Abstract
Background
Computed tomography (CT)-defined sarcopenia is a demonstrated poor prognostic factor
in patients with cancer; however, its influence on outcomes for patients with head
and neck cancer (HNC) has not been established.
Objective
This review synthesizes current knowledge regarding the association between CT-defined
sarcopenia and outcomes for adult patients undergoing radiotherapy with or without
other treatment modalities of curative intent for HNC.
Methods
A systematic review of the literature published between January 2004 and June 2019
was conducted in Medline, Embase, Cumulative Index of Nursing and Allied Health Literature,
Allied and Complementary Medicine Database, and PubMed. Empirical studies of CT-defined
sarcopenia in adult patients (≥18 years) with HNC who had completed radiotherapy of
curative intent with or without other treatment modalities were included. Outcomes
reported included survival, prolonged radiotherapy breaks, and chemotherapy toxicity.
Study quality was assessed using the American Academy of Nutrition and Dietetics Quality
Criteria Checklist. Synthesis of outcomes and clinical relevance was performed using
the Grading of Recommendations Assessment, Development, and Evaluation system.
Results
Of 11 studies (n = 3,461) identified, 3 were positive and 8 were neutral quality.
Studies were heterogeneous in HNC diagnosis, ethnicity, definition of sarcopenia,
CT level of evaluation, and skeletal muscle index threshold value. Eight definitions
for sarcopenia were identified with pretreatment prevalence of 6.6% to 70.9% and posttreatment
prevalence of 12.4% to 65.8%. Pretreatment sarcopenia was independently associated
with reduced: overall survival (OS), 3-year OS, disease-free survival, prolonged radiotherapy
breaks, and chemotherapy-related toxicities. Posttreatment sarcopenia was independently
associated with reduced OS and 5-year OS. The overall certainty of evidence according
to Grading of Recommendations Assessment, Development and Evaluation criteria was
low for OS; 3-year, 5-year, and 10-year OS; locoregional control; locoregional failure;
progression-free survival; metastasis-free survival, disease-specific survival; and
disease-free survival and very low for distant metastasis, prolonged radiotherapy
breaks, and chemotherapy toxicity-related outcomes.
Conclusions
CT-defined sarcopenia is independently associated with reduced OS and treatment completion
in patients with HNC and holds a clinically meaningful prognostic value. The certainty
of the evidence requires strengthening with further research. Understanding the impact
sarcopenia has on outcomes for these patients has implications for informing potential
nutrition interventions and facilitating individualized care.
Keywords
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Biography
M. Findlay is executive research lead–cancer nutrition, oncology specialist dietitian, Royal Prince Alfred Hospital, Camperdown, Australia; oncology dietetics clinical research fellow, Chris O’Brien Lifehouse, New South Wales, Australia; and an adjunct senior lecturer and PhD candidate, Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
Biography
K. White is a professor of cancer nursing, Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
Biography
M. Lai is research officer, Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
Biography
D. Luo is research officer, Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
Biography
J. D. Bauer is an associate professor of nutrition and dietetics, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
Article info
Publication history
Accepted:
March 29,
2020
Received:
July 11,
2019
Footnotes
Supplementary materials: Tables 1 and 4 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT M. Findlay was supported by a Sydney Research PhD Scholarship through the Sydney Local Health District.
Identification
Copyright
© 2020 by the Academy of Nutrition and Dietetics.
