Clinical Research Papers:

Lean body mass wasting and toxicity in early breast cancer patients receiving anthracyclines

Federica Mazzuca, Concetta Elisa Onesti _, Michela Roberto, Marco Di Girolamo, Andrea Botticelli, Paola Begini, Lidia Strigari, Paolo Marchetti and Maurizio Muscaritoli

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Oncotarget. 2018; 9:25714-25722. https://doi.org/10.18632/oncotarget.25394

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Federica Mazzuca1,2, Concetta Elisa Onesti1,3, Michela Roberto1,2, Marco Di Girolamo4, Andrea Botticelli1, Paola Begini5, Lidia Strigari6, Paolo Marchetti1,2 and Maurizio Muscaritoli7

1Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy

2Department of Medical Oncology, Sant’Andrea Hospital, Rome, Italy

3Department of Medical Oncology, University Hospital (CHU) and University of Liège, Liège, Belgium

4Department of Radiology, Sant’Andrea Hospital, Rome, Italy

5Department of Gastroenterology, Sant’Andrea Hospital, Rome, Italy

6Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy

7Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy

Correspondence to:

Concetta Elisa Onesti, email: [email protected]

Keywords: breast cancer; sarcopenia; lean body mass; anthracyclines toxicity; adjuvant chemotherapy

Received: February 12, 2018     Accepted: April 28, 2018     Published: May 22, 2018


Background: Sarcopenia refers to the reduction of both volume and number of skeletal muscle fibers. Lean body mass loss is associated with survival, quality of life and tolerance to treatment in cancer patients. The aim of our study is to analyse the association between toxicities and sarcopenia in early breast cancer patients receiving adjuvant treatment.

Materials and Methods: Breast cancer patients who have received anthracycline-based adjuvant treatment were retrospectively enrolled. CT scan images performed before, during and after adjuvant chemotherapy were used to evaluate lean body mass at third lumbar vertebra level with the software Slice Omatic V 5.0.

Results: 21 stage I–III breast cancer patients were enrolled. According to the skeletal muscle index at third lumbar vertebra cut-off ≤38.5 cm2/m2, 8 patients (38.1%) were classified as sarcopenic before starting treatment, while 10 patients (47.6%) were sarcopenic at the end of treatment. A lower baseline L3 skeletal muscle index is associated with G3-4 vs G0-2 toxicities (33.4 cm2/m2 (31.1–39.9) vs 40.5 cm2/m2 (33.4–52.0), p = 0.028). Similarly skeletal muscle cross sectional area was significantly lower in patients with G3-4 toxicities (86.7 cm2 (82.6–104.7) vs 109.0 cm2 (83.3–143.9), p = 0.017). L3 skeletal muscle index is an independent predictor of severe toxicity (p = 0.0282) in multivariate analysis.

Conclusion: Lean body mass loss is associated with higher grade of toxicity in early breast cancer patients receiving adjuvant chemotherapy.

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