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OBJECTIVE: To identify whether there is an association between body composition phenotypes and toxicity to chemoradiotherapy in women with cervical cancer. METHODS: This is a prospective cohort study that included 330 adult patients with cervical cancer treated with chemoradiotherapy. Computed tomography images were used to assess skeletal muscle index (SMI) and radiodensity (SMD), total adipose tissue index, and visceral adipose tissue index. Chemoradiotherapy toxicity was assessed weekly, and toxicity-induced modification of treatment (TIMT) was considered as any severe adverse event resulting in treatment interruption, delay, or dose reduction. RESULTS: Approximately 45% of the patients presented at least one unfavorable body composition parameter (lower SMI, lower SMD, higher total adipose tissue index, or higher visceral adipose tissue index), 23% had two conditions, and 3% had three conditions. The incidence of toxicity ≥ grade 3 and TIMT was 55% and 30%, respectively. For adverse events ≥ grade 3, lower SMI was the determining factor for worse outcomes when evaluated alone or combined with lower SMD and normal adiposity. All body composition phenotypes were associated with TIMT, increasing the risk when both conditions were present. CONCLUSIONS: Lower SMI was an independent factor for the higher number of adverse events, as it remained a risk factor when analyzed in isolation or in association with adipose tissue. Women with excess adipose tissue associated with lower muscle mass had a risk approximately 4 times higher of delaying or interrupting chemoradiotherapy. Furthermore, for the sum of unfavorable conditions, there was a progressive increase in the risk of TIMT.
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Composición Corporal , Quimioradioterapia , Fenotipo , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/terapia , Persona de Mediana Edad , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Estudios Prospectivos , Adulto , Grasa Intraabdominal/diagnóstico por imagen , Anciano , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/efectos de la radiación , Tomografía Computarizada por Rayos X/métodos , Factores de RiesgoRESUMEN
Patients with cancer are more prone to experience myosteatosis than healthy individuals. The aim of this review was to summarize the methodologies applied for low skeletal muscle radiodensity (SMD) assessment in oncology patients, as well as to describe the major findings related to SMD and cancer outcomes. This scoping review included studies that were published until November 2020 in English, Portuguese, or Spanish; were performed in humans diagnosed with cancer, adult and/or elderly, of both sexes; investigated SMD through computed tomography of the region between the third and fifth lumbar vertebrae, considering at least two muscular groups; and evaluated clinical and/or surgical outcomes. Eighty-eight studies met the inclusion criteria (n = 37,583 patients). Survival was the most evaluated outcome. Most studies reported a significant association between low SMD and unfavorable outcomes. However, this relationship was not clear for survival, antineoplastic treatment, and surgical complications, potentially because of the unstandardized approaches for the assessment of SMD and inadequate study design. Future studies should address these issues to provide an in-depth understanding of the clinical relevance of SMD in cancer outcomes as well as how SMD is influenced by individuals and tumor-related characteristics in patients with cancer.
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Antineoplásicos , Neoplasias , Adulto , Anciano , Composición Corporal/fisiología , Femenino , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagen , Neoplasias/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The aim of this study was to provide the percentiles of distribution of body composition parameters according to cancer staging and body mass index (BMI) stratum, as well as to identify the contribution of age, BMI, and cancer staging in the variation of the different parameters of body composition in a population of patients with endometrial cancer. METHODS: We enrolled 545 patients who had pretreatment computed tomography images, which were used to assess total skeletal muscle (SM); low- and high-radiodensity SM; visceral, subcutaneous, and intramuscular adipose tissue; and mean skeletal muscle radiodensity (SMD). All the body composition parameters were normalized by the square of the stature. They were then presented on average and at the 5th, 50th and 95th percentiles. The correlation of these parameters with age, BMI, and cancer stage was tested, and then a multiple linear regression analysis was performed. P ≤ 0.05 was accepted as statistically significant. RESULTS: BMI was associated with body fat parameters and low-radiodensity SM index; cancer stage was associated with SM index, mean SMD, and high-radiodensity SM index. CONCLUSION: This study provides age, stage, and BMI specific percentiles for body composition parameters, which allowed an in-depth interpretation of how such body compartments, especially the low/high SM sub-ranges, varies according to these stratification variables.
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Composición Corporal , Neoplasias Endometriales , Índice de Masa Corporal , Neoplasias Endometriales/diagnóstico por imagen , Femenino , Humanos , Músculo Esquelético/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Low-radiodensity skeletal muscle has been related to the degree of muscle fat infiltration and seems to be associated with worse outcomes. The aim of this study was to summarize the methodologies used to appraise skeletal muscle radiodensity by computed tomography, to describe the terms used in the literature to define muscle radiodensity and to give recommendations for its measurement standardization. An integrative bibliographic review in four databases included studies published until August 2019 in Portuguese, English or Spanish and performed in humans, adults and/or the elderly, of both sex, which investigated skeletal muscle radiodensity through computed tomography (CT) of the region between the third and fifth lumbar vertebrae and evaluated at least two muscular groups. One hundred and seventeen studies were selected. We observed a trend towards selecting all abdominal region muscle. A significant methodological variation in terms of contrast use, selection of skeletal muscle areas, radiodensity ranges delimitation and their cut-off points, as well as the terminologies used, was also found. The methodological differences detected are probably due to the lack of more precise information about the correlation between skeletal muscle radiodensity by CT and its molecular composition, among others. Therefore, until the gaps are addressed in future studies, authors should avoid arbitrary approaches when reporting skeletal muscle radiodensity, especially when it comes to prognosis inference. Studies using both CT and direct methods of muscle composition evaluation are encouraged, to enable the definition and validation of the best approach to classify fat-infiltrated muscle tissue, which will favour the nomenclature uniformization.
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Músculo Esquelético/anatomía & histología , Tomografía Computarizada por Rayos X/métodos , HumanosRESUMEN
OBJECTIVES: Supplementation with ω-3 has been shown to favor the preservation of body weight and skeletal muscle. The aim of this study was to evaluate the efficacy of ω-3 supplementation on nutritional status, skeletal muscle quantity and quality, and toxicity for treatment of women with cervical cancer. METHODS: This was a randomized, triple-blinded, placebo-controlled clinical trial in women diagnosed with cervical cancer who underwent chemoradiotherapy between March 2016 and August 2017. The intervention group received four capsules with ω-3 (2.5 g/d) and the control group (CG) received the same number of identical-looking capsules with olive oil, for 45 d. Nutritional status was measured by anthropometry and Patient-Generated Subjective Global Assessment. Body composition was assessed by computed tomography. The skeletal muscle index was calculated using the range -29 to +150 HU. For skeletal muscle quality, the area comprised between -29 and +29 HU was denominated low-radiodensity skeletal muscle index and the range between +30 and +150 HU high-radiodensity skeletal muscle index, representing the skeletal muscle area with high or low intramuscular fat infiltration, respectively. RESULTS: The study population comprised 40 patients, with an average age 44.53 ± 8.73. The intervention group maintained body weight and showed an improvement in Patient-Generated Subjective Global Assessment score. A significant reduction in skeletal muscle index was observed in both groups. However, in regard to skeletal muscle quality, patients in the intervention group preserved low- and high-radiodensity skeletal muscle index, whereas those in the control group had increased low-radiodensity skeletal muscle index and significantly reduced high-radiodensity skeletal muscle index, reflecting high intramuscular fat infiltration only in the control group. The incidence of chemotherapy toxicity was significantly lower in the intervention group. CONCLUSIONS: The results suggest that ω-3 supplementation is effective in maintaining nutritional status, skeletal muscle quality, and reduced symptoms of chemoradiotherapy among women with cervical cancer.
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Quimioradioterapia/efectos adversos , Suplementos Dietéticos , Ácidos Grasos Omega-3/administración & dosificación , Neoplasias del Cuello Uterino/dietoterapia , Adulto , Composición Corporal , Brasil , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Estado Nutricional , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapia , Adulto JovenRESUMEN
BACKGROUND/OBJECTIVES: Recent data have shown that dividing skeletal muscle (SM) into sub-ranges of radiodensity can improve the prediction of short-term outcomes in the oncology setting. We aim to investigate whether the skeletal muscle mass, when divided into sub-ranges of low or high-radiodensity, improves the prediction of short-term survival in endometrial cancer (EC) patients when compared to average muscle attenuation and to the overall skeletal muscle radiodensity. SUBJECTS/METHODS: EC patients who had computed tomography (CT) images available within 30 days before treatment were enrolled in this retrospective cohort (n = 232). CT images at the third lumbar vertebra (L3) were used to assess overall skeletal muscle index (SMI). Then we divided SMI into sub-ranges of radiation attenuation: low-radiodensity skeletal muscle index (LRSMI) and high-radiodensity skeletal muscle index (HRSMI). The average muscle radiation attenuation was also assessed. Low SMI was defined when SMI was <38.9 cm2/m2. One-year survival was evaluated by Kaplan-Meier method and Cox Regression. RESULTS: Sarcopenia was found in 25.8% of the patients. Roughly 80% of the patients in the highest quartile of LRSMI were obese. All the skeletal muscle parameters were significantly associated with shorter 1-year survival, LRSMI presented a trend for significance in the adjusted model. When the SM parameters were additionally adjusted for low SMI, only HRSMI and LRSMI remained in the model as early-mortality predictors. CONCLUSIONS: Classifying the skeletal muscle into sub-ranges of radiodensity have an additional value than using the average muscle attenuation of the overall skeletal muscle area and should be exploited in further studies.