Associations Between Patient-Reported Nutritional Status, Toxicity, and Survival in Limited-Stage SCLC

In general, malnutrition is associated with more treatment toxicity and shorter survival in patients with cancer, but little is known about its impact on limited-stage (LS) SCLC. We investigated whether nutritional status and weight loss were associated with treatment outcomes in a randomized trial of thoracic radiotherapy (TRT) in LS SCLC (NCT02041845, N = 170).

Patients received platinum-etoposide-chemotherapy and were randomized to receive TRT of 60 Gy in 40 fractions or 45 Gy in 30 fractions. They reported nutritional status on the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and were categorized as having low (PG-SGA SF score 0-3), intermediate (score 4-8), or high (score ≥ 9) malnutrition risk.

In total, 113 patients who completed the PG-SGA SF at baseline and received one or more fractions of TRT were analyzed. Median PG-SGA SF score was 3.0; 52.2% had low, 29.2% intermediate, and 18.6% had high malnutrition risk; and 22.1% had 5% or more weight loss three months before enrolment. There were no significant differences in grade 3 to 4 toxicity (low: 88.1%, intermediate: 90.9%, high: 85.7%; p = 0.86), median progression-free survival (low: 15.8 months, intermediate: 11.8 months, high: 47.0 months; p = 0.25) or median OS (low: 35.5 months, intermediate: 26.8 months, high: 47.0 months; p = 0.24) across malnutrition categories. Weight loss was not significantly associated with grade 3 to 4 toxicity (≥5%: 92.0%, <5%: 87.0%; p = 0.73), median progression-free survival (≥5%: 24.0 months, <5%: 15.9 months; p = 0.51) or median OS (≥5%: 30.6 months, <5%: 35.5 months; p = 0.74).

Patient-reported nutritional status and weight loss before concurrent chemoradiotherapy were neither associated with toxicity nor survival.