Ultrasound Measurements of Skeletal Muscle Predict Chemotherapy Toxicity in Non-Small Cell Lung Cancer

Non-small cell lung cancer (NSCLC) patients often experience skeletal muscle mass (SMM) reduction, increasing chemotherapy toxicity risk. Although CT and MRI scans are commonly used to assess SMM, their limitations exist. Ultrasound, a convenient alternative, may serve as a predictive tool for chemotherapy toxicity.

This multi-center, prospective study analyzed 163 NSCLC patients undergoing platinum-based chemotherapy. Ultrasound measured quadriceps muscle thickness (X-axis, Y-axis), cross-sectional area (CSA), fascicle length (FL), and pennation angle (PA). Chemotherapy toxicity was evaluated using CTCAE 5.0 criteria. Relationships between ultrasound parameters and toxicity were assessed via point-biserial correlation, logistic regression, and receiver operating characteristic curves (ROC) curve analyses.

Muscle thickness (X-axis, Y-axis), CSA, and PA were significantly correlated with overall toxicity and grade 3-4 hematologic toxicity (p < 0.05), with weaker correlations for non-hematologic toxicity. Multivariable logistic regression confirmed these parameters as independent predictors. ROC curve analysis revealed strong predictive value for CSA (AUC 0.796, cutoff 3.122 cm²) and X-axis thickness (AUC 0.768, cutoff 1.131 cm) in predicting grade 3-4 overall toxicity.

Ultrasound measurements of quadriceps muscle effectively predict severe chemotherapy toxicity (grade 3-4), offering a non-radiative, accessible tool to identify high-risk NSCLC patients, enabling tailored interventions and improved treatment tolerance.