Early body weight loss during concurrent chemo-radiotherapy for non-small cell lung cancer

Abstract

Background and purpose: Radiation-esophagitis and weight loss are frequently observed toxicities in patients treated with concurrent chemo-radiotherapy (CT-RT) for non-small cell lung cancer (NSCLC) and might be related. The purpose was to investigate whether weight loss already starts early after initiation of CT-RT and precedes radiation-esophagitis.

Materials and methods: In a retrospective cohort, weight and esophagitis grade ≥2 were assessed during the first weeks of (CT-)RT in patients treated with concurrent (n = 102) or sequential (n = 92) therapy. In a prospective validation study, data on body weight, esophagitis grade ≥2, nutritional intake and muscle strength were obtained before, during and following CT-RT.

Results: In the retrospective cohort, early weight loss was observed in concurrently treated patients (p = 0.002), independent of esophagitis ≥ grade 2. Early weight loss was also observed in the prospective cohort (p = 0.003) and was not accompanied by decreases in nutritional intake. In addition lower limb muscle strength rapidly declined (p = 0.042). In the later weeks of treatment, further body weight loss occurred (p < 0.001) despite increased nutritional supplementation and body weight was only partly recovered after 4 weeks post CT-RT (p = 0.003).

Conclusions: Weight loss during concurrent CT-RT for NSCLC starts early and prior to onset of esophagitis, requiring timely and intense nutritional rehabilitation.

Fig. 1

Flowchart of inclusion in retrospective and prospective analysis

Fig. 2

a Schematic representation of study points in retrospective cohort. b Schematic representation of study points in prospective cohort

Fig. 3

a Body weight changes and grade dysphagia during concurrent and sequential CT-RT in the retrospective cohort. Left Y axis: body weight loss as percentage of total body weight during concurrent and sequential CT-RT. Right Y axis: percentage of patients with esophagitis grade ≥ 2 during concurrent and sequential CT-RT. b Body weight changes and grade dysphagia during concurrent CT-RT in the prospective cohort. Left Y axis: body weight loss as percentage of total body weight. Right Y axis: number of patients with esophagitis grade ≥ 2 during concurrent and sequential CT-RT. Week 4: diagnosis, Week 0: start of concurrent CT-RT, Week 2: week 2 of concurrent CT-RT, Week 3: week 3 of concurrent CT-RT, Week 5: week 5 of concurrent CT-RT, Week 9: week 4 post CT-RT. *Significant difference between indicated time point and diagnosis (P < 0.05)

Fig. 4

a Caloric intake. The solid line represent total calorie intake which consist of oral intake (grey line) and supportive nutrition (drink supplementation or tube feeding). b Changes in dietary carbohydrate (grams) and fat (grams) intake (oral intake and supportive nutrition). c Changes in total dietary protein (grams) and protein intake per kg body weight (grams/kilograms). Week 4: diagnosis, Week 0: start of concurrent CT-RT, Week 2: week 2 of concurrent CT-RT, Week 3: week 3 of concurrent CT-RT, Week 5: week 5 of concurrent CT-RT, Week 9: week 4 post CT-RT. *Significant difference between indicated time point and diagnosis (P < 0.05)

Fig. 5

Quadriceps not all patients due to weakness, indicating even lower numbers. a Muscle strength dominant hand (kilograms) and quadriceps (Nm). b Quality of life scores (global health score and fatigue score) assessed using QLQ-C30 questionnaire. Week 4: diagnosis, Week 0: start of concurrent CT-RT, Week 2: week 2 of concurrent CT-RT, Week 3: week 3 of concurrent CT-RT, Week 5: week 5 of concurrent CT-RT, Week 9: week 4 post CT-RT. *Significant difference between indicated time point and diagnosis (P < 0.05)