Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction

Background A typical assessment for sarcopenia involves the use of abdominal computed tomography (CT) for calculating the skeletal muscle index (SMI) at the level of the third lumbar vertebra (L3). However, abdominal CT is not regularly performed on patients with head and neck cancer (HNC). We investigated whether masticatory SMI (M-SMI) measurements based on head and neck CT scans can be used to conduct sarcopenia assessments by evaluating whether M-SMI is correlated with L3-SMI. Methods Abdominal and head and neck CT images of patients with trauma (n = 50) and HNC (n = 52) were analyzed retrospectively. Both manual delineation and threshold selection methods were used to measure cross-sectional areas of masticatory muscles and those of muscles at the L3 level on CT images. Muscle cross-sectional areas were normalized to height squared to calculate SMI, and a multivariate linear regression model was established to evaluate the correlation between the M-SMI and L3-SMI. Receiver operating characteristic curve analysis was used to assess the ability of the M-SMI to identify sarcopenia, and Cox logistic regression was used to identify predictors of sarcopenia. Results Patients with HNC had significantly lower M-SMI and L3-SMI than did patients with trauma (p = 0.011 and 0.03, respectively). M-SMI and L3-SMI were strongly correlated (r = 0.901, p < 0.001); in the multivariate model that included sex, the correlation was stronger (r = 0.913, p < 0.001). The associations of sarcopenia with a lower M-SMI (p < 0.001), male sex (p = 0.028), and advanced age (p = 0.011) were significant, and multivariate logistic analysis demonstrated that an M-SMI of <5.5 was an independent predictor of sarcopenia (hazard ratio = 5.37, p < 0.001). Conclusions M-SMI assessment in routine head and neck CT scans is feasible and can be an alternative for detecting sarcopenia in patients with HNC.

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Effect of Epoetin Alfa on Survival and Cancer Treatment–Related Anemia and Fatigue in Patients Receiving Radical Radiotherapy With Curative Intent for Head and Neck Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.22.3693 ◽

2009 ◽

Vol 27 (34) ◽

pp. 5751-5756 ◽

Cited By ~ 39

Author(s):

Peter J. Hoskin ◽

Martin Robinson ◽

Nicholas Slevin ◽

David Morgan ◽

Kevin Harrington ◽

...

Keyword(s):

Head And Neck Cancer ◽

Adverse Events ◽

Cancer Treatment ◽

Head And Neck ◽

Neck Cancer ◽

Functional Assessment ◽

Radical Radiotherapy ◽

Epoetin Alfa ◽

Local Tumor ◽

Curative Intent

Purpose To evaluate the effect of epoetin alfa on local disease-free survival (DFS), overall survival (OS), and cancer treatment–related anemia and fatigue in patients with head and neck cancer receiving radical radiotherapy with curative intent. Patients and Methods Patients (N = 301) with hemoglobin (Hb) less than 15 g/dL were randomly assigned in a ratio of 1:1 to receive radiotherapy plus epoetin alfa (10,000 U subcutaneously [SC] three times weekly if baseline Hb was < 12.5 g/dL; 4,000 U SC three times weekly if baseline Hb ≥ 12.5 g/dL) or radiotherapy alone. Hb levels were monitored weekly. The primary end point was local DFS, defined as the time from random assignment to local disease recurrence or death. Secondary efficacy end points included OS, local tumor response, and local tumor control. Patients were followed at 1, 4, 8, and 12 weeks postradiotherapy and annually for 5 years. Cancer treatment–related anemia and fatigue were evaluated with the Functional Assessment of Cancer Therapy-Anemia and Functional Assessment of Cancer Therapy-Head and Neck. Adverse events were recorded up to 12 weeks postradiotherapy. Results Hb levels increased from baseline with epoetin alfa. The median duration of local DFS was not statistically different between groups (observation, 35.42 months; epoetin alfa, 31.47 months; hazard ratio, 1.04; 95% CI, 0.77 to 1.41). Groups did not significantly differ in DFS, OS, tumor outcomes, or cancer treatment–related anemia or fatigue. No new or unexpected adverse events were observed. Conclusion Addition of epoetin alfa to radical radiotherapy did not affect survival, tumor outcomes, anemia, or fatigue positively or negatively in patients with head and neck cancer.

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Faculty Opinions recommendation of Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.740517857.793587958 ◽

2021 ◽

Author(s):

Giulio Cantu

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Psychosocial Outcomes ◽

Microvascular Reconstruction ◽

Patient Reported

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Clinical outcome in recurrent and/or metastatic head and neck cancer patients after discontinuation of nivolumab monotherapy due to immune-related adverse events

Acta Oto-Laryngologica ◽

10.1080/00016489.2020.1807601 ◽

2020 ◽

Vol 140 (12) ◽

pp. 1043-1048

Author(s):

Ryuji Yasumatsu ◽

Mioko Matsuo ◽

Takahiro Wakasaki ◽

Muneyuki Masuda ◽

Toranoshin Takeuchi ◽

...

Keyword(s):

Head And Neck Cancer ◽

Clinical Outcome ◽

Adverse Events ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer

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Sarcopenia measured with handgrip strength and skeletal muscle mass to assess frailty in older patients with head and neck cancer

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2020.10.002 ◽

2020 ◽

Author(s):

Christiaan D.A. Meerkerk ◽

Najiba Chargi ◽

Pim A. de Jong ◽

Frederiek van den Bos ◽

Remco de Bree

Keyword(s):

Skeletal Muscle ◽

Head And Neck Cancer ◽

Head And Neck ◽

Muscle Mass ◽

Neck Cancer ◽

Older Patients ◽

Skeletal Muscle Mass ◽

Handgrip Strength

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Association of immune-related adverse events (irAEs) with improved response, progression-free survival, and overall survival for patients with metastatic head and neck cancer receiving anti-PD-1 therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.6014 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. 6014-6014 ◽

Cited By ~ 12

Author(s):

Corey Christian Foster ◽

Sara Kochanny ◽

Arun Khattri ◽

Rajesh Acharya ◽

Allison Dekker ◽

...

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Adverse Events ◽

Head And Neck ◽

Neck Cancer ◽

Progression Free Survival ◽

Free Survival

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Hearing evaluation of patients with head and neck cancer: Comparison of Common Terminology Criteria for Adverse Events, Brock and Chang adverse event criteria in patients receiving cisplatin

Head & Neck ◽

10.1002/hed.23714 ◽

2014 ◽

Vol 37 (8) ◽

pp. 1102-1107 ◽

Cited By ~ 3

Author(s):

A. Dimitrios Colevas ◽

Ruth R. Lira ◽

Electra A. Colevas ◽

Philip W. Lavori ◽

Cato Chan ◽

...

Keyword(s):

Adverse Event ◽

Head And Neck Cancer ◽

Adverse Events ◽

Head And Neck ◽

Neck Cancer ◽

Hearing Evaluation

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The Association of Cachexia with Head and Neck Cancer Burden and Pathologic Features

Proceedings of IMPRS ◽

10.18060/24742 ◽

2020 ◽

Vol 3 ◽

Author(s):

Marelle Rukes ◽

Alexander Jones ◽

Leah Novinger ◽

Kyle Davis ◽

Vincent Campiti ◽

...

Keyword(s):

Weight Loss ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Head And Neck Carcinoma ◽

Depth Of Invasion ◽

Skeletal Muscle Index ◽

Pathologic Features ◽

Significant Difference ◽

The Impact

Background and Hypothesis: Head and neck cancer (HNC) is frequently associated with cachexia, characterized by involuntary weight loss, sarcopenia, and malnutrition. In HNC patients, dysphagia and anorexia from obstructive aerodigestive tumors propagates cachexia even further. However, the impact of pathologic features and burden of HNC on cachexia has yet to be investigated. We therefore hypothesize that larger, more aggressive tumors impose greater cachexia severity in HNC patients. Methods: A single-institution, retrospective study of adult patients undergoing surgical resection of head and neck carcinoma from 2014-2017 was performed. Patients without 30-day preoperative abdominal CT imaging for skeletal muscle index (SMI, cm2/m2) measurements were excluded. Patient demographics, comorbidities, nutrition data, and cancer pathology reports were collected. Cachexia was defined as unintentional weight loss >5% over 6 months or >2% with BMI <20 kg/m2. Statistical analyses were performed using 2-sided one-way Welch’s ANOVA or Pearson’s c2 tests. Significance was determined at p <0.05. Results: The cohort included 125 predominantly white (92.0%), male (75.2%) HNC patients age 59.9 ± 11.5 years. Sixty-seven (53.6%) patients had cachexia, twenty (16.0%) of whom were severe (weight loss ≥15%). Patients with severe cachexia had larger tumors (5.5 ± 2.1 cm, p=0.021) than patients with mild-to-moderate cachexia (weight loss 5-14.9%; 4.9 ± 2.1 cm) or no cachexia (4.1 ± 1.9 cm). Worsening cachexia severity was also associated with lower SMI (p=0.004), BMI (p=0.002), and serum albumin (p=0.011). There was no statistically significant difference between cachexia groups comparing patient age, comorbidities, tumor grade, depth of invasion, nodal metastases, cancer stage, perineural invasion, lymphovascular invasion, or extranodal extension. Conclusion and Potential Impact: Tumor burden of HNC patients, but not adverse pathologic features, is associated with greater cachexia severity. Identifying pro-cachectic markers produced by larger tumors could provide a molecular target for anti-cachexia therapies and improve cancer patient outcomes.

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