Toxicity of induction chemotherapy in head and neck cancer: The central role of skeletal muscle mass

Background To assess the impact of nutritional status on tolerance to induction chemotherapy by docetaxel, cisplatin and 5-fluorouracil (ICT) in head and neck cancer (HNC). Methods Ninety-two HNC patients were included. Toxicity was assessed according to common terminology criteria for adverse events. Nutritional status was assessed by body mass index (BMI), serum albumin, nutritional risk index (NRI), and CT scan (skeletal muscle mass index [SMI] at the first lumbar vertebral level). Results Before treatment, average BMI was 22.7 +/- 4.6 kg/m(2), serum albumin 38.7 +/- 5.8 g/L, NRI 97.6 +/- 10.6, and SMI 36.4 +/- 7.9 cm(2)/m(2). After treatment, BMI was 23 +/- 4.5, serum albumin 30.2 +/- 7.1, and NRI 88.1 +/- 9.2. During ICT, 52 (62%) patients developed at least one toxicity >= Grade 3. Pre-treatment SMI was the only predictive factor of toxicity irrespective of BMI (p = 0.04). Conclusion Low skeletal muscle mass is a predictive factor of toxicity to ICT in HNC.