The predictive and prognostic value of low skeletal muscle mass for dose-limiting toxicity and survival in head and neck
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HEAD AND NECK
The predictive and prognostic value of low skeletal muscle mass for dose‑limiting toxicity and survival in head and neck cancer patients receiving concomitant cetuximab and radiotherapy L. F. J. Huiskamp1 · N. Chargi1 · L. A. Devriese2 · P. A. de Jong3 · R. de Bree1,4 Received: 16 September 2019 / Accepted: 8 April 2020 © The Author(s) 2020
Abstract Purpose This study aims to investigate the predictive value of low skeletal muscle mass (SMM) for cetuximab dose-limiting toxicity (DLT) and its prognostic value in head and neck squamous cell carcinoma (HNSCC) patients treated with concomitant cetuximab and radiotherapy. Methods Patients diagnosed with HNSCC and treated with primary or adjuvant concomitant cetuximab and radiotherapy were included. Clinical and demographic variables were retrospectively retrieved and SMM was measured at the level of the third cervical vertebra using pre-treatment diagnostic computed tomography or magnetic resonance imaging. An optimal cut-off value for low SMM was determined based on the lowest log-likelihood associated with cetuximab DLT. A multivariate linear regression model was used to determine predictive factors for cetuximab DLT. The prognostic value of low SMM for disease-free and overall survival was analyzed using Kaplan–Meier curves. Results The optimal cut-off value for low SMM as a predictor of cetuximab DLT was an LSMI ≤ 45.2 c m2/m2. Of the 91 included patients, 74.7% had low SMM and 30.8% experienced cetuximab DLT. At multivariate analysis, low SMM had no predictive value for DLT (OR 0.83; 95% CI 0.27–2.56; p = 0.74). The Kaplan–Meier curve demonstrated that patients with low SMM had significantly lower overall survival (Log Rank χ2 = 5.87; p = 0.02). Conclusion Low SMM is highly prevalent in HNSCC patients treated with concomitant cetuximab and radiotherapy. Low SMM has no predictive value for cetuximab DLT in HNSCC patients. Low SMM is probably not a prognostic factor for overall survival in highly selected HNSCC patients treated with concomitant cetuximab and radiotherapy and unfit for platin-based chemotherapy. Keywords Sarcopenia · Dose-limiting toxicity · Cetuximab · Skeletal muscle mass · Head and neck cancer · Computerassisted image analysis
* R. de Bree [email protected] 1
Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
2
Department of Medical Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
3
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
4
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, House Postal Number Q.05.4.300, PO BOX 85500, 3508 GA Utrecht, The Netherlands
Abbreviations SMM Skeletal muscle mass DLT Dose-limiting toxicity OS Overall survival DFS Disease-fr
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