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

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2024-11, Vol.127, p.112539, Article 112539
• Main Authors: Aredes, Mariah Azevedo, de Paula, Nathália Silva, Villaça Chaves, Gabriela
• Format: Article
• Language: English
• Subjects: Adipose tissue; Adiposity; Adverse events; Body composition; Body fat; Cancer; Cancer therapies; Cervical cancer; Chemoradiotherapy; Chemotherapy; Clinical outcomes; Computed tomography; Computer tomography; Confounding (Statistics); Constipation; Drug dosages; Genotype & phenotype; Gynecological tumors; Hematology; Medical records; Muscle radiodensity; Muscles; Musculoskeletal system; Obesity; Parameter modification; Phenotypes; Radiation therapy; Risk factors; Skeletal muscle; Sociodemographics; Squamous cell carcinoma; Toxicity; Tumors; Weight control; Womens health
• ISSN: 0899-9007; 1873-1244; 1873-1244
• DOI: 10.1016/j.nut.2024.112539

•This is the first study assessing the association between body composition phenotypes in a prospective cohort.•Low muscle mass was an independent factor for severe toxicity events when analyzed alone or combined with adipose tissue.•Women with excess adipose tissue and low muscle mass had an approximately 4 times higher risk of delaying or interrupting chemoradiotherapy.•There was progressive increase in the risk of adverse events according to the number of unfavorable body composition conditions. 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.