To the Editor We particularly appreciated the article by Grossberg and colleagues1 evaluating the effect of pre–radiation therapy (RT) and post-RT sarcopenia on survival and disease control. They found that the reduction of body mass index and lean mass can predict oncologic outcomes for patients with head and neck cancer (HNC). These findings pointed out the importance of the multidisciplinary management of patients with HNC during the administration of RT with or without chemotherapy, as well as after the completion of therapies. In fact, it is well recognized that patients with HNC are at specific risk of body mass variations, somewhat unrelated to caloric intake because driven by the aberrant metabolic and inflammatory state.2 Recently, a panel of experts participated in a consensus process to identify the features related to cancer cachexia, defined as a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.2 Conversely to the finding of Grossberg and colleagues1 that weight loss alone failed to predict worsened survival, the international consensus statement strongly recommends the following diagnostic criteria for cachexia: weight loss of greater than 5%, body mass index (calculated as weight in kilograms divided by height in meters squared) less than 20, or sarcopenia. In that consensus statement, a direct measure of muscularity was recommended in the presence of fluid retention, large tumor mass, or overweight. The lumbar skeletal muscle index criterion for men in the analysis by Grossberg et al1 seems to differ substantially from that of the consensus recommendation (52.4 vs 55 cm2/m2, respectively). Nevertheless, the need to identify predictive markers of precachexia, cachexia, and refractory cachexia that could lead to a personalized follow-up in patients with HNC remains unresolved.
Mazzola R, Fiorentino A, Alongi F. Cachexia in Radiotherapy-Treated Patients With Head and Neck CancerA Phenomenon That Should Be Investigated. JAMA Oncol. 2016;2(6):831. doi:10.1001/jamaoncol.2016.1387