Main Session
Sep
30
PQA 08 - Gastrointestinal Cancer, Nonmalignant Disease, Palliative Care
3509 - Association of Skeletal Muscle and Adiposity Measured by Computed Tomography with Toxicity and pCR in Esophageal Squamous Cell Carcinoma Receiving Standardized Neoadjuvant Chemoradiotherapy
Presenter(s)
Wei-Xiang Qi, MD, RT - Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai
W. X. Qi1, C. Zhao2, S. Li1,3, H. Li1, J. Y. Chen1,3, and S. Zhao1; 1Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China, 2Department of oncology, The Second Affiliated Hospital of Guizhou Medical University, guiyang, China, 3Shanghai Key Laboratory of Proton Therapy, Shanghai, China
Purpose/Objective(s):
Neoadjuvant chemoradiotherapy(nCRT) followed by curative surgery has been the standardized treatment option for locally advanced esophageal squamous cell carcinoma (ESCC) and nCRT-induced toxicities have been frequently reported in ESCC patients. The body composition of ESCC patients might be associated with the toxicity and efficacy of nCRT and surgical resection. The aim of this study was to evaluate the association between three body composition measures [skeletal muscle measures (SMM), Skeletal muscle radiodensity (SMD), and total adiposity tissue (TAT)] and nCRT-induced toxicity in a large prospective cohort.Materials/Methods:
Locally advanced ESCC patients treated with standardized nCRT between January 2019 and December 2024 were included (NCT03792347, NCT04435197, NCT04513418, NCT03990532). CT scans before nCRT were used to quantify the indices of skeletal muscle and adipose tissue at the levels of the third lumbar vertebra (L3). SMM, SMD and TAT were categorized as low, intermediate, and high, based on the tertiles of SMM, mean HU and TAT, respectively. nCRT-induced hematologic toxicity was scored using CTCAE v4.03 (anemia, leukocytopenia, neutropenia, and thrombocytopenia). Treatment interruption of nCRT (treatment delay and discontinuation) was also evaluated. The relationship between SMM, SMD, TAT and toxicities/efficacy was assessed in univariate and multivariate logistic regression models.Results:
In total, 297 patients (male n = 254, median age 66 years) were included. 215 patients (72.4%) presented with stage III, and 61 with stage IV followed by 21 with stage II. The median primary tumor length and treatment duration of nCRT was 4.8cm and 31days. After nCRT, a total of 278 patients received curative surgery with a pCR of 49.6% and TRG 0-1 of 72.3%. During the nCRT, hematological toxicity =grade 2 was experienced in 80.5% (n = 239) of the patients, and 10.1% (n = 30) experienced treatment interruption of nCRT. No significant difference of pCR and primary tumor response among the three groups according to three body composition measures (SMM, SMD and TAT). Multivariate logistic regression analysis showed that high SMM (ORadj 0.47, 95% CI 0.23–0.97, P = 0.042) were statistically significantly associated with overall =grade 2 hematological toxicity. High SMM (ORadj 0.29, 95% CI 0.086–0.97, P = 0.044) and high TAT (ORadj 0.25, 95% CI 0.072–0.90, P = 0.033) were statistically significantly associated with a lower risk of developing treatment interruption of nCRT.Conclusion:
ESCC patients with pretreatment high SMM and TAT are at significant lower risk for =grade 2 hematological toxicities and treatment interruption of nCRT.Further studies are still needed to evaluate the long-term outcomes of different body composition in ESCC patients treated with nCRT and improve the pretreatment SMM/TAT could reduce the risk of toxicity without compromising efficacy.