Sarcopenia and Treatment Toxicity in Older Adults Undergoing Chemoradiation for Head and Neck Cancer: Identifying Factors to Predict Frailty

Abstract

This study was performed to identify treatment related toxicities in older adults undergoing concurrent chemoradiotherapy for head and neck cancer and nutritional and skeletal muscle measures that might identify frailty. Imaging analysis was done with the following skeletal muscle measurements: skeletal muscle index (SMI), skeletal muscle density (SMD), and skeletal muscle gauge (SMG). Patients were dichotomized by age into younger (<70 years old, 221 patients) and older age groups (≥70 years old, 51 patients). Low SMI was more common in older patients (86.7%) compared to younger patients (51.7%, p < 0.01), as were low SMD (57.8% vs. 37.3%, p = 0.012) and low SMG (76.1% vs. 44.2%, p < 0.01), despite having similar BMIs (27.3 kg/m2 versus 27.7 kg/m2, p = 0.71). Older patients were significantly more likely to experience chemotherapy toxicity than younger patients (54.9% versus 32.3%, p < 0.01). On multivariate analysis age (p < 0.01), current smoking status (p < 0.01), and low SMI (p < 0.01) remained as significant predictors for missed chemotherapy cycles or discontinuation. Older patients were more likely to require ≥5-day radiation breaks than younger patients (27.5% versus 8.6%, p < 0.01). On multivariate analysis, age (p < 0.01), low albumin status (p = 0.03), and low SMI (p = 0.04) were identified as predictors of prolonged radiation treatment breaks. Based on the results of our study, sarcopenia may be used as an additional marker for frailty alongside traditional performance status scales.

Keywords: chemotherapy; geriatric assessment; geriatric oncology; sarcopenia; treatment toxicity.

Figure 1

A representative case example of a 54-year-old man with an HPV-positive oropharynx cancer. A single axial CT slice is taken at the C3 vertebral body level with contours of the sternocleidomastoid and paravertebral muscles delineated in turquoise. Skeletal muscle was defined as −29 to +150 Hounsfield Units (HUs), and the total cross-sectional area (CSA) was computed automatically within the contoured perimeters.

Figure 2

A comparison of older and younger patients with and without sarcopenia with similar BMI. The left panel represents a 70-year-old man with HPV-positive oropharynx cancer with sarcopenia (BMI 27.6 kg/m²) experiencing 10 days of radiation treatment delay, while the right panel represents a 56-year-old man with HPV-positive oropharynx cancer without sarcopenia (BMI 26.7 kg/m²) having no days of radiation treatment delay.