Characterization of Anthropometric Changes that Occur During Neoadjuvant Therapy for Potentially Resectable Pancreatic Cancer. Ann Surg Oncol 2015 Jul;22(7):2416-23
Date
12/19/2014Pubmed ID
25519927DOI
10.1245/s10434-014-4285-2Scopus ID
2-s2.0-84930476950 (requires institutional sign-in at Scopus site) 123 CitationsAbstract
BACKGROUND: Little is known about changes in body composition that may occur during neoadjuvant therapy for pancreatic cancer. This study was designed to characterize these changes and their potential relationships with therapeutic outcomes.
METHODS: The study population consisted of patients with potentially resectable pancreatic cancer treated on a phase II trial of neoadjuvant chemotherapy and chemoradiation. Skeletal muscle and adipose tissue compartments were measured before and after administration of neoadjuvant therapy using SliceOMatic software (TomoVision, 2012) and protocol-mandated CT scans. Sarcopenia was defined using gender-adjusted norms.
RESULTS: Among 89 eligible patients, 46 (52 %) patients met anthropometric criteria for sarcopenia prior to the initiation of neoadjuvant therapy. Further depletion of skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue occurred during neoadjuvant therapy, but these losses did not preclude the performance of potentially curative surgery. Degree of skeletal muscle loss correlated with disease-free survival while visceral adipose loss was associated with overall and progression-free survival. However, completion of all therapy, including pancreatectomy, was the only independently significant predictor of outcome in a multivariate analysis of overall survival.
DISCUSSION: These data suggest that body composition analysis of standard CT images may provide clinically relevant information for patients with potentially resectable pancreatic cancer who receive neoadjuvant therapy. Anthropometric changes must be considered in the design of preoperative therapy regimens, and further efforts should focus on maintenance of muscle and visceral adipose tissue in the preoperative setting.
Author List
Cooper AB, Slack R, Fogelman D, Holmes HM, Petzel M, Parker N, Balachandran A, Garg N, Ngo-Huang A, Varadhachary G, Evans DB, Lee JE, Aloia T, Conrad C, Vauthey JN, Fleming JB, Katz MHAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdenocarcinomaAntineoplastic Combined Chemotherapy Protocols
Body Composition
Body Weight
Carcinoma, Pancreatic Ductal
Chemoradiotherapy
Chemotherapy, Adjuvant
Cisplatin
Clinical Trials, Phase II as Topic
Combined Modality Therapy
Deoxycytidine
Follow-Up Studies
Humans
Neoadjuvant Therapy
Neoplasm Staging
Pancreatectomy
Pancreatic Neoplasms
Prognosis
Retrospective Studies
Sarcopenia
Survival Rate
