Purpose: This study investigates the association between body composition change during concurrent chemoradiotherapy (CCRT) and outcome in patients with locally advanced cervical cancer (LACC). Experimental Design: Pre- and post-treatment computed tomography (CT) images of 245 patients with LACC who were treated between 2004 and 2015 were analysed. Skeletal muscle index (SMI) and density (SMD), subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI) were measured from two sets of CT images at the level of the L3 vertebra. Sarcopenia and a low SMD were defined using published cut-points. Predictors of overall survival (OS) and cancer-specific survival (CSS) were analysed using Cox regression models. Results: The median follow-up was 62.7 (range, 7.3-152.3) months. Among the 245 patients, 127 (51.8%) had pre-treatment sarcopenia and 154 (62.9%) had a low SMD. SMI did not decrease significantly during CCRT, 0.6%/150 days (95% CI: -1.8 to 0.6; p = 0.35). However, a SMI loss during CCRT of >10.0%/150 days was independently associated with poorer OS (hazard ratio: 6.02, 95% confidence interval: 3.04-11.93; p < 0.001) and CSS (hazard ratio: 3.49, 95% confidence interval: 1.44-8.42; p = 0.006) when adjusted for FIGO stage, pathology, and treatment. Pre-treatment sarcopenia and change of SMD, SATI, and VATI during CCRT were not associated with survival. Conclusions: Skeletal muscle measurements could be imaging biomarkers to predict outcomes for patients with LACC in clinical practice. Further studies are needed to determine whether multimodal interventions can preserve skeletal muscle mass and thereby improve survival.
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