ESTRO 2022

Session Item

Head and neck

Session Type: Poster (digital)

Track: Clinical

Journey:

Impact of sarcopenia in oropharyngeal cancer patients treated with radical chemo-radiotherapy

chiara lucrezia deantoni, Italy

Presentation Number: PO-1100

Abstract

Abstract Title:

Impact of sarcopenia in oropharyngeal cancer patients treated with radical chemo-radiotherapy

Authors:

chiara lucrezia deantoni¹, Anna Chiara¹, Aurora Mirabile², Sara Broggi³, Claudio Fiorino³, Andrei Fodor¹, Marcella Pasetti¹, Roberta Tummineri¹, Flavia Zerbetto¹, Simone Baroni¹, Ariadna Sanchez Galvan¹, Vanesa Gregorc², Italo Dell'Oca¹, Nadia Gisella Di Muzio⁴

¹IRCCS San Raffaele Scientific Institute, Radiation Oncology, Milano, Italy; ²IRCCS San Raffaele Scientific Institute, Department Unit of Oncology, Medical Oncology Department, Milano, Italy; ³IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy; ⁴Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milano, Italy

Show Affiliations

Purpose or Objective

Sarcopenia (SP), defined as loss of muscle mass and functions, recently emerged as an independent prognostic factor in oncological patients (pts), connected with poor survival and sometimes with a higher treatment toxicity profile. This study aims to determine the possible impact of SP on survival and acute toxicity in our oropharyngeal pts.

Material and Methods

76 pts with locally advanced oropharyngeal squamous cell carcinoma, stage III-IVC, were treated in our Center with Helical TomoTherapy (HT) between 2005 and 2021. HT was delivered with a Simultaneous Integrated Boost (SIB) technique: 54 Gy (1.8 Gy/day) to the clinically negative neck region and 66 Gy (2.2 Gy/day) or 69 Gy (2.3 Gy/day) to the tumor and positive nodal regions based on 18FDG CT/PET imaging. All pts received concomitant platinum-based CT (at least 200 mg/m2).

SP is generally determined on single-slice CT measurement of the cross sectional muscle area (CSA) at the level of the third lumbar vertebra (L3). Swartz et al (2016) proposed and validated an algorithm that correlated CSA at L3 with CSA at C3, easier to obtain in head and neck pts, and then CSA at C3 with lumbar skeletal muscle index (SMI). Twenty pts (26%) presented SP at the beginning of treatment, according to Prado (2008) that defined SP if SMI was <55.4 cm2/m2 in males and < 39 cm2/m2 in females.

Results

All pts concluded the treatment. The acute toxicity profile was analyzed as “less than” versus “more or equal to” grade 3 CTCAE 4.0. 13 pts (65%) in SP group and 22 pts (39%) in non-SP group presented a toxicity more or equal to grade 3, but this difference was not statistically significant (p-value 0.25). Overall survival was analyzed in 65 pts (47 NS and 18 S), excluding pts who finished CT RT less than 6 months ago (median follow up 41, range 3.4-126.1). Overall survival was significantly different in non-SP versus SP group (fig 1, p value 0.035). The same difference was notable in N0-N2a pts, suggesting an important role of SP also in pts with a lower nodal burden and theoretically better prognosis.

Conclusion

Although the results are preliminary and limited to a small population, our case series has the advantage to be very homogeneous in pts and type of treatment characteristics. In our setting, SP seems to have a crucial impact on overall survival. Further investigation is necessary to confirm our data and whether SP is a potentially modifiable risk factor to improve pts outcome.