Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol.

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Abstract

Perioperative chemotherapy with FLOT constitutes a standard of care approach for locally advanced, resectable gastric or gastro-esophageal junction (GEJ) cancer. We aimed at investigating anthropometric, CT-based and FDG-PET-based body composition parameters and dynamics during this multidisciplinary approach and the impact on clinical outcomes.

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Most cited references 41

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Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial

Salah-Eddin Al-Batran, Nils Homann, Claudia Pauligk … (2019)

Docetaxel-based chemotherapy is effective in metastatic gastric and gastro-oesophageal junction adenocarcinoma. This study reports on the safety and efficacy of the docetaxel-based triplet FLOT (fluorouracil plus leucovorin, oxaliplatin and docetaxel) as a perioperative therapy for patients with locally advanced, resectable tumours.

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Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

E.C. Smyth, M Verheij, W Allum … (2016)

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Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.

Carla Prado, Jessica R L Lieffers, Linda McCargar … (2008)

Emerging evidence on body composition suggests that sarcopenic obesity (obesity with depleted muscle mass) might be predictive of morbidity and mortality in non-malignant disease and also of toxicity to chemotherapy. We aimed to assess the prevalence and clinical implications of sarcopenic obesity in patients with cancer. Between Jan 13, 2004, and Jan 19, 2007, 2115 patients with solid tumours of the respiratory or gastrointestinal tract from a cancer treatment centre serving northern Alberta, Canada, were identified. Available lumbar CT images of the obese patients were analysed for total skeletal muscle cross-sectional area; these values were also used to estimate total body fat-free mass (FFM). Of the 2115 patients initially identified, 325 (15%) were classified as obese (body-mass index [BMI] > or =30). Of these obese patients, 250 had CT images that met the criteria for analysis. The remaining 75 patients were recorded as without assessable scans. Obese patients had a wide range of muscle mass. Sex-specific cut-offs that defined a significant association between low muscle mass with mortality were ascertained by optimum stratification analysis: 38 (15%) of 250 patients who had assessable CT images that met the criteria for analysis were below these cut-offs and were classified as having sarcopenia. Sarcopenic obesity was associated with poorer functional status compared with obese patients who did not have sarcopenia (p=0.009), and was an independent predictor of survival (hazard ratio [HR] 4.2 [95% CI 2.4-7.2], p<0.0001). Estimated FFM showed a poor association with body-surface area (r(2)=0.37). Assuming that FFM represents the volume of distribution of many cytotoxic chemotherapy drugs, we estimated that individual variation in FFM could account for up to three-times variation in effective volume of distribution for chemotherapy administered per unit body-surface area, in this population. This study provides evidence of the great variability of body composition in patients with cancer and links body composition, especially sarcopenic obesity, to clinical implications such as functional status, survival, and potentially, chemotherapy toxicity.

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Author and article information

Journal

Journal ID (iso-abbrev): J Cancer Res Clin Oncol

Title: Journal of cancer research and clinical oncology

Publisher: Springer Science and Business Media LLC

ISSN (Electronic): 1432-1335

ISSN (Print): 0171-5216

Publication date (Electronic): Jul 21 2022

Affiliations

[1 ] Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria.

[2 ] Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.

[3 ] Cancer Cluster Salzburg, Salzburg, Austria.

[4 ] Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria.

[5 ] Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.

[6 ] Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.

[7 ] Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria. lu.weiss@salk.at.

[8 ] Cancer Cluster Salzburg, Salzburg, Austria. lu.weiss@salk.at.

Article

Publisher Item ID: 10.1007/s00432-022-04096-w

DOI: 10.1007/s00432-022-04096-w

PubMed ID: 35864270

SO-VID: 17f764d4-f7d5-4b94-ac99-04cb73ed7b47

History

Keywords: Perioperative chemotherapy,Body mass index,Gastric cancer,Sarcopenia,Skeletal muscle index

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Keywords: Perioperative chemotherapy, Body mass index, Gastric cancer, Sarcopenia, Skeletal muscle index

Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol.

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Abstract

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Karger: Nutrition and Dietetics

Most cited references 41

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial

Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.

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