Impact of sarcopenia in locally advanced head and neck cancer treated with chemoradiation: An Indian tertiary care hospital experience

Background: Sarcopenia is emerging as a poor prognostic factor in terms of treatment outcome as well as complications in cancer patients. This study aims to determine the prevalence of sarcopenia and its impact on outcome and toxicity in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive chemo radiotherapy.

Material and methods: Three hundred patients of locally advanced HNSCC were included. All patients were treated with radical radiotherapy dose of 70 Gy/35# over 7 weeks along with concurrent chemotherapy. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using skeletal muscle mass at level C3. The impact of sarcopenia on treatment outcome, Disease Free Survival (DFS) and toxicity was evaluated. Association between patient factors and outcome was calculated in univariate and multivariate analyses.

Results: Sarcopenic patients were more likely to be elderly, female gender and hypopharyngeal primary. The average SMI of the entire patient cohort was 31.9 cm²/m² and for males and females were 32.78 cm²/m² and 26.19 cm²/m² respectively. As per cut of criteria used nearly 91% of the patient cohort were sarcopenic. Sarcopenic patients had a worse treatment outcome namely poorer disease free survival, more toxicities and more treatment gaps. As per ROC curve patients with SMI of >32 cm²/m² fared better than those with SMI < 32 cm²/m².

Conclusion: Sarcopenia in HNSCC patients receiving definitive chemo radiotherapy is an independent prognostic factor and is associated with a worse treatment outcome and more toxicities.