Impact of early weight loss during concurrent chemoradiotherapy on survival in advanced stage NSCLC patients

Abstract

Objective: Previously, we reported early weight loss (EWL) during concurrent chemoradiotherapy (CCRT) in advanced stage non-small cell lung cancer (NSCLC) patients that could not be attributed to acute radiation-induced esophagitis (ARIE) or decreased dietary intake. Here, we assessed effect of EWL during CCRT on overall survival (OS). Methods: All advanced stage NSCLC patients treated with CCRT from 2 hospitals between January 906 and December 913 were retrospectively analyzed. Exclusion criteria were weight loss prior to CCRT, no weight recorded or CCRT not completed. EWL was defined as weight loss ≥5% from start of radiotherapy (RT) until the end of the 3 rd week. Compared were EWL versus no EWL for OS, estimated with Kaplan Meier and log-rank test. Cox multivariate analysis was performed including EWL, WHO status, T- and N status, histology, age and BMI. Results: 27 Patients (18%) of in total 152 eligible patients experienced EWL. Groups were comparable regarding disease stage, Charlson comorbidity index score and WHO status. No difference in incidence of ARIE ≥2 in the first 3 weeks of RT was observed between the groups (37% versus 32%, p=0.613). Median OS (95% CI) was 15.2 (2.1-28.4) months in EWL patients and 23.0 (13.1-32.9) months in non-EWL patients (p=0.035). Adjusted HR for EWL is 2.070 (1.202-3.564), p=0.009. Conclusions: EWL in NSCLC patients treated with CCRT is associated with worse OS. These data emphasize the importance of good nutritional status. It warrants further investigation into early nutritional intervention irrespective of onset of ARIE, to combat weight loss during CCRT and to improve treatment outcome.