Skeletal muscle mass in head and neck cancer patients: Radiological assessment and association with clinical outcome

In recent years, it has been shown that routinely performed imaging, such as computed tomography (CT) scans, can be used to extract additional information on patient’s functional and biological status, which may be used to identify patients at increased risk of adverse outcomes during and after treatment. Low skeletal muscle mass is the most known example of this application; research has shown that modern imaging such as CT or MRI can be used to accurately assess skeletal muscle quantity. Our research shows that the quantity of skeletal muscle mass can easily and reliably be assessed on CT imaging of the head and neck area. Low skeletal muscle mass, as identified on routinely performed CT and MRI of the head and neck area, is associated with increased chemotherapy dose-limiting toxicity, increased pharyngocutaneous fistula formation after total laryngectomy and decreased overall survival in several head and neck patient categories. These results are in concurrence with results in other types of cancer. Routinely performed imaging can also be used to assess the presence of arterial calcification, as a proxy for cardiovascular disease.

Concluding, routinely performed imaging does not only provide easily accessible and clinically relevant information on disease status, but also holds valuable information on body composition of a patient, which may be used in individualized risk stratification, treatment adaptation and patient optimization strategies to ultimately decrease short-term adverse outcomes and increase survival.