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Observational Study
. 2021 Jun:159:21-27.
doi: 10.1016/j.radonc.2021.03.005. Epub 2021 Mar 15.

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

Aaron J Grossberg  1 , Crosby D Rock  2 , Jared Edwards  3 , Abdallah S R Mohamed  4 , Debra Ruzensky  5 , Angela Currie  5 , Patricia Rosemond  5 , Jack Phan  4 , G Brandon Gunn  4 , Steven J Frank  4 , William H Morrison  4 , Adam S Garden  4 , Clifton D Fuller  4 , David I Rosenthal  6
Affiliations
Observational Study

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

Aaron J Grossberg et al. Radiother Oncol. 2021 Jun.

Abstract

Background and purpose: Sarcopenia is associated with decreased survival in head and neck cancer patients treated with radiotherapy. This study sought to determine whether in-clinic multifrequency bioelectrical impedance analysis (BIA) can identify survival-associated sarcopenia in patients with head and neck cancer.

Materials and methods: This prospective observational study enrolled 50 patients with head and neck cancer undergoing radiation therapy. Baseline BIA measures of skeletal muscle (SM) mass, fat-free mass (FFM), and fat mass (FM) were compared to CT-based estimates using linear regression. Sex-specific BIA-derived thresholds for sarcopenia were defined by the maximum Youden Index on receiver operator characteristic (ROC) curves. Patients were stratified by sarcopenia status and OS was compared using the Kaplan-Meier method and log-rank test.

Results: Among 48 evaluable patients, 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). SM mass index < 9.19 kg/m2 identified sarcopenia men with high sensitivity (91.7%) and specificity (92.9%), whereas in women SM mass index < 6.53 kg/m2 was sensitive for sarcopenia (100%), but not specific. Patients with sarcopenia, defined by either CT or BIA, exhibited decreased OS (HR = not estimable; CT p = 0.009; BIA p = 0.03).

Conclusion: BIA provides accurate estimates of body composition in head and neck cancer patients. Implementation of BIA in clinical practice may identify patients with sarcopenia at risk for poor survival.

Keywords: Bioelectrical impedance analysis; Cachexia; Head and neck cancer; Radiotherapy; Sarcopenia.

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Conflict of interest statement

Conflict of Interest

AJG, CDR, JE, ASRM, DR, AC, PR, JP, GBG, SJF, WHM, ASG, CDF, and DIR declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.. BIA measures of body composition compared to CT-based estimates and BMI.
A, Skeletal Muscle (SM), B, Fat Free Mass (FFM) and C, Fat Mass (FM) measured by BIA compared to SM and FM estimates derived from lumbar CT scans. Normalized measures of body composition D, Skeletal Muscle Index (SMI), E, Fat Free Mass Index (FFMI) and F, Fat Mass Index (FMI) measured by BIA compared to SMI and adipose index (ADI) estimates derived from lumbar CT scans.
Figure 2.
Figure 2.. The effect of sarcopenia at diagnosis on overall survival.
A, Patients with sarcopenia on presentation, measured using CT imaing, demonstrated decreased overall survival compared with patients with normal SMI. B, Patients with BIA-defined sarcopenia on presentation also demonstrated decreased overall survival compared with patients with a normal SM mass index.
Figure 3.
Figure 3.. Body composition measures during treatment.
Violin plot showing distribution of A, BMI, B, SM mass, C, FFM, and D, FM at baseline and at each weekly clinic visit during RT.
See this image and copyright information in PMC

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