Early body weight loss during concurrent chemo-radiotherapy for non-small cell lung cancer

Background and purpose Radiation-esophagitis and weight loss are frequently observed toxicities in patients treated with concurrent chemo-radiotherapy (CT-RT) for non-small cell lung cancer (NSCLC) and might be related. The purpose was to investigate whether weight loss already starts early after initiation of CT-RT and precedes radiation-esophagitis. Materials and methods In a retrospective cohort, weight and esophagitis grade ≥2 were assessed during the first weeks of (CT-)RT in patients treated with concurrent ( n = 102) or sequential ( n = 92) therapy. In a prospective validation study, data on body weight, esophagitis grade ≥2, nutritional intake and muscle strength were obtained before, during and following CT-RT. Results In the retrospective cohort, early weight loss was observed in concurrently treated patients ( p = 0.002), independent of esophagitis ≥ grade 2. Early weight loss was also observed in the prospective cohort ( p = 0.003) and was not accompanied by decreases in nutritional intake. In addition lower limb muscle strength rapidly declined ( p = 0.042). In the later weeks of treatment, further body weight loss occurred ( p < 0.001) despite increased nutritional supplementation and body weight was only partly recovered after 4 weeks post CT-RT ( p = 0.003). Conclusions Weight loss during concurrent CT-RT for NSCLC starts early and prior to onset of esophagitis, requiring timely and intense nutritional rehabilitation.