Characterization of Anthropometric Changes that Occur During Neoadjuvant Therapy for Potentially Resectable Pancreatic Cancer

• Published in: Annals of surgical oncology Vol. 22; no. 7; pp. 2416 - 2423
• Main Authors: Cooper, Amanda B., Slack, Rebecca, Fogelman, David, Holmes, Holly M., Petzel, Maria, Parker, Nathan, Balachandran, Aparna, Garg, Naveen, Ngo-Huang, An, Varadhachary, Gauri, Evans, Douglas B., Lee, Jeffrey E., Aloia, Thomas, Conrad, Claudius, Vauthey, Jean-Nicolas, Fleming, Jason B., Katz, Matthew H. G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2015; Springer Nature B.V
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Body Composition; Body Weight; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - therapy; Chemoradiotherapy - adverse effects; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Clinical Trials, Phase II as Topic; Combined Modality Therapy; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Follow-Up Studies; Humans; Medicine; Medicine & Public Health; Neoadjuvant Therapy - adverse effects; Neoplasm Staging; Oncology; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - therapy; Pancreatic Tumors; Prognosis; Retrospective Studies; Sarcopenia - etiology; Surgery; Surgical Oncology; Survival Rate; Resectable Pancreatic Cancer; Preoperative Therapy; Overall Survival; Visceral Adipose Tissue; Subcutaneous Adipose Tissue
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-4285-2

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.