Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark.
Department of Diabetes and Endocrinology, University of Southern Denmark, Esbjerg, Denmark.
Acta Oncol. 2023 Nov;62(11):1403-1411. doi: 10.1080/0284186X.2023.2245558. Epub 2023 Aug 17.
This study investigated changes in body weight, lean body mass (LBM), fat mass (FM), muscle strength and functional performance during radiation treatment in head and neck cancer (HNSCC) patients. Secondly, it investigated the impact of cisplatin-based chemoradiation (CCRT) on LBM loss compared with radiation alone.
48 patients (all tumor sites) received either 6 weeks of radiation alone ( = 16) with 66-68 Gy in 33-34 Fx, 5-6 Fx/week or CCRT, adding weekly cisplatin or carboplatin ( = 32). LBM and FM was evaluated using Dual-energy X-ray Absorptiometry bi-weekly from pre- to two weeks post-treatment. Maximal muscle strength (knee extension, leg - and chest press) and functional performance (stair climb, chair rise, and arm curl) were assessed pre- and post-treatment.
Body weight and LBM had declined significantly already week 2 into treatment and declined significantly further through week 4 and 6 before leveling off after week 6. Bi-weekly, from treatment start to week 2, 2-4, and 4-6, LBM declined 1.2 ± 0.4 kg ( = .002; 95% CI: 0.4;2.0), 2.0 ± 0.4 kg ( < .0001; 1.2;2.8) and 1.4 ± 0.4 kg ( = .001; 0.6;2.2). With a two-week delay, FM declined significantly from week 2-8. All measures of muscle strength declined significantly from pre- to post-treatment. Functional performance was unchanged. LBM loss from pre- to post-treatment was significantly associated with impaired muscle strength ( = 0.3-0.5). CCRT patients lost 3.1 ± 0.8 kg of LBM ( = .0001; 1.5;4.7) more from pre- to post-treatment compared with patients receiving radiation alone. Analyses adjusting for nimorazole, tumor stage, baseline BMI, mean radiation dose to constrictor muscles and oral cavity confirmed this.
Accelerated and substantial LBM loss was already initiated within the first two weeks of treatment - before the onset of radiation-induced mucositis. LBM loss was associated with muscle strength impairment. Patients receiving CCRT experienced significantly larger LBM loss than patients receiving radiation alone. Registered on clinincaltrials.gov (Identifier: NCT05890859).
本研究旨在调查头颈部癌症（HNSCC）患者在接受放射治疗过程中体重、去脂体重（LBM）、体脂肪量（FM）、肌肉力量和功能表现的变化。其次，研究了顺铂为基础的放化疗（CCRT）与单纯放疗相比对 LBM 损失的影响。
48 名患者（所有肿瘤部位）分别接受 6 周单纯放疗（ = 16），采用 66-68Gy 剂量，33-34 次分割，每周 5-6 次，或 CCRT，每周加用顺铂或卡铂（ = 32）。在治疗前至治疗后两周内，每两周使用双能 X 射线吸收法评估 LBM 和 FM。在治疗前和治疗后评估最大肌肉力量（膝关节伸展、腿部 - 和胸部按压）和功能表现（爬楼梯、坐起和手臂卷曲）。
体重和 LBM 在治疗的第 2 周就显著下降，在第 4 周和第 6 周进一步显著下降，直到第 6 周后才稳定下来。从治疗开始到第 2 周、第 2-4 周和第 4-6 周，LBM 分别下降了 1.2±0.4kg（ = 0.002；95%CI：0.4；2.0）、2.0±0.4kg（ < .0001；1.2；2.8）和 1.4±0.4kg（ = 0.001；0.6；2.2）。从第 2 周到第 8 周，FM 以两周为间隔显著下降。所有肌肉力量测量值均在治疗前后显著下降。功能表现无变化。从治疗前到治疗后，LBM 的损失与肌肉力量受损显著相关（ = 0.3-0.5）。与单独接受放疗的患者相比，接受 CCRT 的患者在治疗前到治疗后的 LBM 损失中损失了 3.1±0.8kg（ = 0.0001；1.5；4.7）。对尼莫唑、肿瘤分期、基线 BMI、缩肌和口腔平均辐射剂量进行分析，结果证实了这一点。
在治疗的头两周内，LBM 就已经开始迅速且大量流失 - 在放射性粘膜炎出现之前。LBM 的损失与肌肉力量的受损有关。与单独接受放疗的患者相比，接受 CCRT 的患者的 LBM 损失显著更大。在 clinincaltrials.gov 上注册（标识符：NCT05890859）。
