Patients with head and neck cancer (HNC) are at risk for adverse events because of the required intensive, multimodal treatment due to advanced disease at presentation. Recognizing frail patients is mandatory for tailored treatment. However, a frailty assessment is time-intensive and requires active patient participation. Low skeletal muscle mass (LSMM) as measured on pretreatment neck imaging could be a practical and rapid-imaging biomarker for frailty and adverse events in HNC.
Therefore, this dissertation of Aniek Zwart focused on the validation and the clinical value of skeletal muscle mass measurements on neck imaging that are part of the standard diagnostic workup in HNC. Analysis showed high agreement of skeletal muscle measurements regardless of applied imaging modality (MRI, diagnostic CT or low-dose CT), position of arms, and observers. LSMM was prevalent condition in HNC. Regardless of HNC type, patients with LSMM were significantly frailer and had a higher malnutrition risk. In mucosal HNC, LSMM and oncological stage were independently related to the occurrence of (chemo)radiotherapy-related toxicities. In cutaneous HNC, frailty was related to postoperative complications and LSMM was not.
In conclusion, skeletal muscle mass is a practical, robust, and rapid imaging biomarker for (chemo)radiotherapy-related toxicity, frailty, and malnutrition in HNC. These new insights may be useful for shared decision-making and personalized medicine. Future research is needed to analyse the effect of LSMM-based interventions on patients’ health and clinical outcomes.
