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

  • Panje, Cédric M.1
  • Höng, Laura2
  • Hayoz, Stefanie3
  • Baracos, Vickie E.4
  • Herrmann, Evelyn5
  • Garcia Schüler, Helena6
  • Meier, Urs R.7
  • Henke, Guido1
  • Schacher, Sabina8
  • Hawle, Hanne3
  • Gérard, Marie-Aline3
  • Ruhstaller, Thomas9
  • Plasswilm, Ludwig10
  • 1 Kantonsspital St. Gallen, Department of Radiation Oncology, St. Gallen, Switzerland , St. Gallen (Switzerland)
  • 2 Luzerner Kantonsspital, Department of Radiation Oncology, Luzern, Switzerland , Luzern (Switzerland)
  • 3 Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland , Bern (Switzerland)
  • 4 University of Alberta, Division of Palliative Care Medicine, Department of Oncology, Edmonton, Alberta, Canada , Edmonton (Canada)
  • 5 Inselspital Bern, Department of Radiation Oncology, Bern, Switzerland , Bern (Switzerland)
  • 6 University Hospital Zurich, Zurich, Switzerland , Zurich (Switzerland)
  • 7 Kantonsspital Winterthur, Department of Radiation Oncology, Winterthur, Switzerland , Winterthur (Switzerland)
  • 8 Kantonsspital Winterthur, Department of Medical Oncology, Winterthur, Switzerland , Winterthur (Switzerland)
  • 9 Kantonsspital St. Gallen and University of Basel, Department of Medical Oncology and Hematology, Basel, Switzerland , Basel (Switzerland)
  • 10 St Gallen and University of Bern, Department of Radiation Oncology, Kantonsspital St Gallen, Bern, Switzerland , Bern (Switzerland)
Published Article
Radiation Oncology
Springer (Biomed Central Ltd.)
Publication Date
Sep 11, 2019
DOI: 10.1186/s13014-019-1372-3
Springer Nature


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.

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