Low Skeletal Muscle Mass is a Risk Factor for Aspiration Pneumonia During Chemoradiotherapy

OBJECTIVES:This study aimed to investigate whether pretreatment skeletal muscle mass index (SMI) is a predictor for the risk of aspiration pneumonia and to explore the relationship between low SMI and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC) receiving chemoradiotherapy (CRT).METHODS:We retrospectively reviewed the data of patients with HNSCC who received CRT during 2010-2019. Patients received a combination of radiotherapy and cisplatin-based chemotherapy (3 cycles of 80 mg/m2 cisplatin on days 1, 22, and 43). Aspiration pneumonia were defined as the presence of both subjective and objective symptoms. Kaplan-Meier curves were generated to analyze survival.RESULTS:Among the 159 patients, 36 (22.6%) developed aspiration pneumonia during treatment. Median SMI in patients with and without pneumonia was 12.4 cm2 /m2 (9.0-20.7) and 13.6 cm2 /m2 (8.1-19.7), respectively (P < .01). Multivariate logistic regression revealed that SMI was the only independent predictor of aspiration pneumonia (P = .0026). Mean OS was significantly shorter for patients with low SMI than for patients with normal SMI (66.9 months vs. 92.7 months, P = .001).CONCLUSION:Pretreatment low SMI predicts development of aspiration pneumonia and is a strong negative prognostic predictor for OS in patients with HNSCC undergoing CRT. Supportive treatment can be provided to patients at high risk of a low SMI. This study is the first to report SMI as a prognostic predictor in HNSCC. Laryngoscope, 131:E1524-E1529, 2021.