Nutrition

Association between body composition phenotypes and treatment toxicity in women with cervical cancer undergoing chemoradiotherapy

To identify whether there is an association between body composition phenotypes and toxicity to chemoradiotherapy in women with cervical cancer. This is a prospective cohort study that included 330 adult patients with cervical cancer treated with chemoradiotherapy. Computed tomography images were used to assess skeletal muscle index (SMI) and radiodensity (SMD), total adipose tissue index, and visceral adipose tissue index. Chemoradiotherapy toxicity was assessed weekly, and toxicity-induced modification of treatment (TIMT) was considered as any severe adverse event resulting in treatment interruption, delay, or dose reduction. Approximately 45% of the patients presented at least one unfavorable body composition parameter (lower SMI, lower SMD, higher total adipose tissue index, or higher visceral adipose tissue index), 23% had two conditions, and 3% had three conditions. The incidence of toxicity ≥ grade 3 and TIMT was 55% and 30%, respectively. For adverse events ≥ grade 3, lower SMI was the determining factor for worse outcomes when evaluated alone or combined with lower SMD and normal adiposity. All body composition phenotypes were associated with TIMT, increasing the risk when both conditions were present. Lower SMI was an independent factor for the higher number of adverse events, as it remained a risk factor when analyzed in isolation or in association with adipose tissue. Women with excess adipose tissue associated with lower muscle mass had a risk approximately 4 times higher of delaying or interrupting chemoradiotherapy. Furthermore, for the sum of unfavorable conditions, there was a progressive increase in the risk of TIMT.

Fiber, lactose and fat-modified diet for the prevention of gastrointestinal chemo-radiotherapy-induced toxicity in patients with cervical cancer: Randomized clinical trial

The most frequent early gastrointestinal (GI) toxicity symptoms are nausea (58%), diarrhea (46.7%), and vomiting (45.5%) in patients with cervical cancer (CC). Approximately 90% of patients undergoing abdominopelvic radiotherapy present with changes in the GI tract, such as degenerative alterations in mucosal epithelial cells and nutrient malabsorption. To evaluate the effect of a diet modified in fiber, lactose, and fat on the prevention of chemoradiotherapy (QTRT)-induced GI toxicity compared to the usual prescription in women with locally advanced CC. A total of 134 women with a confirmed diagnosis of CC in locally advanced stages (IB2-IVA) were included in a randomized clinical trial conducted between February 2017 and March 2020. The intervention group (IG) received a modified diet of fiber, lactose, and fat, while the usual prescription group (UP) followed habitual nutritional recommendations. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) v4. A total of 134 women were included in the IG (65) and UP (69) groups. The mean age in the IG and UP groups were 47.2±13.4 and 49.7±14.2 years, respectively. Radiotherapy doses received by the IG and UP groups were 50.1±6.7 and 49.9±4.6 Gy, respectively. IG had a lower risk of presenting with mild constipation compared to the UP (hazard ratio: 0.46, 95% confidence interval: 0.28-0.76, P<0.01). Patients with locally advanced stages of CC undergoing QTRT who received fiber, lactose, and fat-modified diet may have a lower risk of mild constipation during abdominal radiotherapy.

Identifying low muscle mass and monitoring body composition changes in newly diagnosed cancer patients: Agreement between multifrequency bioelectrical impedance analysis and computed tomography

Low muscle mass (MM) is significant in cancer patients, and computed tomography (CT) is considered the reference standard for MM assessment. We investigated the consistency of CT and multifrequency bioelectrical impedance analysis (mBIA) in detecting body composition at baseline and during anticancer treatment and the relationship between MM and malnutrition as well as complications in lung and cervical cancer patients. Abdominal CT and mBIA were conducted to assess body composition at baseline for all patients and repeated for patients with cervical cancer after 4 wk of chemoradiotherapy. Concordance was compared by intraclass correlation coefficient and Bland-Altman plots. Receiver operating characteristic analysis was used to assess the diagnostic efficacy of mBIA for low MM. Correlation analysis was conducted to assess the relationship between MM and Nutritional Risk Screening 2002 and Global Leadership Initiative on Malnutrition. Furthermore, we assessed whether there was a difference in the incidence of chemoradiotherapy side effects in the low MM group derived by CT or mBIA. A total of 77 cervical and 73 lung cancer patients were enrolled. mBIA showed fair discriminative capacity (area under the curve = 0.651) for detecting low MM, the concordance of skeletal MM and visceral fat area between CT and mBIA was good (intraclass correlation coefficient = 0.712 and 0.698, respectively), and mBIA and CT had consistent observations of muscle and fat changes (P = 0.051 and 0.124, respectively). There was no difference in the incidence of chemoradiotherapy side effects in the low MM group compared with controls regardless of whether derived by CT or mBIA (P > 0.05). MM was correlated with Nutritional Risk Screening 2002 and Global Leadership Initiative on Malnutrition but showed unsatisfactory prediction of malnutrition (area under the curve <0.7). mBIA- and CT-derived body composition was highly correlated, and agreement was reached on body composition changes during treatment.

Prognostic value of muscle measurement using the standardized phase of computed tomography in patients with advanced ovarian cancer

The prognostic role of sarcopenia or myosteatosis is controversial in advanced-stage epithelial ovarian cancer (EOC). The phase of computed tomography (CT) could influence muscle measurement and confound its association with outcomes. This study evaluated the prognostic value of muscle measurement in patients with stage III EOC using a standardized phase of computed tomography. Pretreatment CT images of 147 patients with stage III EOC were analyzed. All CT images were contrast-enhanced and acquired according to the standardized protocol. Skeletal muscle index (SMI) and radiodensity (SMD) were measured using CT images at the level of the third lumbar vertebra. The skeletal muscle gauge (SMG) was calculated by multiplying SMI and SMD. Harrell's concordance index (C-index) and time-dependent receiver operating characteristic curves were used to measure the predictive value of the models. The median follow-up period was 37.5 mo. SMI, SMD, and SMG were independently associated with overall survival when adjusted for clinical variables. Adding SMG to the model including stage, residual tumor, and malignant ascites significantly improved C-indices (0.704 vs. 0.629; P < 0.001). Models including SMG had a superior C-index compared with models including SMI and SMD (0.704 vs. 0.668; P = 0.01). The SMG model achieved the highest area under the curve for 5-year overall survival prediction (0.619 for clinical model, 0.702 for SMI model, and 0.710 for SMG model). Muscle measurements obtained from a standardized phase of CT images were associated with survival in advanced-stage EOC. The integration of SMI and SMD into SMG may improve prognostication and unify findings in future studies.

Relationship between preoperative nutritional status with postoperative IL-10 and neopterin in gynecologic oncology patients

We aimed to investigate the relationship between preoperative nutritional status with postoperative interleukin-10 (IL-10) and neopterin in gynecologic oncology cases. This prospective study included cases hospitalized in our clinic. Preoperative cases were divided into two groups as low and high risk according to Nutritional risk score (NSR-2002). Demographic and clinical characteristics and questionnaires including the NSR-2002 form were recorded. IL-10 and neopterin levels were analyzed 1 week postoperatively. Forty-five low-risk and 43 high-risk cases were evaluated. The mean ages of the cases were 56.7 ± 7.8 and 57.2 ± 14.3 years, respectively, and no significant difference was found between them (P = 0.854). There was a statistically significant difference between the two groups in terms of upper arm circumference (P = 0.043), triceps skinfold thickness (P = 0.010), shorter wound healing time (P = 0.009), neopterin (P = 0.037), IL-10 (P = 0.043), preoperative ferritin (P = 0.001), hemoglobulin (P = 0.026), albumin (P = 0.047), postoperative ferritin (P = 0.015), hemoglobulin (P = 0.044), and albumin (P = 0.042) levels in favor of the low-risk group. Among the significant factors, only wound healing time had positive correlation (P = 0.006, r = +0.290). Nutritional status is closely related to case recovery in the postoperative period. Postoperative changes to high interleukin-10 and neopterin levels in cases with low nutritional index show the importance of nutrition in the postoperative period.