Accelerated loss of lean body mass in head and neck cancer patients during cisplatin-based chemoradiation

Simon Lønbro*, Søren Gam, Anne Pernille Hermann, Christian Rønn Hansen, Jørgen Johansen

*Corresponding author for this work

Research output: Contribution to journalConference articleResearchpeer-review

Abstract

Background: This study investigated changes in body weight, lean body mass (LBM), fat mass (FM), muscle strength and functional performance during radiation treatment in head and neck cancer (HNSCC) patients. Secondly, it investigated the impact of cisplatin-based chemoradiation (CCRT) on LBM loss compared with radiation alone. Methods: 48 patients (all tumor sites) received either 6 weeks of radiation alone (n = 16) with 66–68 Gy in 33–34 Fx, 5-6 Fx/week or CCRT, adding weekly cisplatin or carboplatin (n = 32). LBM and FM was evaluated using Dual-energy X-ray Absorptiometry bi-weekly from pre- to two weeks post-treatment. Maximal muscle strength (knee extension, leg - and chest press) and functional performance (stair climb, chair rise, and arm curl) were assessed pre- and post-treatment. Results: Body weight and LBM had declined significantly already week 2 into treatment and declined significantly further through week 4 and 6 before leveling off after week 6. Bi-weekly, from treatment start to week 2, 2–4, and 4–6, LBM declined 1.2 ± 0.4 kg (p =.002; 95% CI: 0.4;2.0), 2.0 ± 0.4 kg (p <.0001; 1.2;2.8) and 1.4 ± 0.4 kg (p =.001; 0.6;2.2). With a two-week delay, FM declined significantly from week 2–8. All measures of muscle strength declined significantly from pre- to post-treatment. Functional performance was unchanged. LBM loss from pre- to post-treatment was significantly associated with impaired muscle strength (R 2 = 0.3–0.5). CCRT patients lost 3.1 ± 0.8 kg of LBM (p =.0001; 1.5;4.7) more from pre- to post-treatment compared with patients receiving radiation alone. Analyses adjusting for nimorazole, tumor stage, baseline BMI, mean radiation dose to constrictor muscles and oral cavity confirmed this. Conclusion: Accelerated and substantial LBM loss was already initiated within the first two weeks of treatment - before the onset of radiation-induced mucositis. LBM loss was associated with muscle strength impairment. Patients receiving CCRT experienced significantly larger LBM loss than patients receiving radiation alone. Registered on clinincaltrials.gov (Identifier: NCT05890859).

Original languageEnglish
JournalActa Oncologica
Volume62
Issue number11
Pages (from-to)1403-1411
ISSN0284-186X
DOIs
Publication statusPublished - Nov 2023
Event21st Acta Oncologica Symposium—BiGART 2023 - Biology-Guided Adaptive Radiotherapy - Aarhus, Denmark
Duration: 20. Jun 202321. Jun 2023

Conference

Conference21st Acta Oncologica Symposium—BiGART 2023 - Biology-Guided Adaptive Radiotherapy
Country/TerritoryDenmark
CityAarhus
Period20/06/202321/06/2023

Keywords

  • body composition
  • concurrent chemoradiation
  • functional performance
  • Head and neck cancer
  • lean body mass
  • muscle strength
  • radiation
  • Chemoradiotherapy/adverse effects
  • Body Weight
  • Humans
  • Cisplatin
  • Head and Neck Neoplasms
  • Squamous Cell Carcinoma of Head and Neck
  • Body Composition/physiology

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