Sarcopenia following concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

Multimodality treatment using chemotherapy, radiotherapy and surgery is standard practice for locally advanced esophageal squamous cell carcinoma (ESCC). Sarcopenia commonly occurs in patients with esophageal cancer. The effect of concurrent chemoradiotherapy (CCRT) on sarcopenia in patients with locally advanced ESCC remains unclear. We aimed to evaluate the effect of CCRT on sarcopenia in locally advanced ESCC.

This study included patients with locally advanced ESCC who received CCRT without surgery between 2011-2020. Sarcopenia was assessed using the skeletal muscle index (SMI) at the third lumbar vertebra (L3), which includes the psoas, paraspinal, and abdominal wall muscles, based on cross-sectional computed tomography (CT) scans before and after CCRT.

In total, 213 patients with locally advanced ESCC who did not undergo esophagectomy after CCRT were included. Before CCRT, 178 patients (83.6%) had sarcopenia, while 35 patients (16.4%) did not. Moreover, 17 patients (48.6%) in the non-sarcopenia group developed sarcopenia after CCRT. The SMI significantly decreased after CCRT in both the sarcopenia and non-sarcopenia groups. The median overall survival (OS) was 12.6-15.7 months in all groups. The incidence of baseline sarcopenia showed no significant association with survival or CCRT-related toxicity. Male, high N-stage and decreasing body mass index (BMI) after CCRT were associated with poor survival prognosis.

Most patients with locally advanced ESCC had sarcopenia. Moreover, CCRT was associated with sarcopenia. Therefore, assessing sarcopenia before treatment and initiating interventions for prevention or treatment of sarcopenia may improve sarcopenia status.