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Early Skeletal Muscle Loss in Non-Small Cell Lung Cancer Patients Receiving Chemoradiation and Relationship to Survival

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Abstract

Purpose

Sarcopenia is associated with reduced survival in cancer. Currently, data on sarcopenia at presentation and muscle loss throughout treatment are unknown in patients receiving chemoradiation therapy (CRT) for non-small cell lung cancer (NSCLC). This study evaluated skeletal muscle changes in NSCLC patients receiving CRT and relationship with survival.

Methods

Secondary analysis of 41 patients with NSCLC treated with CRT assessed for skeletal muscle area and muscle density by computed tomography pre-treatment and 3 months post-treatment. Images at week 4 of treatment were available for 32 (78%) patients. Linear mixed models were applied to determine changes in skeletal muscle over time and related to overall survival using Kaplan-Meier plots.

Results

Muscle area and muscle density decreased significantly by week 4 of CRT (− 6.6 cm2, 95% CI − 9.7 to − 3.1, p < 0.001; − 1.3 HU, 95% CI − 1.9 to − 0.64, p < 0.001, respectively), with minimal change between week 4 of CRT and 3 months post-CRT follow-up (− 0.2 cm2, 95% CI − 3.6–3.1, p = 0.91; − 0.27, 95% CI − 0.91–0.36, p = 0.36, respectively). Sarcopenia was present in 25 (61%) and sarcopenic obesity in 6 (14%) of patients prior to CRT, but not associated with poorer survival. Median survival was shorter in patients with low muscle density prior to treatment although not statistically significant (25 months + 8.3 vs 53 months + 13.0, log-rank p = 0.17).

Conclusion

Significant loss of muscle area and muscle density occurs in NSCLC patients early during CRT. A high proportion of patients are sarcopenic prior to CRT; however, this was not significantly associated with poorer survival.

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Acknowledgements

The authors would like to thank Jason Callahan and Nick Hardcastle for their technical support and Gavin Abbott for his statistical support

Statement of authorship

NK participated in the design of the study, performed the statistical analysis, interpretation of results and drafted the manuscript. JB participated in data collection, interpretation of results and writing the manuscript. SE participated in the design of the study, interpretation of results and writing the manuscript.

Funding

This work was supported by a National Health and Medical Research Council New Investigator Project Grant (APP1003895) and a Victorian Cancer Agency Tumour Stream Research Grant (both SJE).

Author information

Authors and Affiliations

  1. Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia

    Nicole Kiss

  2. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Nicole Kiss

  3. Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

    Nicole Kiss

  4. Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3002, Australia

    Julian Beraldo & Sarah Everitt

  5. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia

    Sarah Everitt

  6. Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia

    Sarah Everitt

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  1. Nicole Kiss
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Corresponding author

Correspondence to Nicole Kiss.

Ethics declarations

Approval to conduct the study was granted by the Institutional Research and Ethics committees (ACTRN 12611001283965), all patients provided written, informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

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Kiss, N., Beraldo, J. & Everitt, S. Early Skeletal Muscle Loss in Non-Small Cell Lung Cancer Patients Receiving Chemoradiation and Relationship to Survival. Support Care Cancer 27, 2657–2664 (2019). https://doi.org/10.1007/s00520-018-4563-9

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  • DOI: https://doi.org/10.1007/s00520-018-4563-9

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