Toxicidade em pacientes com câncer no trato gastrointestinal durante a quimioterapia: associações com Sarcopenia e Caquexia

Abstract

Chemotherapy is a systemic treatment of great relevance for cancer patients; however, it can lead to a series of adverse events, called toxicities. In the evaluation of nutritional status, sarcopenia and cachexia have been associated with several unfavorable prognoses in cancer, such as increased toxicity during chemotherapy. Thus, the objective of this study was to evaluate the effects of cachexia and sarcopenia on the occurrence of toxicities in patients during the first three cycles of chemotherapeutic treatment for gastrointestinal cancer. A prospective study was conducted with patients starting the first cycle of chemotherapy. Haematological and gastrointestinal toxicity and the presence of a dose limiting toxicity (DLT) were assessed according to the NCI Common Toxicity Criteria. Functional capacity was evaluated using dynamometry and the performance scale ECOG. Sarcopenia and muscle attenuation was assessed using skeletal muscle index with computed tomography by measuring crosssectional areas of the L3 portion (cm2 /m2 ) and classification according to specific cutoff points. Diagnosis of cachexia was performed according to the current consensus, based on involuntary weight loss in the absence of anorexia associated, with presence of sarcopenia. To examine associations between sarcopenia, cachexia, nutritional status and functional capacity with DLT we used univariate and multivariate regression. The associations were tested and statistical significance was considered when p <0.05. In results, sixty (60) patients were evaluated, with a higher prevalence of males (55%) and mean age of 60 years. At baseline, the majority of the participants presented adequate nutritional status and good functional capacity (85%) for ECOG. During chemotherapy, sarcopenic patients had significantly higher degrees of toxicity for anorexia (p = 0.045), nausea (p = 0.044), and leukopenia (0.036). In cachetics, significant levels of toxicities were found for nausea (p = 0.026) and anorexia (0.013 and 0.028 in the first and second cycles, respectively). In multivariate analysis including the only factor associated with DLT was cachexia and ECOG Scale. In conclusion, cachexia and ECOG were parameters predict risk factor for severe toxicity events in patients with gastrointestinal cancer during chemotherapy.