Department of Orthopedics and Physical Rehabilitation; School of Medicine; Department of Radiation Oncology; Department of Radiology; Department of Surgery
Neoplasms | Oncology | Orthopedics | Pathological Conditions, Signs and Symptoms | Radiation Medicine | Radiology | Rehabilitation and Therapy
Introduction: Fifteen to seventy percent of cancer patients demonstrate sarcopenia.1-6,[i],[ii],[iii],[iv],[v],[vi],[vii],[viii],[ix],[x],[xi],[xii],[xiii] Analysis of iliopsoas cross-sectional area, a non-invasive surrogate measure for sarcopenia in patients with cancer has been associated with survival.[xiv],[xv],[xvi],[xvii] The pectoralis muscle may be a more accessible target for measuring sarcopenia in lung cancer patients,[xviii] but it is not known if it this correlates with iliopsoas cross-sectional area. Since measurements vary, it is most accurate to use internal controls. We attempted to examine the cross-sectional area of the two muscles and any change over the treatment period.
Methods: Charts were reviewed in 44 subjects who underwent surgical treatment of lung cancer. Available imaging at pre-treatment, 6 months, and 12 months was reviewed for the cross-sectional area of the pectoralis and the iliopsoas. The cross-sectional area of the pectoralis and the iliopsoas were measured manually at diagnosis by two different researchers, and the pectoralis was measured at 6 months and 12 months in subjects who were treated for lung cancer. Follow-up iliopsoas data was not available.
Results: Of the 44 subjects, 13 had a complete set of imaging. The mean age was 66 years old and the mean BMI was 28.72. There were 8 females and 5 males. 12 out of 13 were Caucasian. 12 out of 13 were stage T1 or T2. 12 out of 13 had undergone lobectomy. 10 out of the 13 were at ECOG performance status grade 0 at diagnosis. 4 out of 13 had postoperative events. The mean iliopsoas area at diagnosis was 8.17cm2. The mean pectoralis area at diagnosis was 14.5 cm2. The mean pectoralis area at 6 months was 13.9 cm2. The mean pectoralis area at 12 months was 14.5cm2. 8 out of 13 subjects had a decrease in mean pectoralis area at 6 months and 6 subjects had a decrease at 12 months.
Conclusion: There was no significant decrease in cross-sectional area of the pectoralis over the lung cancer treatment period. This could be because of the initial high performance status of our sample, the small size, or sarcopenia occurs comorbidly with presentation.
[i] Bowden JC, Williams LJ, Simms A, Price A, Campbell S, Fallon MT, Fearon KC. Prediction of 90 day and overall survival after chemoradiotherapy for lung cancer: role of performance status and body composition. Clinical Oncology. 2017 Sep 1;29(9):576-84.
[ii] Kim EY, Lee HY, Kim KW, Lee JI, Kim YS, Choi WJ, Kim JH. Preoperative Computed Tomography–Determined Sarcopenia and Postoperative Outcome after Surgery for Non-Small Cell Lung Cancer. Scandinavian Journal of Surgery. 2017 Dec 1:1457496917748221.
[iii] Amini N, Spolverato G, Gupta R, Margonis GA, Kim Y, Wagner D, Rezaee N, Weiss MJ, Wolfgang CL, Makary MM, Kamel IR. Impact total psoas volume on short-and long-term outcomes in patients undergoing curative resection for pancreatic adenocarcinoma: a new tool to assess sarcopenia. Journal of Gastrointestinal Surgery. 2015 Sep 1;19(9):1593-602.
[iv] Kasatkina E. CT-assessment of sarcopenia as a predictor of post-Whipple complications. European Congress of Radiology 2013.
[v] Sabel MS, Lee J, Cai S, Englesbe MJ, Holcombe S, Wang S. Sarcopenia as a prognostic factor among patients with stage III melanoma. Annals of surgical oncology. 2011 Dec 1;18(13):3579-85.
[vi] Blauwhoff-Buskermolen S, Versteeg KS, de van der Schueren MA, den Braver NR, Berkhof J, Langius JA, Verheul HM. Loss of muscle mass during chemotherapy is predictive for poor survival of patients with metastatic colorectal cancer. Journal of Clinical Oncology. 2016 Feb 22;34(12):1339-44.
[vii] Villaseñor A, Ballard-Barbash R, Baumgartner K, Baumgartner R, Bernstein L, McTiernan A, Neuhouser ML. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. Journal of Cancer Survivorship. 2012 Dec 1;6(4):398-406.
[viii] Kuroki LM, Mangano M, Allsworth JE, Menias CO, Massad LS, Powell MA, Mutch DG, Thaker PH. Pre-operative assessment of muscle mass to predict surgical complications and prognosis in patients with endometrial cancer. Annals of surgical oncology. 2015 Mar 1;22(3):972-9.
[ix] Peng PD, Van Vledder MG, Tsai S, De Jong MC, Makary M, Ng J, Edil BH, Wolfgang CL, Schulick RD, Choti MA, Kamel I. Sarcopenia negatively impacts short‐term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. Hpb. 2011 Jul 1;13(7):439-46.
[x] Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clinical cancer research. 2009 Apr 15;15(8):2920-6.
[xi] Reisinger KW, Bosmans JW, Uittenbogaart M, Alsoumali A, Poeze M, Sosef MN, Derikx JP. Loss of skeletal muscle mass during neoadjuvant chemoradiotherapy predicts postoperative mortality in esophageal cancer surgery. Annals of surgical oncology. 2015 Dec 1;22(13):4445-52.
[xii] Cushen SJ, Power DG, Murphy KP, McDermott R, Griffin BT, Lim M, Daly L, MacEneaney P, O'Sullivan K, Prado CM, Ryan AM. Impact of body composition parameters on clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with docetaxel. Clinical nutrition ESPEN. 2016 Jun 1;13:e39-45.
[xiii] van Vugt JL, Braam HJ, van Oudheusden TR, Vestering A, Bollen TL, Wiezer MJ, de Hingh IH, van Ramshorst B, Boerma D. Skeletal muscle depletion is associated with severe postoperative complications in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal cancer. Annals of surgical oncology. 2015 Oct 1;22(11):3625-31.
[xiv] Feliciano EM, Kroenke CH, Meyerhardt JA, Prado CM, Bradshaw PT, Kwan ML, Xiao J, Alexeeff S, Corley D, Weltzien E, Castillo AL. Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer: Results From the C Scans Study. JAMA oncology. 2017 Dec 1;3(12):e172319-.
[xv] Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. The lancet oncology. 2008 Jul 1;9(7):629-35.
[xvi] Peng P, Hyder O, Firoozmand A, Kneuertz P, Schulick RD, Huang D, Makary M, Hirose K, Edil B, Choti MA, Herman J. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. Journal of gastrointestinal surgery. 2012 Aug 1;16(8):1478-86.
[xvii] Tan BH, Birdsell LA, Martin L, Baracos VE, Fearon KC. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clinical cancer research. 2009 Nov 15;15(22):6973-9.
[xviii] Go SI, Park MJ, Song HN, Kang MH, Park HJ, Jeon KN, Kim SH, Kim MJ, Kang JH, Lee GW. Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer. Supportive Care in Cancer. 2016 May 1;24(5):2075-84.
lung cancer, sarcopenia, pectoralis, iliopsoas, imaging
Rights and Permissions
Copyright 2019 The Author(s)
DOI of Published Version
Prehabilitation World Congress 2019
Baima J, Schipani ES, Kamran W, Varlotto JM, McIntosh LJ, Uy K, Emmerick I, Most MJ. (2019). Sarcopenia in lung cancer: Could chest imaging help?. Orthopedics and Physical Rehabilitation Publications. https://doi.org/10.13028/8vgg-7267. Retrieved from https://escholarship.umassmed.edu/ortho_pp/191