Skeletal Muscle Ultrasound in Patients with Oesophagogastric Cancer
Research type
Research Study
Full title
Investigating the role of skeletal muscle ultrasound to assess muscle loss in patients with oesophagogastric (OG) cancer: correlation with CT muscle mass, physical function and nutritional status.
IRAS ID
301229
Contact name
Javed Sultan
Contact email
Sponsor organisation
Northern Care Alliance NHS Foundation Trust
Duration of Study in the UK
1 years, 2 months, 1 days
Research summary
Research Summary
One third of patients with cancer of the stomach and gullet present with low muscle mass due to poor nutrition and side effects related to cancer. A further one third of patients will then lose muscle during anti-cancer treatment such as chemotherapy and surgery. Patients with low muscle mass are less physically and functionally capable, are more likely to experience complications during treatment, and take longer to recover. CT scans can accurately measure muscle mass. However, CT delivers high radiation doses, are relatively expensive and require expertise to interpret. Ultrasound is emerging as a promising tool to measure muscle mass in other areas of medicine and might be of clinical use in patients with cancer. This requires further investigation.
This study will involve patients >18 years old receiving treatment (chemotherapy/surgery) for stomach and gullet cancer recruited at a single site (Salford Royal NHS Hospital). Follow up assessments at a second site (Christies NHS trust). All patients must have capacity to consent. We aim to investigate if ultrasound measurement of muscle is as good as CT measurements, and whether muscle loss detected on ultrasound is associated with worse clinical outcomes.
Willing participants will spend 10-15 minutes on 3 separate occasions during chemotherapy treatment (a period of approximately 3 months) completing the study assessments with a member of the research team. Assessments include: a questionnaire, an ultrasound scan of the upper leg and upper arm muscle, and two brief physical tests to assess muscle strength. The physical tests include squeezing a hand grip device, repeated standing from a chair, and walking in a straight line. If ultrasound can detect significant changes in muscle mass and function, it could be used as a monitoring tool to help guide supportive interventions such as exercise or extra nutritional support.Summary of Results
Background Loss of skeletal muscle mass and function, termed sarcopenia, can result in worse outcomes during treatment for Oesophagogastric (OG) cancer. Despite this, skeletal muscle mass and function are not routinely monitored in current clinical practice. Ultrasonography has shown promise as an effective method to quantify muscle size and quality and could provide a convenient tool to quantify muscle loss and identify those at risk of treatment-related complications. The aim of this study was to use ultrasound to measure skeletal muscle changes in patients going through cancer treatment.
Methods
Consecutive patients offered curative treatment for OG cancer (neoadjuvant chemotherapy (NAC) followed by surgery) were prospectively recruited to the MUSEC study. Thigh muscle architecture was measured by ultrasound and physical function assessed as 1 minute sit-to-stand at four time points during multimodal cancer treatment. The primary outcome was a detectable change in skeletal muscle ultrasound assessment. Secondary outcome measures included: correlation with CT skeletal muscle index (SMI), physical function, and the association between the Ultrasound Sarcopenia Index (USI) and treatment-related complications.
Results
Fifty patients were recruited. Overall, a significant deterioration in quadriceps muscle thickness, rectus femoris cross sectional area, rectus femoris echointensity, and USI was observed during treatment. USI showed only moderate correlation with CT SMI (r = -. 511, p=0.001) as USI classified more patients as ‘sarcopenic’ at baseline (37% vs 18%, p=0.001), and detected a greater magnitude of muscle loss during NAC (-20.2 ±18% vs -6.5 ±7.4%, p<0.001). Furthermore, USI had a stronger correlation with physical function when compared to CT SMI (r .589, p<0.001 versus r .149, p=0.169). USI at baseline was associated with a higher incidence of dose-limiting chemotoxicity and severe chemotoxicity but did not predict post-operative complications or length of hospital stay.
Conclusions:
In patients receiving treatment for OG cancer, ultrasound provides a clinically meaningful, bedside assessment of skeletal muscle and might predict chemotherapy-related toxicity. Ultrasound-defined low muscle mass correlated better with physical function and outperformed the current gold-standard CT assessment of sarcopenia. Further external validation studies are required in other patient populations, but ultrasound could prove an effective tool to monitor skeletal muscle health across multiple medical and surgical specialties.REC name
North of Scotland Research Ethics Committee 1
REC reference
21/NS/0141
Date of REC Opinion
13 Oct 2021
REC opinion
Favourable Opinion