Early body weight loss during concurrent chemo-radiotherapy for non-small cell lung cancer

Background and purpose Radiation-esophagitis and weight loss are frequently observed toxicities in patients treated with concurrent chemo-radiotherapy (CT-RT) for non-small cell lung cancer (NSCLC) and might be related. The purpose was to investigate whether weight loss already starts early after initiation of CT-RT and precedes radiation-esophagitis. Materials and methods In a retrospective cohort, weight and esophagitis grade >= 2 were assessed during the first weeks of (CT-)RT in patients treated with concurrent (n=102) or sequential (n=92) therapy. In a prospective validation study, data on body weight, esophagitis grade >= 2, nutritional intake and muscle strength were obtained before, during and following CT-RT. Results In the retrospective cohort, early weight loss was observed in concurrently treated patients (p=0.002), independent of esophagitis >= grade 2. Early weight loss was also observed in the prospective cohort (p=0.003) and was not accompanied by decreases in nutritional intake. In addition lower limb muscle strength rapidly declined (p = 0.042). In the later weeks of treatment, further body weight loss occurred (p<0.001) despite increased nutritional supplementation and body weight was only partly recovered after 4 weeks post CT-RT (p=0.003). Conclusions Weight loss during concurrent CT-RT for NSCLC starts early and prior to onset of esophagitis, requiring timely and intense nutritional rehabilitation.