Adult survivors of pediatric solid abdominal/pelvic cancers treated with radiation therapy (RT) were likely to have lower lean body mass and insulin resistance than adults in the general US population, according to findings of a study published in Cancer Epidemiology, Biomarkers, and Prevention.
Although previous studies have reported changes in body composition and cardiometabolic characteristics of adult survivors of pediatric lymphoblastic leukemia and brain tumors, as well as those who underwent hematopoietic stem cell transplantation (HSCT) as children, less is known about the impact of treatment-related factors on adult survivors of pediatric solid abdominal/pelvic tumors.
This study included all eligible adult survivors aged 18 years or older in the St. Jude Lifetime Cohort with a solid tumor abdominal/pelvic cancer — such as neuroblastoma, Wilms tumor, hepatoblastoma, germ cell tumor, osteosarcoma or Ewing carcinoma, soft-tissue sarcoma, as well as other solid cancers of an abdominal or pelvic organ — diagnosed at least 10 years previously.
Whole body, dual X-ray absorptiometry (DXA) was used to measure body composition; insulin sensitivity/resistance was assessed using the homeostatic model assessment (HOMA-IR) index formula; and strength and mobility were evaluated using different flexion and extension tests, including a handgrip test, and a 6-minute walk test, among other tests. In addition, other laboratory indicators of cardiovascular health, such as levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, and hemoglobin A1C were measured. Information on lifestyle factors, such as smoking history, were collected using a structured questionnaire.
Data related to body composition of survivors were matched according to age, sex, and ethnicity with data collected for the general US population as part of the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). In addition, the NHANES data were also used to compare the prevalence of insulin resistance, low HDL, high LDL, and triglycerides in survivors with that of the general US population.
Of the 431 survivors included in this analysis, the median ages at cancer diagnosis and assessment were 3.6 years and 29.9 years, respectively.
A key finding of this study was that the mean relative lean mass was significantly lower for both male (P <.001) and female survivors (P <.001) compared with the comparator groups.
Of note, multivariate analyses showed increasing pelvic and abdominal RT doses were significantly associated with lower lean body mass in both male and female survivors.
An evaluation of the prevalence of insulin resistance in survivors (40.2%) compared with that found using data from NHANES (33.8%) showed a significant difference (P =.006). Although the prevalence of low HDL (P =.046) and high triglycerides (P <.001) were also significantly higher in survivors compared with the general US population, a significant difference in LDL level was not observed when these 2 groups were compared (P =.026).
Moreover, significantly increased risks of insulin resistance (P <.001), reduced quadriceps strength (P <.001), and shorter distance covered in the 6-minute walk test (P <.01) were observed in adult survivors with normal/high lean mass and high fat mass compared with those with normal/high lean mass and normal/low fat mass.
“This is important, given that findings from this and other studies indicate that survivors of abdominal/pelvic solid tumors do not have increased [body mass index], an important risk factor for cardiometabolic diseases, relative to the general population,” the study authors noted.
“Moving forward, while it may not be possible to avoid [RT] as a key treatment for many solid tumors, further research is required to assess whether interventions in both [childhood] and adulthood could remediate abnormalities in body composition and cardiometabolic impairments,” the study authors remarked in their concluding statements.
Wilson CL, Liu W, Chemaitilly W, et al. Body composition, metabolic health, and functional impairment among adults treated for abdominal and pelvic tumors during childhood. Cancer Epidemiol Biomarkers Prev. Published online August 13, 2020. doi:10.1158/1055-9965.EPI-19-1321