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Front. Oncol. | doi: 10.3389/fonc.2019.01112

Body Composition Evaluation in Head and Neck Cancer Patients: A Review

 Inês A. Correia1,  Pedro M. Neves1, Antti Mäkitie2, 3, 4 and  Paula Ravasco1, 5*
  • 1Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa, Portugal
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Finland
  • 3Faculty of Medicine, University of Helsinki, Finland
  • 4Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Sweden
  • 5Hospital of Santa Maria, University Hospital Center Lisbon Norte, Portugal

Abstract
Introduction
Head and neck cancer (HNC) patients show a high risk of malnutrition due to the lifestyle habits adopted prior to the diagnosis as well as to the compromising impact of both the anatomical location of the tumour and the treatment modalities on food intake. Weight change, measurement of skinfold thickness, biochemical parameters, bioelectrical impedance analysis (BIA), computed tomography (CT), magnetic resonance (MRI) or dual-energy x-ray absorptiometry (DXA) are available techniques to evaluate nutritional status and/or body composition in the clinical practice.
Evaluating body composition alterations in HNC patients is essential to be able to offer the best therapeutical interventions. In this paper, we review the existing literature regarding body composition evaluation in HNC patients to determine, which is the most suitable method for this population, regarding availability in the day-to-day practice, patient burden, cost, sensibility and specificity.

Methodology
A literature search for relevant papers indexed in MEDLINE, Cochrane Library and Scielo was conducted, with no publication date restriction and for all published articles until the 31 January, 2019. All the papers written in English, with interventions in humans, exclusively considering HNC patients were selected.

Results
A total of 40 studies with different methodologies were included in this review. In 15 studies BIA was the used assessment method and three of them also evaluated skinfold thickness and one was a bioelectric impedance vector analysis (BIVA). Body composition assessment was made with DXA in eight studies, one of which also included muscle biopsies. In two studies the chosen method was both BIA and DXA. CT/ positron emission tomography-CT was applied in 11 studies and one also included MRI. In one study body composition was assessed with skinfold measurements alone and one study only used BIVA.

Conclusions
Despite the different existing body composition assessment tools, it seems that skeletal muscle mass (SMM) measurement at the level of cervical spine C3 vertebra may be a reliable method for SMM assessment as it strongly correlates with cross-sectional area measures at the level of L3 and it allows a cost-effective body composition assessment without the need for additional radiation exposure.

Keywords: head and neck cancer, Body Composition, Cachexia, Lean Body Mass, BIA, DEXA, CT

Received: 23 May 2019; Accepted: 07 Oct 2019.

Copyright: © 2019 Correia, Neves, Mäkitie and Ravasco. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD, PhD. Paula Ravasco, Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa, Lisboa, Portugal, p.ravasco@medicina.ulisboa.pt