Impact of Early Weight Loss During Concurrent Chemoradiotherapy (Ccrt) on Survival in Advanced Stage Non-Small Cell Lung Cancer (Nsclc) Patients

Abstract

ABSTRACT Aim: Previously, we reported on early weight loss (WL) and muscle weakness during CCRT that could not be attributed to acute radiation esophagitis (ARIE). Thus, we here hypothesized that early WL reflects an acute catabolic response to CCRT that adversely affects disease-free (DFS) and overall survival (OS). Methods: All advanced NSCLC patients (pts) staged by FDG-PET/CT-scan and jointly treated with CCRT between 01-2006 and 12-2011 were screened. Exclusion criteria were: another malignancy within 2 years of diagnosis, swallowing difficulties before CCRT, WL ≥5% prior to treatment, weight missing at start or week 3 of RT. Early WL was defined as WL ≥5% from start RT to week 3 RT. Pt characteristics, chemotherapy (CTx) regimen, RT dose, weight, performance status (PS), ARIE occurrence, DFS and OS date were analyzed. The early WL and non-early WL group were compared; DFS and OS were estimated with Kaplan Meier curves, and compared using the log-rank test. Results: 73 of the 131 identified pts treated with CCRT were eligible (Table 1). Most pts underwent 1 or 2 induction cycles of CTx (mainly cisplatin/etoposide; CE) or gemcitabine/carboplatin, and 2 cycles of concurrent CTx (mainly CE or cisplatin/vinorelbin). Mean total RT dose was 64.1 Gy (range 51-79 Gy). 15 pts (20.5%) had early WL: 4 (26.7%) of these had ARIE ≥ grade 2 at week 3 RT compared with 19/58 (32.7%) of non-early WL pts (p = 0.810). Only age (p = 0.006), but not T- and N-stage, TNM stage, PS nor gender were significantly different for early vs non-early WL pts. Median DFS [95% CI] was 10.3 [7.8-12.7] months for early WL and 15.6 [8.7-22.5] months for non-early WL pts (p = 0.252). Median OS [95% CI] was 13.0 [7.4-18.6] and 23.9 [16.8-31.0] months (p = 0.008), respectively, with an associated 2-year OS of 20% and 48.3% (p = 0.048). Patient characteristics Characteristic With early WL (n = 15) Without early WL (n = 58) Age (years), mean ± SD (range) 57.7 ± 10.6 (34.2 -75) 65.4 ± 8.9 (41.1 – 83.4) Gender (n (%)) Male Female 10 (66.7) 5 (33.3) 37 (63.8) 22 (36.2) Weight at start RT (kg), mean ± SD (range) 72.3 ± 17.6 (48-100) 76.4 ± 15.0 (48 – 136) WHO PS (n(%)) 0 1 2 11 (73.3) 3 (20.0) 1 ( 6.7) 29 (50.0) 27 (46.6) 2 ( 3.4) BMI at start RT, mean ± SD (range) BMI categories (n(%)) BMI 24.8 ±4.4 (17.8-32.2) 2 (13.3) 6 (40.0) 7 (46.7) 25.7 ± 3.9 (18.4 -39.3) 0 (0.0) 25 (43.1) 33 (56.9) Histology/cytology (n(%)) Adeno Squamous cell Other/not otherwise specified 4 (26.7) 4 (26.7) 7 (46.7) 20 (34.5) 13 (22.4) 25 (43.1) TNM, 7th edition (n(%)) IIIA IIIB IV oligometastatic 5 (33.3) 9 (60.0) 1 (6.7) 30 (51.7) 22 (37.9) 6 (10.3) Smoking (n(%)) Current Former Never Unknown 9 (60.0) 4 (26.7) 0 (0.0) 2 (13.3) 28 (48.3) 30 (51.7) 0 (0.0) 0 (0.0) Conclusions: Early WL is associated with worse OS in NSCLC patients treated with CCRT. This early WL was not correlated with occurrence of ARIE ≥ grade 2. This study provides further rationale to investigate the efficacy of early intervention to combat radiation-induced cachexia and enhance treatment response. Disclosure: All authors have declared no conflicts of interest.