Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses

Federica Medici; Alberto Bazzocchi; Milly Buwenge; Alice Zamagni; Gabriella Macchia; Francesco Deodato; Savino Cilla; Pierandrea De Iaco; Anna Myriam Perrone; Lidia Strigari; Stefania Rizzo; Alessio G Morganti

doi:10.3389/fonc.2022.887156

Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses

Front Oncol. 2022 May 26:12:887156. doi: 10.3389/fonc.2022.887156. eCollection 2022.

Authors

Affiliations

¹ Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy.
² Diagnostic and Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy.
³ Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy.
⁴ Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy.
⁵ Division of Oncologic Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁶ Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, Bologna, Italy.
⁷ Medical Physics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁸ Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
⁹ Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Abstract

Background: Sarcopenia (SP) is defined as the quantitative and functional impairment of skeletal muscles. SP is commonly related to older age and is frequent in patients with cancer. To provide an overview of SP in patients treated with radiotherapy (RT) and to evaluate the current evidence, we analyzed the available systematic reviews and meta-analyses.

Methods: Reviews were identified using PubMed, Scopus, and Cochrane library databases, without date restriction. Only systematic reviews and meta-analyses on the prognostic impact of SP and on any treatments aimed at reducing SP effect, in patients undergoing RT, were included in this review. The analyses not separately reporting the results in patients treated with RT were excluded. The quality assessment was performed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews).

Results: From the 84 papers identified, five reviews met the inclusion criteria with four reports mainly including non-randomized trials. Three reviews on the effect of SP showed a significantly negative impact on overall survival in patients undergoing RT and/or chemoradiation for H&N cancers (HR: 1.63-2.07). Two reviews on interventional studies showed the possibility of 1) improving physical functions through nutritional and physical interventions and 2) avoiding muscle wasting by means of sufficient protein intake. The quality assessment of the included review showed that two and three analyses are classifiable as having low and moderate overall confidence rating, respectively.

Conclusions: The analyzed reviews uniformly confirmed the negative impact of SP in patients with H&N tumors undergoing RT and the possibility of improving muscle mass and function through nutritional and physical interventions. These results justify further research on this topic based on a more uniform SP definition and on a complete evaluation of the potentially confounding parameters.

Keywords: AMSTAR-2; literature review; prognostic factors; radiotherapy; sarcopenia.

Publication types

Review