subgroup of patients treated within the phase III study SAKK 75/08 with trimodality therapy (induction chemotherapy, radiochemotherapy and surgery) for locally advanced esophageal cancer.MethodsSarcopenia was assessed by skeletal muscle index at the 3rd lumbar vertebra (L3) in cross-sectional computed tomography scans before induction chemotherapy, before radiochemotherapy and after neoadjuvant therapy in a subgroup of 61 patients from four centers in Switzerland. Sarcopenia was determined by previously established cut-off values (Martin et al., PMID: 23530101) and correlated with prospectively collected outcomes including treatment-related toxicity, postoperative morbidity, treatment feasibility and survival.ResultsUsing the published cut-off values, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9% during neoadjuvant therapy (p < 0.001). Feasibility of neoadjuvant therapy and surgery was not different in initially sarcopenic and non-sarcopenic patients. We observed in sarcopenic patients significantly increased grade ≥ 3 toxicities during chemoradiation (83.3% vs 52.4%, p = 0.04) and a non-significant trend towards increased postoperative complications (66.7% vs 42.9%, p = 0.16). No difference in survival according to sarcopenia could be observed in this small study population.ConclusionsTrimodality therapy in locally advanced esophageal cancer is feasible in selected patients with sarcopenia. Neoadjuvant chemoradiation increased the percentage of sarcopenia. Sarcopenic patients are at higher risk for increased toxicity during neoadjuvant radiochemotherapy and showed a non-significant trend to more postoperative morbidity.

【 授权许可】

CC BY