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Sarcopenia as determinant for tube dependency
sarcopenia using routinely performed CT imaging of the head and neck area, whereas he most common method for sarcopenia assessment in cancer patients is based on abdominal CT imaging, for instance using the psoas muscle or using total muscle area at the level of lumbar vertebra L3. However, abdominal imaging is not routinely available in head and neck cancer patients which limits its applicability in this population. While the optimal measurement level, measurement method or cut-off value for sarcopenia on CT imaging is still debated, a high correlation of C3 SMI with L3 SMI has been reported before (53, 54). Thus, in head and neck cancer patients, measurement on head and neck CT imaging currently appears to be the most applicable method.
CONCLUSION
Sarcopenia, as measured by SMI at C3 level on routine CT imaging of the head and neck area, contributes to the risk of prolonged feeding tube dependency in HNC patients treated with primary CRT. Due to its non-invasive and time-efficient character, routine measurement of neck SMI could be a valuable addition to clinical practice. Firstly, it could aid in the shared decision making regarding proactive tube placement, especially in the intermediate risk category based on our previously published prediction model on prolonged feeding tube dependency risks. Secondly, sarcopenia might be modifiable prior to treatment, and as such it may present a relevant lead for pretreatment optimization of patients’ condition. The results of this study therefore warrant further research on the feasibility and effectiveness of such interventions.
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