2758 - Impact of Sarcopenia on Survival and Late Toxicity among Patients with Locally Advanced Cervical Cancer Treated with Definitive Chemoradiotherapy and Brachytherapy

Purpose/Objective(s): Cervical cancer is a public health concern in developing countries. Evidence regarding the relationship between sarcopenia and overall survival in patients with cervical cancer shows diverse results, with heterogeneity among published data. Additionally, there is no information available about the potential relationship between this baseline characteristic and late radiotherapy toxicity. Here, we evaluate survival and late toxicity outcomes in patients with sarcopenia and locally advanced cervical cancer treated with definitive chemoradiotherapy and brachytherapy.

Materials/Methods: With the use of Slice – O – Matic, V4.2 (Tomovision, Montreal, Canada) we determine the Skeletal Muscle Index (SMI) using the computed tomography performed for staging of patients with locally advanced cervical cancer (stage IB3 – IIIC2) treated between 2015 and 2018. Sarcopenia was defined as a SMI ? 35.6 cm ² /m ². Overall survival was assessed using the Kaplan – Meier and log – rank methods, as well as Cox proportional hazards. Logistic regression was used to analyze late toxicity.

Results: Among the 411 patients analyzed, 45 had sarcopenia. Stage (HR 1.709, 95% CI 1.156 – 2.528, p= 0.007), sarcopenia (HR 2.728, 95% CI 1.670 – 4.457, p <0.001), protraction >56 days (HR 1.698, 95% CI 1.017 – 2.835, p=0.043) and the use of an EQD2 <80 Gy and >85 Gy (HR 1.787, 95% CI 1.244 – 2.568, p= 0.002) were variables related to a lower survival among the studied population. Age greater than 51 years (OR 1.562, 95% CI 1.012 – 2.410, p= 0.044), more than 5 applications of chemotherapy (OR 1.642, 95% CI 1.052 – 2.564, p= 0.029) and sarcopenia (OR 1.954, 95% CI 1.025 – 3.725, p= 0.042), were associated with late radiation proctitis.

Conclusion: This is the first study conducted in a Mexican population, with the aim of determine the impact of sarcopenia on overall survival and the development of late radiation proctitis in patients with cervical cancer. Recognizing sarcopenia as a poor prognostic factor when studying these outcomes, the implementation of multidisciplinary teams involving radiation oncologists, oncology nutrition specialists and physiotherapists should be evaluated for the development of strategies that can improve muscle mass and nutritional status since the diagnosis and during the chemoradiation and brachytherapy treatment.