Association of body composition with survival and locoregional control of radiotherapy-treated head and neck squamous cell carcinoma

Aaron Grossberg, Sasikarn Chamchod, Clifton D. Fuller, Abdallah S.R. Mohamed, Jolien Heukelom, Hillary Eichelberger, Michael E. Kantor, Katherine A. Hutcheson, G. Brandon Gunn, Adam S. Garden, Steven Frank, Jack Phan, Beth Beadle, Heath D. Skinner, William H. Morrison, David I. Rosenthal

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Importance: Major weight loss is common in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy (RT). How baseline and posttreatment body composition affects outcome is unknown. Objective: To determine whether lean body mass before and after RT for HNSCC predicts survival and locoregional control. Design, Setting, and Participant: Retrospective study of 2840 patients with pathologically proven HNSCC undergoing curative RT at a single academic cancer referral center from October 1, 2003, to August 31, 2013. One hundred ninety patients had computed tomographic (CT) scans available for analysis of skeletal muscle (SM). The effect of pre-RT and post-RT SM depletion (defined as a CT-measured L3 SM index of less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women) on survival and disease control was evaluated. Final follow-up was completed on September 27, 2014, and data were analyzed from October 1, 2014, to November 29, 2015. Main Outcomes and Measures: Primary outcomeswere overall and disease-specific survival and locoregional control. Secondary analyses included the influence of pre-RT body mass index (BMI) and interscan weight loss on survival and recurrence. Results: Among the 2840 consecutive patients who underwent screening, 190 had whole-body positron emission tomography-CT or abdominal CT scans before and after RT and were included for analysis. Of these, 160 (84.2%) were men and 30 (15.8%) were women; their mean (SD) age was 57.7 (9.4) years. Median follow up was 68.6 months. Skeletal muscle depletion was detected in 67 patients (35.3%) before RT and an additional 58 patients (30.5%) after RT. Decreased overall survival was predicted by SM depletion before RT (hazard ratio [HR], 1.92; 95%CI, 1.19-3.11; P = .007) and after RT (HR, 2.03; 95%CI, 1.02-4.24; P = .04). Increased BMI was associated with significantly improved survival (HR per 1-U increase in BMI, 0.91; 95%CI, 0.87-0.96; P < .001).Weight loss without SM depletion did not affect outcomes. Post-RT SMdepletion was more substantive in competing multivariate models of mortality risk than weight loss-based metrics (Bayesian information criteria difference, 7.9), but pre-RT BMI demonstrated the greatest prognostic value. Conclusions and Relevance: Diminished SM mass assessed by CT imaging or BMI can predict oncologic outcomes for patients with HNSCC, whereas weight loss after RT initiation does not predict SMloss or survival.

Original languageEnglish (US)
Pages (from-to)782-789
Number of pages8
JournalJAMA Oncology
Volume2
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

Body Composition
Radiotherapy
Survival
Skeletal Muscle
Weight Loss
Body Mass Index
Carcinoma, squamous cell of head and neck
Positron-Emission Tomography
Referral and Consultation
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Association of body composition with survival and locoregional control of radiotherapy-treated head and neck squamous cell carcinoma. / Grossberg, Aaron; Chamchod, Sasikarn; Fuller, Clifton D.; Mohamed, Abdallah S.R.; Heukelom, Jolien; Eichelberger, Hillary; Kantor, Michael E.; Hutcheson, Katherine A.; Gunn, G. Brandon; Garden, Adam S.; Frank, Steven; Phan, Jack; Beadle, Beth; Skinner, Heath D.; Morrison, William H.; Rosenthal, David I.

In: JAMA Oncology, Vol. 2, No. 6, 01.06.2016, p. 782-789.

Research output: Contribution to journalArticle

Grossberg, A, Chamchod, S, Fuller, CD, Mohamed, ASR, Heukelom, J, Eichelberger, H, Kantor, ME, Hutcheson, KA, Gunn, GB, Garden, AS, Frank, S, Phan, J, Beadle, B, Skinner, HD, Morrison, WH & Rosenthal, DI 2016, 'Association of body composition with survival and locoregional control of radiotherapy-treated head and neck squamous cell carcinoma', JAMA Oncology, vol. 2, no. 6, pp. 782-789. https://doi.org/10.1001/jamaoncol.2015.6339
Grossberg, Aaron ; Chamchod, Sasikarn ; Fuller, Clifton D. ; Mohamed, Abdallah S.R. ; Heukelom, Jolien ; Eichelberger, Hillary ; Kantor, Michael E. ; Hutcheson, Katherine A. ; Gunn, G. Brandon ; Garden, Adam S. ; Frank, Steven ; Phan, Jack ; Beadle, Beth ; Skinner, Heath D. ; Morrison, William H. ; Rosenthal, David I. / Association of body composition with survival and locoregional control of radiotherapy-treated head and neck squamous cell carcinoma. In: JAMA Oncology. 2016 ; Vol. 2, No. 6. pp. 782-789.
@article{1d1d37fdb46b4b0e8ecce5164d70eef1,
title = "Association of body composition with survival and locoregional control of radiotherapy-treated head and neck squamous cell carcinoma",
abstract = "Importance: Major weight loss is common in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy (RT). How baseline and posttreatment body composition affects outcome is unknown. Objective: To determine whether lean body mass before and after RT for HNSCC predicts survival and locoregional control. Design, Setting, and Participant: Retrospective study of 2840 patients with pathologically proven HNSCC undergoing curative RT at a single academic cancer referral center from October 1, 2003, to August 31, 2013. One hundred ninety patients had computed tomographic (CT) scans available for analysis of skeletal muscle (SM). The effect of pre-RT and post-RT SM depletion (defined as a CT-measured L3 SM index of less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women) on survival and disease control was evaluated. Final follow-up was completed on September 27, 2014, and data were analyzed from October 1, 2014, to November 29, 2015. Main Outcomes and Measures: Primary outcomeswere overall and disease-specific survival and locoregional control. Secondary analyses included the influence of pre-RT body mass index (BMI) and interscan weight loss on survival and recurrence. Results: Among the 2840 consecutive patients who underwent screening, 190 had whole-body positron emission tomography-CT or abdominal CT scans before and after RT and were included for analysis. Of these, 160 (84.2{\%}) were men and 30 (15.8{\%}) were women; their mean (SD) age was 57.7 (9.4) years. Median follow up was 68.6 months. Skeletal muscle depletion was detected in 67 patients (35.3{\%}) before RT and an additional 58 patients (30.5{\%}) after RT. Decreased overall survival was predicted by SM depletion before RT (hazard ratio [HR], 1.92; 95{\%}CI, 1.19-3.11; P = .007) and after RT (HR, 2.03; 95{\%}CI, 1.02-4.24; P = .04). Increased BMI was associated with significantly improved survival (HR per 1-U increase in BMI, 0.91; 95{\%}CI, 0.87-0.96; P < .001).Weight loss without SM depletion did not affect outcomes. Post-RT SMdepletion was more substantive in competing multivariate models of mortality risk than weight loss-based metrics (Bayesian information criteria difference, 7.9), but pre-RT BMI demonstrated the greatest prognostic value. Conclusions and Relevance: Diminished SM mass assessed by CT imaging or BMI can predict oncologic outcomes for patients with HNSCC, whereas weight loss after RT initiation does not predict SMloss or survival.",
author = "Aaron Grossberg and Sasikarn Chamchod and Fuller, {Clifton D.} and Mohamed, {Abdallah S.R.} and Jolien Heukelom and Hillary Eichelberger and Kantor, {Michael E.} and Hutcheson, {Katherine A.} and Gunn, {G. Brandon} and Garden, {Adam S.} and Steven Frank and Jack Phan and Beth Beadle and Skinner, {Heath D.} and Morrison, {William H.} and Rosenthal, {David I.}",
year = "2016",
month = "6",
day = "1",
doi = "10.1001/jamaoncol.2015.6339",
language = "English (US)",
volume = "2",
pages = "782--789",
journal = "JAMA oncology",
issn = "2374-2437",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Association of body composition with survival and locoregional control of radiotherapy-treated head and neck squamous cell carcinoma

AU - Grossberg, Aaron

AU - Chamchod, Sasikarn

AU - Fuller, Clifton D.

AU - Mohamed, Abdallah S.R.

AU - Heukelom, Jolien

AU - Eichelberger, Hillary

AU - Kantor, Michael E.

AU - Hutcheson, Katherine A.

AU - Gunn, G. Brandon

AU - Garden, Adam S.

AU - Frank, Steven

AU - Phan, Jack

AU - Beadle, Beth

AU - Skinner, Heath D.

AU - Morrison, William H.

AU - Rosenthal, David I.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Importance: Major weight loss is common in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy (RT). How baseline and posttreatment body composition affects outcome is unknown. Objective: To determine whether lean body mass before and after RT for HNSCC predicts survival and locoregional control. Design, Setting, and Participant: Retrospective study of 2840 patients with pathologically proven HNSCC undergoing curative RT at a single academic cancer referral center from October 1, 2003, to August 31, 2013. One hundred ninety patients had computed tomographic (CT) scans available for analysis of skeletal muscle (SM). The effect of pre-RT and post-RT SM depletion (defined as a CT-measured L3 SM index of less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women) on survival and disease control was evaluated. Final follow-up was completed on September 27, 2014, and data were analyzed from October 1, 2014, to November 29, 2015. Main Outcomes and Measures: Primary outcomeswere overall and disease-specific survival and locoregional control. Secondary analyses included the influence of pre-RT body mass index (BMI) and interscan weight loss on survival and recurrence. Results: Among the 2840 consecutive patients who underwent screening, 190 had whole-body positron emission tomography-CT or abdominal CT scans before and after RT and were included for analysis. Of these, 160 (84.2%) were men and 30 (15.8%) were women; their mean (SD) age was 57.7 (9.4) years. Median follow up was 68.6 months. Skeletal muscle depletion was detected in 67 patients (35.3%) before RT and an additional 58 patients (30.5%) after RT. Decreased overall survival was predicted by SM depletion before RT (hazard ratio [HR], 1.92; 95%CI, 1.19-3.11; P = .007) and after RT (HR, 2.03; 95%CI, 1.02-4.24; P = .04). Increased BMI was associated with significantly improved survival (HR per 1-U increase in BMI, 0.91; 95%CI, 0.87-0.96; P < .001).Weight loss without SM depletion did not affect outcomes. Post-RT SMdepletion was more substantive in competing multivariate models of mortality risk than weight loss-based metrics (Bayesian information criteria difference, 7.9), but pre-RT BMI demonstrated the greatest prognostic value. Conclusions and Relevance: Diminished SM mass assessed by CT imaging or BMI can predict oncologic outcomes for patients with HNSCC, whereas weight loss after RT initiation does not predict SMloss or survival.

AB - Importance: Major weight loss is common in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy (RT). How baseline and posttreatment body composition affects outcome is unknown. Objective: To determine whether lean body mass before and after RT for HNSCC predicts survival and locoregional control. Design, Setting, and Participant: Retrospective study of 2840 patients with pathologically proven HNSCC undergoing curative RT at a single academic cancer referral center from October 1, 2003, to August 31, 2013. One hundred ninety patients had computed tomographic (CT) scans available for analysis of skeletal muscle (SM). The effect of pre-RT and post-RT SM depletion (defined as a CT-measured L3 SM index of less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women) on survival and disease control was evaluated. Final follow-up was completed on September 27, 2014, and data were analyzed from October 1, 2014, to November 29, 2015. Main Outcomes and Measures: Primary outcomeswere overall and disease-specific survival and locoregional control. Secondary analyses included the influence of pre-RT body mass index (BMI) and interscan weight loss on survival and recurrence. Results: Among the 2840 consecutive patients who underwent screening, 190 had whole-body positron emission tomography-CT or abdominal CT scans before and after RT and were included for analysis. Of these, 160 (84.2%) were men and 30 (15.8%) were women; their mean (SD) age was 57.7 (9.4) years. Median follow up was 68.6 months. Skeletal muscle depletion was detected in 67 patients (35.3%) before RT and an additional 58 patients (30.5%) after RT. Decreased overall survival was predicted by SM depletion before RT (hazard ratio [HR], 1.92; 95%CI, 1.19-3.11; P = .007) and after RT (HR, 2.03; 95%CI, 1.02-4.24; P = .04). Increased BMI was associated with significantly improved survival (HR per 1-U increase in BMI, 0.91; 95%CI, 0.87-0.96; P < .001).Weight loss without SM depletion did not affect outcomes. Post-RT SMdepletion was more substantive in competing multivariate models of mortality risk than weight loss-based metrics (Bayesian information criteria difference, 7.9), but pre-RT BMI demonstrated the greatest prognostic value. Conclusions and Relevance: Diminished SM mass assessed by CT imaging or BMI can predict oncologic outcomes for patients with HNSCC, whereas weight loss after RT initiation does not predict SMloss or survival.

UR - http://www.scopus.com/inward/record.url?scp=85010915192&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010915192&partnerID=8YFLogxK

U2 - 10.1001/jamaoncol.2015.6339

DO - 10.1001/jamaoncol.2015.6339

M3 - Article

C2 - 26891703

AN - SCOPUS:85010915192

VL - 2

SP - 782

EP - 789

JO - JAMA oncology

JF - JAMA oncology

SN - 2374-2437

IS - 6

ER -