Early body weight loss during concurrent chemo-radiotherapy for non-small cell lung cancer.
OBJECTIVE
Radiation-esophagitis and weight loss are frequently observed toxicities in patients treated with concurrent chemo-radiotherapy (CT-RT) for non-small cell lung cancer (NSCLC) and might be related. The purpose was to investigate whether weight loss already starts early after initiation of CT-RT and precedes radiation-esophagitis.


METHODS
In a retrospective cohort, weight and esophagitis grade ≥2 were assessed during the first weeks of (CT-)RT in patients treated with concurrent (n = 102) or sequential (n = 92) therapy. In a prospective validation study, data on body weight, esophagitis grade ≥2, nutritional intake and muscle strength were obtained before, during and following CT-RT.


RESULTS
In the retrospective cohort, early weight loss was observed in concurrently treated patients (p = 0.002), independent of esophagitis ≥ grade 2. Early weight loss was also observed in the prospective cohort (p = 0.003) and was not accompanied by decreases in nutritional intake. In addition lower limb muscle strength rapidly declined (p = 0.042). In the later weeks of treatment, further body weight loss occurred (p < 0.001) despite increased nutritional supplementation and body weight was only partly recovered after 4 weeks post CT-RT (p = 0.003).


CONCLUSIONS
Weight loss during concurrent CT-RT for NSCLC starts early and prior to onset of esophagitis, requiring timely and intense nutritional rehabilitation.
Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Céline M H
CM
Op den Kamp
Dirk K M
DK
De Ruysscher
Marieke
M
van den Heuvel
Meike
M
Elferink
Ruud M A
RM
Houben
Cary J G
CJ
Oberije
Gerben P
GP
Bootsma
Wiel H
WH
Geraedts
Cordula C M
CC
Pitz
Ramon C
RC
Langen
Emiel F M
EF
Wouters
Annemie M W J
AM
Schols
Anne-Marie C
AM
Dingemans