Association of Sarcopenia With Toxicity-Related Discontinuation of Adjuvant Endocrine Therapy in Women With Early-Stage Hormone Receptor-Positive Breast Cancer

Authors

Anurag Saraf, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: anurag_saraf@dfci.harvard.edu.
Ismail Tahir, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.Follow
Bonnie Hu, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Anna-Sophia W. Dietrich, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.Follow
P Erik Tonnesen, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.Follow
Gregory C. Sharp, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Gayle Tillman, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Eric J. Roeland, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
Ryan D. Nipp, Department of Medical Oncology, University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma.
Amy Comander, Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Jeffery Peppercorn, Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Florian J. Fintelmann, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.Follow
Rachel B. Jimenez, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.

Document Type

Article

Publication Title

International journal of radiation oncology, biology, physics

Abstract

PURPOSE: Sarcopenia, an age-related decline in muscle mass and physical function, is associated with increased toxicity and worse outcomes in women with breast cancer (BC). Sarcopenia may contribute to toxicity-related early discontinuation of adjuvant endocrine therapy (aET) in women with hormone receptor-positive (HR+) BC but remains poorly characterized. METHODS AND MATERIALS: This multicenter, retrospective cohort study included consecutive women with stage 0-II HR+ BC who received breast conserving therapy (lumpectomy and radiation therapy) and aET from 2011 to 2017 with a 5-year follow-up. Skeletal muscle index (SMI, cm/m) was analyzed using a deep learning model on routine cross-sectional radiation simulation imaging; sarcopenia was dichotomized according to previously validated reports. The primary endpoint was toxicity-related aET discontinuation; logistic regression analysis evaluated associations between SMI/sarcopenia and aET discontinuation. Cox regression analysis evaluated associations with time to aET toxicity, ipsilateral breast tumor recurrence (IBTR), and disease-free survival (DFS). RESULTS: A total of 305 women (median follow-up, 89 months) were included with a median age of 67 years and early-stage BC (12% stage 0, 65% stage I). A total of 60 (20%) women experienced toxicity-related aET discontinuation. Sarcopenia was associated with toxicity-related early discontinuation of aET (odds ratio, 2.18; P = .036) and shorter time to aET toxicity (hazard ratio [HR], 1.62; P = .031). SMI or sarcopenia were not independently associated with IBTR or DFS; toxicity-related aET discontinuation was associated with worse IBTR (HR, 9.47; P = .002) and worse DFS (HR, 4.53; P = .001). CONCLUSIONS: Among women with early-stage HR+ BC who receive adjuvant radiation therapy and hormone therapy, sarcopenia is associated with toxicity-related early discontinuation of aET. Further studies should validate these findings in women who did not receive adjuvant radiation therapy. These high-risk patients may be candidates for aggressive symptom management and/or alternative treatment strategies to improve outcomes.

First Page

94

Last Page

103

DOI

10.1016/j.ijrobp.2023.07.018

Publication Date

1-1-2024

Recommended Citation

Saraf, Anurag; Tahir, Ismail; Hu, Bonnie; Dietrich, Anna-Sophia W.; Tonnesen, P Erik; Sharp, Gregory C.; Tillman, Gayle; Roeland, Eric J.; Nipp, Ryan D.; Comander, Amy; Peppercorn, Jeffery; Fintelmann, Florian J.; and Jimenez, Rachel B., "Association of Sarcopenia With Toxicity-Related Discontinuation of Adjuvant Endocrine Therapy in Women With Early-Stage Hormone Receptor-Positive Breast Cancer" (2024). Radiology. 3.
https://scholar.bridgeporthospital.org/radiology/3

Identifier

37506979 (pubmed); 10.1016/j.ijrobp.2023.07.018 (doi); S0360-3016(23)07679-4 (pii)