title: Characterization of Anthropometric Changes that Occur During Neoadjuvant Therapy for Potentially Resectable Pancreatic Cancer.
abstract: BACKGROUND
  Little is known about changes in body composition that may occur during neoadjuvant therapy for pancreatic cancer. This study was designed to characterize these changes and their potential relationships with therapeutic outcomes.
  
  
  METHODS
  The study population consisted of patients with potentially resectable pancreatic cancer treated on a phase II trial of neoadjuvant chemotherapy and chemoradiation. Skeletal muscle and adipose tissue compartments were measured before and after administration of neoadjuvant therapy using SliceOMatic software (TomoVision, 2012) and protocol-mandated CT scans. Sarcopenia was defined using gender-adjusted norms.
  
  
  RESULTS
  Among 89 eligible patients, 46 (52 %) patients met anthropometric criteria for sarcopenia prior to the initiation of neoadjuvant therapy. Further depletion of skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue occurred during neoadjuvant therapy, but these losses did not preclude the performance of potentially curative surgery. Degree of skeletal muscle loss correlated with disease-free survival while visceral adipose loss was associated with overall and progression-free survival. However, completion of all therapy, including pancreatectomy, was the only independently significant predictor of outcome in a multivariate analysis of overall survival.
  
  
  CONCLUSIONS
  These data suggest that body composition analysis of standard CT images may provide clinically relevant information for patients with potentially resectable pancreatic cancer who receive neoadjuvant therapy. Anthropometric changes must be considered in the design of preoperative therapy regimens, and further efforts should focus on maintenance of muscle and visceral adipose tissue in the preoperative setting.
authors.affiliation: Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Cooper
authors.forename: Rebecca
authors.initials: R
authors.lastname: Slack
authors.forename: David
authors.initials: D
authors.lastname: Fogelman
authors.forename: Holly M
authors.initials: HM
authors.lastname: Holmes
authors.forename: Maria
authors.initials: M
authors.lastname: Petzel
authors.forename: Nathan
authors.initials: N
authors.lastname: Parker
authors.forename: Aparna
authors.initials: A
authors.lastname: Balachandran
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.forename: An
authors.initials: A
authors.lastname: Ngo-Huang
authors.forename: Gauri
authors.initials: G
authors.lastname: Varadhachary
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Thomas
authors.initials: T
authors.lastname: Aloia
authors.forename: Claudius
authors.initials: C
authors.lastname: Conrad
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001823:Body Composition; D001835:Body Weight; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D017322:Clinical Trials, Phase II as Topic; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005500:Follow-Up Studies; D006801:Humans; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D055948:Sarcopenia / Q000209:etiology*; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine