Scripties UMCG - Rijksuniversiteit Groningen
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The impact of low skeletal muscle mass on prognosis and toxicity in head and neck cancer patients treated with radiotherapy.- A single centre retrospective cohort study using prospectively collected data

(2018) Van Rijn-Dekker, M.I. (Irene)

Background: Sarcopenia, defined as the loss of skeletal muscle mass and strength, is emerging as an adverse prognostic factor for both survival and complication risk in cancer patients. The aim of this study was to determine the impact of low skeletal muscle mass, i.e. sarcopenia, on clinical outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with primary radiotherapy. Patients and methods: Patients with HNSCC who were treated from January 2007 to June 2016 in our centre were included in this study. Clinical prospectively collected variables were retrospectively retrieved. The pre-treatment planning CT-scan was used to measure the cross-sectional area (CSA) of skeletal muscles at the third cervical vertebra (C3) with Mirada DBx software. The prediction rule by Swartz et al. was used to estimate CSA at the third lumbar vertebra (L3) using CSA C3. L3 skeletal muscle index (SMI) was calculated. Survival was univariate analysed using Kaplan Meier curves and toxicity was, among others, multivariate analysed using association models. Results: In total, 750 patients with HNSCC were included. The cut-off value of sarcopenia was set at SMI <42.4 cm2/m2 (men) and <30.6 cm2/m2 (women). Patients with sarcopenia had a significantly poorer survival than others (overall survival (p<0.001) and disease-free survival (p<0.001)). Lower SMI was univariate associated with more radiotherapy-induced toxicity. Conclusion: Sarcopenia is strongly associated with poor survival. On top of that, decreased SMI is univariate associated with increased radiotherapy-induced toxicity six and twelve months after treatment. In the future it is well possible that calculating SMI becomes clinical relevant in HNSCC patients.

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