Background Concurrent chemoradiotherapy for locally advanced cervical cancer (LACC) must be completed within 56 days, with each added day increasing recurrence risk by 1%. Sarcopenia, malnutrition, and cachexia affect 20–60% of patients, yet guidelines do not recommend routine screening, and their independent associations with outcomes remain unmapped. Methods We searched MEDLINE, Scopus, Web of Science, and Cochrane (1995–2025) for studies reporting cachexia, malnutrition, or sarcopenia with survival, toxicity, treatment completion, or quality of life in LACC patients receiving chemoradiotherapy. Two reviewers screened records, extracted data, and assessed bias using QUIPS. Results Twenty-three studies (4,352 women; cohorts 41–391) used heterogeneous definitions. Malnutrition was assessed in 17 studies, sarcopenia in 15, and cachexia in 2. Malnutrition showed 1.5- to 3.7-fold higher mortality. Chemotherapy-defined sarcopenia predicted survival in 5 of 11 assessments (HR 1.75–3.60); sarcopenic obesity carried HR 2.65. On-treatment body-composition loss showed strongest effects: ≥7–10% skeletal-muscle decline (HR 6.02) and ≥15% intermuscular fat loss (HR 8.52) predicted higher mortality. Grade ≥3 toxicity and treatment interruption were 1.2- to 2.5-fold more frequent in malnourished or sarcopenic women, increasing to 3–5-fold with multiple unfavorable body-composition features. Quality-of-life scores declined 11% during treatment. Seventeen studies had high bias risk from attrition and inadequate confounder control. Conclusions Malnutrition, sarcopenia, and cachexia correlate with poor survival and treatment tolerance in LACC chemoradiotherapy; on-treatment muscle loss shows strongest prognostic value. Screening at baseline and muscle quantification on chemotherapy can identify high-risk patients. Consensus definitions, prospective validation, and multimodal prehabilitation trials are needed before implementation.
Cachexia, sarcopenia, malnutrition and their impact on survival, treatment toxicities, and quality of life in locally advanced cervical cancer patients undergoing concomitant chemoradiotherapy: A scoping review
Pentimalli, Francesca;
2025-01-01
Abstract
Background Concurrent chemoradiotherapy for locally advanced cervical cancer (LACC) must be completed within 56 days, with each added day increasing recurrence risk by 1%. Sarcopenia, malnutrition, and cachexia affect 20–60% of patients, yet guidelines do not recommend routine screening, and their independent associations with outcomes remain unmapped. Methods We searched MEDLINE, Scopus, Web of Science, and Cochrane (1995–2025) for studies reporting cachexia, malnutrition, or sarcopenia with survival, toxicity, treatment completion, or quality of life in LACC patients receiving chemoradiotherapy. Two reviewers screened records, extracted data, and assessed bias using QUIPS. Results Twenty-three studies (4,352 women; cohorts 41–391) used heterogeneous definitions. Malnutrition was assessed in 17 studies, sarcopenia in 15, and cachexia in 2. Malnutrition showed 1.5- to 3.7-fold higher mortality. Chemotherapy-defined sarcopenia predicted survival in 5 of 11 assessments (HR 1.75–3.60); sarcopenic obesity carried HR 2.65. On-treatment body-composition loss showed strongest effects: ≥7–10% skeletal-muscle decline (HR 6.02) and ≥15% intermuscular fat loss (HR 8.52) predicted higher mortality. Grade ≥3 toxicity and treatment interruption were 1.2- to 2.5-fold more frequent in malnourished or sarcopenic women, increasing to 3–5-fold with multiple unfavorable body-composition features. Quality-of-life scores declined 11% during treatment. Seventeen studies had high bias risk from attrition and inadequate confounder control. Conclusions Malnutrition, sarcopenia, and cachexia correlate with poor survival and treatment tolerance in LACC chemoradiotherapy; on-treatment muscle loss shows strongest prognostic value. Screening at baseline and muscle quantification on chemotherapy can identify high-risk patients. Consensus definitions, prospective validation, and multimodal prehabilitation trials are needed before implementation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
