Status of hydration assessed by bioelectrical impedance analysis: a valuable predictive factor for radiation-induced oral mucositis in head and neck cancer patients

AbstractImportanceDepleted skeletal muscle mass (sarcopenia) is associated with decreased survival and cancer control in head and neck cancer patients treated with radiotherapy. There is a need for validated measures of body composition that can be implemented in routine clinical workflow.ObjectiveTo validate the use of bioelectrical impedance analysis (BIA) for body composition analysis and diagnosis of sarcopenia in head and neck cancer patients.DesignIn this prospective observational cohort study, baseline 50 patients with head and neck cancer undergoing radiation therapy (RT) were enrolled between February 2016 and March 2017. Baseline BIA measures of skeletal muscle (SM) mass, fat-free mass (FMM), and fat mass (FM) were compared to CT-based estimates of body composition using linear regression. Sex-specific BIA-derived thresholds for sarcopenia were defined by the maximum Youden Index on receiver operator characteristic (ROC) curves of BIA against CT-defined sarcopenia. Changes in body composition across treatment were compared against changes in body weight using linear regression.ParticipantsIn total, 50 patients with pathologically confirmed stage I to IVB non-metastatic head and neck cancer treated with definitive radiation therapy were enrolled.SettingSingle academic referral center.Main Outcome and MeasureThe primary outcome was relative agreement between baseline lean body mass and fat body mass predicted from BIA measurement and CT imaging.ResultsOf the 48 evaluable patients 16 (33.3%) were sarcopenic at baseline based on CT analysis. BIA measures of body composition were strongly correlated with CT measures: SM mass (r = 0.97; R2 = 0.94; p < 0.0001), FFM (r = 0.97; R2 = 0.94; p < 0.0001) and FM (r = 0.95; R2 = 0.90; p < 0.0001). Relationship with normalized indices of SM mass, FFM, and FM was similar between BIA and CT, but not BIA and body mass index (BMI). Patients lost a mean of 5.7 ± 5.8 kg during treatment, of which 1.5 ± 1.9 kg was SM, 2.6 ± 3.3 kg was FFM, and 2.2 ± 2.6 kg was FM. Eight additional patients developed sarcopenia by the end of RT.ConclusionsBIA provides accurate estimates of body composition in head and neck cancer patients. Implementation of BIA in clinical practice may identify patients with sarcopenia.Trial RegistrationClinicalTrials.gov identifier: NCT02615275

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Evaluation of Skeletal Muscle Mass by Using Bioelectrical Impedance Analysis (BIA) in Head and Neck Cancer Patients

Practica Oto-Rhino-Laryngologica ◽

10.5631/jibirin.111.775 ◽

2018 ◽

Vol 111 (11) ◽

pp. 775-780

Author(s):

Yoh-ichiro Iwasa ◽

Ryosuke Kitoh ◽

Shin-ichi Usami

Keyword(s):

Skeletal Muscle ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Muscle Mass ◽

Neck Cancer ◽

Bioelectrical Impedance Analysis ◽

Skeletal Muscle Mass ◽

Bioelectrical Impedance ◽

Impedance Analysis

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(P072) Prospective Validation of Bioelectrical Impedance Analysis for Clinically Applicable Monitoring of Body Composition in Head and Neck Cancer Patients Treated With Radiotherapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.02.168 ◽

2017 ◽

Vol 98 (2) ◽

pp. E34

Author(s):

Aaron J. Grossberg ◽

Crosby D. Rock ◽

Abdallah S.R. Mohammed ◽

Debra Ruzensky ◽

Angela Currie ◽

...

Keyword(s):

Body Composition ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Bioelectrical Impedance Analysis ◽

Bioelectrical Impedance ◽

Impedance Analysis

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Bioelectrical impedance analysis of head and neck cancer patients at presentation

Acta Oto-Laryngologica ◽

10.1080/00016489.2016.1266510 ◽

2017 ◽

Vol 137 (4) ◽

pp. 417-420 ◽

Cited By ~ 6

Author(s):

Marie Lundberg ◽

Pia Nikander ◽

Katja Tuomainen ◽

Helena Orell-Kotikangas ◽

Antti Mäkitie

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Bioelectrical Impedance Analysis ◽

Bioelectrical Impedance ◽

Impedance Analysis

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Bioelectrical impedance analysis as a quantitative measure of sarcopenia in head and neck cancer patients treated with radiotherapy

Radiotherapy and Oncology ◽

10.1016/j.radonc.2021.03.005 ◽

2021 ◽

Vol 159 ◽

pp. 21-27

Author(s):

Aaron J. Grossberg ◽

Crosby D. Rock ◽

Jared Edwards ◽

Abdallah S.R. Mohamed ◽

Debra Ruzensky ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Bioelectrical Impedance Analysis ◽

Quantitative Measure ◽

Bioelectrical Impedance ◽

Impedance Analysis

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Effectiveness of curcumin mouthwash on radiation-induced oral mucositis among head and neck cancer patients: A triple-blind, pilot randomised controlled trial

Indian Journal of Dental Research ◽

10.4103/ijdr.ijdr_822_18 ◽

2020 ◽

Vol 31 (5) ◽

pp. 718

Author(s):

Gaurav Sharma ◽

Swikant Shah ◽

Hemamalini Rath ◽

SurendraNath Senapati ◽

Ekagrata Mishra

Keyword(s):

Head And Neck Cancer ◽

Randomised Controlled Trial ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Oral Mucositis ◽

Controlled Trial ◽

Pilot Randomised Controlled Trial ◽

Radiation Induced ◽

Randomised Controlled

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Randomized double-blind, placebo-controlled trial evaluating oral glutamine on radiation-induced oral mucositis and dermatitis in head and neck cancer patients

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy329 ◽

2019 ◽

Vol 109 (3) ◽

pp. 606-614 ◽

Cited By ~ 4

Author(s):

Chih-Jen Huang ◽

Ming-Yii Huang ◽

Pen-Tzu Fang ◽

Frank Chen ◽

Yu-Tsang Wang ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Oral Mucositis ◽

University Hospital ◽

Phase Iii ◽

Care Providers ◽

Double Blind ◽

Radiation Induced

ABSTRACT Background Glutamine is the primary fuel for the gastrointestinal epithelium and maintains the mucosal structure. Oncologists frequently encounter oral mucositis, which can cause unplanned breaks in radiotherapy (RT). Objectives The aim of this study was to explore the association between oral glutamine and acute toxicities in patients with head and neck cancer undergoing RT. Methods This was a parallel, double-blind, randomized, placebo-controlled Phase III trial conducted in a university hospital. A central randomization center used computer-generated tables to allocate interventions to 71 patients with stages I–IV head and neck cancers. The patients, care providers, and investigators were blinded to the group assignment. Eligible patients received either oral glutamine (5 g glutamine and 10 g maltodextrin) or placebo (15 g maltodextrin) 3 times daily from 7 d before RT to 14 d after RT. The primary and secondary endpoints were radiation-induced oral mucositis and neck dermatitis, respectively. These were documented in agreement with the National Cancer Institute Common Terminology Criteria for Adverse Events version 3. Results The study included 64 patients (placebo n = 33; glutamine n = 31) who completed RT for the completers’ analysis. Based on multivariate analysis, glutamine had no significant effect on the severity of oral mucositis (OR: 0.3; 95% CI: 0.05, 1.67; P = 0.169). Only the change in body mass index (BMI) was significant in both multivariate completers (OR: 0.41; 95% CI: 0.20, 0.84; P = 0.015) and per-protocol analysis (OR: 0.40; 95% CI: 0.20, 0.83; P = 0.014). No difference was found in the incidence and severity of neck dermatitis between the two arms. Conclusions The decrease in BMI was strongly related to the severity of oral mucositis in the head and neck cancer patients under RT, but not to the use of glutamine. This trial was registered at clinicaltrials.gov as NCT03015077.

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