Concurrent Chemoradiotherapy Induces Body Composition Changes in Locally Advanced Head and Neck Squamous Cell Carcinoma: Comparison between Oral Cavity and Non-Oral Cavity Cancer

Abstract

Few prospective cohort trials have evaluated the difference in treatment-interval total body composition (TBC) changes assessed by dual-energy X-ray absorptiometry (DXA) between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC) receiving concurrent chemoradiotherapy (CCRT): oral cavity cancer with adjuvant CCRT (OCC) and non-oral cavity with primary CCRT (NOCC). This study prospectively recruited patients with LAHNSCC. Clinicopathological variables, blood nutritional/inflammatory markers, CCRT-related factors, and TBC data assessed by DXA before and after treatment were collected. Multivariate linear regression analysis identified the factors associated with treatment-interval changes in body composition parameters, including lean body mass (LBM), total fat mass (TFM), and bone mineral content (BMC). A total of 127 patients (OCC (n = 69) and NOCC (n = 58)) were eligible. Body composition parameters were progressively lost during CCRT in both subgroups. Extremities lost more muscle mass than the trunk for LBM, whereas the trunk lost more fat mass than the extremities for TFM. BMC loss preferentially occurred in the trunk region. Different factors were independently correlated with the interval changes of each body composition parameter for both OCC and NOCC subgroups, particularly mean daily calorie intake for LBM and TFM loss, and total lymphocyte count for BMC loss. In conclusion, treatment-interval TBC changes and related contributing factors differ between the OCC and NOCC subgroups.

Keywords: DXA; bone mineral content; concurrent chemoradiotherapy; head and neck cancer; lean body mass; total fat mass.

Figure 1

The CONSORT diagram. Incomplete CCRT was defined as patients who dropped out during the CCRT course or could not complete at least four cycles of weekly cisplatin (40 mg/m²) commitants with planned radiotherapy (64–72 Gy). Patients with incomplete data indicated that they failed to complete the required DXA examinations or scheduled blood tests; CCRT, concurrent chemoradiotherapy; DXA, dual-energy X-ray absorptiometry; LAHNC, locally advanced head and neck cancer.

Figure 2

Box plots show the values of BMI, BW, and body composition parameters (LBM, TFM, BMC, ASM) at CCRT start (open box) and CCRT end (close box) in oral cavity cancer and non-oral cavity cancer. * denotes p < 0.05, considered significance between start and end. BMI, body mass index; BW, body weight; LBM, lean body mass; TFM, total fat mass; BMC, bone mineral content; ASM, appendicular skeletal mass; CCRT, concurrent chemoradiotherapy.

Figure 3

Percentage of treatment-interval changes in different body compartments of LBM, TFM, and BMC for both oral cavity cancer and non-oral cavity cancer. The percentage of change at each body compartment is determined by (posttreatment value−pretreatment value)/(pretreatment value) × 100%. * denotes p < 0.05, considered significant. LBM, lean body mass; TFM, total fat mass; BMC, bone mineral content; CCRT, concurrent chemoradiotherapy.

Figure 4

Oral cavity cancer patients with grade ¾ toxicity of anemia or neutropenia developed more TFM loss (A,B). Non-oral cavity cancer patients with grade ¾ mucositis toxicity developed more LBM loss (C). The association of age with ∆LBM in oral cavity cancer patients or BMI with ∆LBM in non-oral cavity cancer patients (D,E). Δ indicates a value obtained by subtracting the pre-CCRT value from the post-CCRT value. LBM, lean body mass; TFM, total fat mass; CCRT, concurrent chemoradiotherapy; BMI, body mass index.