Abstract
Major weight loss is common in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy (RT). How baseline and posttreatment body composition affects outcome is unknown. To determine whether lean body mass before and after RT for HNSCC predicts survival and locoregional control. Retrospective study of 2840 patients with pathologically proven HNSCC undergoing curative RT at a single academic cancer referral center from October 1, 2003, to August 31, 2013. One hundred ninety patients had computed tomographic (CT) scans available for analysis of skeletal muscle (SM). The effect of pre-RT and post-RT SM depletion (defined as a CT-measured L3 SM index of less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women) on survival and disease control was evaluated. Final follow-up was completed on September 27, 2014, and data were analyzed from October 1, 2014, to November 29, 2015. Primary outcomes were overall and disease-specific survival and locoregional control. Secondary analyses included the influence of pre-RT body mass index (BMI) and interscan weight loss on survival and recurrence. Among the 2840 consecutive patients who underwent screening, 190 had whole-body positron emission tomography-CT or abdominal CT scans before and after RT and were included for analysis. Of these, 160 (84.2%) were men and 30 (15.8%) were women; their mean (SD) age was 57.7 (9.4) years. Median follow up was 68.6 months. Skeletal muscle depletion was detected in 67 patients (35.3%) before RT and an additional 58 patients (30.5%) after RT. Decreased overall survival was predicted by SM depletion before RT (hazard ratio [HR], 1.92; 95% CI, 1.19-3.11; P = .007) and after RT (HR, 2.03; 95% CI, 1.02-4.24; P = .04). Increased BMI was associated with significantly improved survival (HR per 1-U increase in BMI, 0.91; 95% CI, 0.87-0.96; P < .001). Weight loss without SM depletion did not affect outcomes. Post-RT SM depletion was more substantive in competing multivariate models of mortality risk than weight loss-based metrics (Bayesian information criteria difference, 7.9), but pre-RT BMI demonstrated the greatest prognostic value. Diminished SM mass assessed by CT imaging or BMI can predict oncologic outcomes for patients with HNSCC, whereas weight loss after RT initiation does not predict SM loss or survival.
Highlights
Decreased overall survival was predicted by skeletal muscle (SM) depletion before RT and after RT (HR, 2.03; 95% CI, 1.02-4.24; P = .04)
Increased body mass index (BMI) was associated with significantly improved survival (HR per 1-U increase in BMI, 0.91; 95% CI, 0.87-0.96; P < .001)
Diminished SM mass assessed by computed tomographic (CT) imaging or BMI can predict oncologic outcomes for patients with head and neck squamous cell carcinoma (HNSCC), whereas weight loss after RT initiation does not predict SM loss or survival
Summary
Population Cohort and End Points In this single-center retrospective analysis, the records of 2840 consecutive patients with HNSCC treated with curativeintent RT from October 1, 2003, to August 31, 2013, were screened. All patients were presented at a multidisciplinary tumor board for treatment recommendations. Standard treatment for HNSCC included primary surgery, single-modality RT (66-70 Gy), or concurrent CRT (66-72 Gy), dependent on the site and stage of the tumor and risk factors (to convert radiation absorbed dose to rad, multiply gray by 100). Induction chemotherapy was offered to patients with high-risk, advanced T-stage or N-stage disease at the discretion of the medical oncologist. For patients treated with primary surgery, postop-
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