Affiliation:
1. Institute for Cancer Outcomes and Survivorship University of Alabama at Birmingham Birmingham Alabama USA
2. Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA
3. Vanderbilt‐Ingram Cancer Center Vanderbilt University Nashville Tennessee USA
4. Division of Radiation Oncology University of Alabama at Birmingham Birmingham Alabama USA
5. Division of Hematology and Oncology University of Alabama at Birmingham Birmingham Alabama USA
Abstract
AbstractBackgroundStudies examining changes in skeletal muscle and adipose tissue during treatment for cancer in children, adolescents, and young adults and their effect on the risk of chemotherapy toxicity (chemotoxicity) are limited.MethodsAmong 78 patients with lymphoma (79.5%) and rhabdomyosarcoma (20.5%), changes were measured in skeletal muscle (skeletal muscle index [SMI]; skeletal muscle density [SMD]) and adipose tissue (height‐adjusted total adipose tissue [hTAT]) between baseline and first subsequent computed tomography scans at the third lumbar vertebral level by using commercially available software. Body mass index (BMI; operationalized as a percentile [BMI%ile]) and body surface area (BSA) were examined at each time point. The association of changes in body composition with chemotoxicities was examined by using linear regression.ResultsThe median age at cancer diagnosis of this cohort (62.8% male; 55.1% non‐Hispanic White) was 12.7 years (2.5–21.1 years). The median time between scans was 48 days (range, 8–207 days). By adjusting for demographics and disease characteristics, this study found that patients undergo a significant decline in SMD (β ± standard error [SE] = −4.1 ± 1.4; p < .01). No significant changes in SMI (β ± SE = −0.5 ± 1.0; p = .7), hTAT (β ± SE = 5.5 ± 3.9; p = .2), BMI% (β ± SE = 4.1 ± 4.8; p = .3), or BSA (β ± SE = −0.02 ± 0.01; p = .3) were observed. Decline in SMD (per Hounsfield unit) was associated with a greater proportion of chemotherapy cycles with grade ≥3 nonhematologic toxicity (β ± SE = 1.09 ± 0.51; p = .04).ConclusionsThis study shows that children, adolescents, and young adults with lymphoma and rhabdomyosarcoma undergo a decline in SMD early during treatment, which is associated with a risk of chemotoxicities. Future studies should focus on interventions designed at preventing the loss of muscle during treatment.Plain Language Summary
We show that among children, adolescents, and young adults with lymphoma and rhabdomyosarcoma receiving chemotherapy, skeletal muscle density declines early during treatment.
Additionally, a decline in skeletal muscle density is associated with a greater risk of nonhematologic chemotoxicities.