Sarcopenia (also known as sarcopenia) is characterized by progressive and extensive degeneration of skeletal muscle and is associated with functional decline Related. Sarcopenia has primary and secondary causes, caused by the aging process or chronic cytokine-mediated inflammation (associated with health conditions including cancer), respectively.

Sarcopenia is known to affect people with various The prognosis of cancer patients is adversely affected. Early recognition of sarcopenia is critical for improving patient care and overall prognosis. However, to better support cancer patients, greater understanding of new interventions and assessment of the survival benefits of managing sarcopenia are needed.

Impact of sarcopenia on cancer treatment and outcomes

Sarcopenia is increasingly recognized as a poor prognostic factor for cancer treatment and outcome. Growing evidence suggests that patients with sarcopenia are at higher risk for postoperative complications and prolonged hospital stay after cancer resection. Due to increased incidence of side effects and treatment interruptions, chemoradiotherapy is less well tolerated in patients with sarcopenia.

In general, people with various types of cancer People with sarcopenia have a lower survival rate than those without sarcopenia. This difference was seen in both non-metastatic and metastatic patients receiving treatment.

Different groups have studied sarcopenia in surgery , chemotherapy and radiotherapy cohorts. Radiation therapy plays an important role in the treatment of head and neck tumors, upper gastrointestinal tumors, and pelvic malignancies such as the cervix and bladder. Here we highlight some studies evaluating sarcopenia in patients undergoing radiation therapy.

Head and neck cancer and sarcopenia

Radiation (with or without chemotherapy) is Standard treatment for cancer (HNSCC) with significant side effects such as mucositis, dysgeusia, dysphagia, dysphagia, nausea and vomiting. Treatment toxicity leads to dietary insufficiency and subsequent malnutrition. Therefore, HNSCC patients may lose approximately 6% to 12% of their body weight during treatment. Other factors associated with weight loss included advanced disease stage, use of concurrent chemotherapy, and higher body mass index (BMI). In locally advanced disease, higher treatment and radiation doses increase damage to normal tissue, increasing the likelihood and severity of side effects.

A 2019 study found that sarcopenia reducedradiochemotherapy compliance in patients with locally advanced HNSCC, and increased chemotherapy toxicity. Of the 246 patients surveyed, 58% had sarcopenia prior to treatment, and about 20% of these patients had treatment interruptions of more than a week. In addition, 45% of sarcopenia patients experienced dose-limiting chemotherapy toxicity. The 3-year overall survival (OS) of patients with sarcopenia was relatively poor compared with patients without sarcopenia (65.3% VS 79.9%).

A similar study showed that after The risk of developing dose-limiting toxicity was approximately 3-fold increased in sarcopenic patients (CRT).

In another study of 190 HNSCC patients treated with CRT In patient studies, sarcopenia before and after treatment was associated with poorer OS. OS in sarcopenic patients was significantly lower from 75% to 62% relative to non-sarcopenic patients. A similar study reported a two-fold increase in the prevalence of sarcopenia after treatment compared to before treatment. In addition, sarcopenia patients also had a three-fold increased risk of recurrence and death.

Upper gastrointestinal (UGI) cancer and sarcopenia< /span>

Limited prognosis for cancer of the esophagus, stomach, liver, and pancreas . This is related to their advanced symptoms and metastatic site. Poor nutritional status is also associated with poor prognosis in UGI cancer patients. Patients with UGI cancer often present with dysphagia, weight loss, loss of appetite, nausea, vomiting, hematemesis, and liver dysfunction. TheseFactors promote nutritional deficiencies that lead to the development of sarcopenia.

Report on a Phase III trial of esophageal cancer treatment indicated that the incidence of CRT-related toxicity was higher in the sarcopenia group. The incidence of grade ≥3 toxicity was 83.3% compared to 54.4% in non-sarcopenic patients. Furthermore, during neoadjuvant CRT, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9%. However, no significant differences in survival were observed between sarcopenic and non-sarcopenic patients.

However, patients with sarcopenia after CRT were relatively poor OS in other patients in the cohort (median OS was 45 months vs 74 months) .

Pelvic organ cancer and sarcopenia< /p>

①In pelvic organ cancers, the prevalence of sarcopenia is often underestimate. In locally advanced cervical cancer, the prevalence of sarcopenia ranges from 33%-51%.

One study found that after treatment, 69% of Cervical cancer patients presented with clinical malnutrition, and 58% of patients presented with sarcopenia. In addition, patients with >10% reduction in skeletal muscle index (SMI) had higher recurrence rates and decreased survival.

②In a patient undergoing radical cystectomy In a study of 205 bladder cancer patients, sarcopenia was associated with poor cancer-specific survival (CSS) and OS.

About 68% of patients have sarcopenia, And these patients tended to be older than those without sarcopenia (median age, 72 vs 67.5 years). Specifically, 5-year CSS (49% vs 72%) and OS (39) in sarcopenic patients compared with non-sarcopenic patients % vs 70%) was significantly reduced.

In addition, in patients with inoperable bladder cancer, The OS was very poor in sarcopenic patients compared with sarcopenic patients (11 months vs 31 months).

Muscle of cancer patients Management of sarcopenia

Due to sarcopenia’s prognostic significance for cancer patients Therefore, early detection of sarcopenia and appropriate interventions are necessary.

1, Motion and Resistance Training is currently used to treat age-related sarcopenia. However, exercise therapy may not be suitable for a small number of patients due to poor adherence, advanced disease, fatigue from cancer, and side effects of treatment that limit functional ability. Therefore, an assessment of the patient followed by a supervised structured training program is the ideal approach.

2, although diet< /span> Plays an important role in sarcopenia, but dietary interventions are not as well-studied as resistance training has demonstrated. Research shows that there are three areas considered essential in the diet: vitamin D, calcium and calcium strong>Antioxidants. Also, a combination of dietary intervention and exercise may lead to better results in the treatment of sarcopenia.

3. Yibukang is imported from the United States Special nutrition for cancer patients, which can be the shortest timecomprehensively solutionNutrition problems for cancer patients, so that patients can regain weight and constitution in the shortest time, and ensure blood picture (white blood cells, neutrophils, red blood cells, platelets) normal. It is also the only tumor-specific nutrition that realizes quadruple immune nutrition (glutamic acid, arginine, leucine, nucleotide) + omega-3 formula.

4. Exogenous hormone therapy, such as low-dose< strong>Corticosteroids, progesterone, and testosterone supplements , showed certain advantages in terms of weight gain and appetite. However, the benefits of such therapies must be considered in conjunction with their risks and side effects.

5, ibuprofen , celecoxib cloth, and indomethacin non-steroidal anti-inflammatory drugs (NSAIDs) may also Helps relieve muscle loss. It works by inhibiting systemic inflammation, thereby interrupting weight loss and cachexia.

Reference:

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