Fatih SARGIN, İsmail BEYPINAR, Hasan Şenol COŞKUN

Vücut Yağ Oranının Kemoterapiye Bağlı Bulantı-Kusma Üzerine Etkisi

Giriş: Kanser, dünyada en önde gelen ölüm nedenleri arasındadır. Kanser tedavisinde kemoterapi hala önemli bir yer tutmaktadır ve en sık akut yan etkileri bulantı ve kusmadır. Antineoplastik ilaç dozları boy ve kiloya göre hesaplanan vücut yüzey alanına göre ayarlanmaktadır. Vucut yüzey alanı boy ve kilo ile ilişkili olmakla beraber vücut yağ-kas kompozisyonu farklılıklar göstermektedir. Çalışmada vücut yağ oranının kemoterapiye bağlı bulantı-kusma üzerine etkisi araştırıldı. Yöntemler: Daha önce herhangi bir tedavi almamış ve yüksek emetojenik kemoterapi alan 52 hasta çalışmaya dahil edildi. Hastaların tedavi öncesi deri altı yağ kalınlıklarına göre SIRI metodu ile yaklaşık vücut yağ oranları hesaplandı, Elektriksel empedans yöntemi kullanılarak sıvı kompartmanları ve yağ oranları belirlendi. Kemoterapi öncesinde standart anti-emetik tedaviler uygulanarak ilk kemoterapileri sonrasındaki 3 haftalık dönem boyunca bulantı kusma yan etkisi değerlendirildi. Bulgular: Hastaların %75’i kadın ve en sık tanı meme kanseriydi. En sık kullanılan kemoterapi rejimi ise siklofosfamid-doksorubisin-5-FU kombinasyonuydu. SIRI ve BCM metodları arasında yağ, sıvı ve kas dokusu dağılımları ilişkisi istatistiksel olarak anlamlı olarak korele bulundu. 52 hastanın 17'sinde kemoterapiye bağlı bulantı ve kusma gelişti. Vücut yağ oranı (Siri metod, p = 0.921), (BCM metod, p = 0.783), vücut kitle indeksi (p=0.858), vücut yüzey alanı (p = 0.705) ve vücut sıvı kompartmanı değişimlerinin kemoterapi sonrasında oluşan bulantı-kusma üzerine anlamlı bir etkisi saptanmadı. Sonuç: Çalışmamızda vücut kompozisyonunun kemoterapi sonrası bulantı kusma ile ilişkisi saptanmadı. BU nedenle özellikle obez hastalarda yan etkilerden endişe edilerek doz sınırlamasına gidilmemesi gerektiği ve hesaplanan aktüel sonuçlara göre kemoterapi verilmesi önerilir. Çalışmanın diğer akut ve kronik toksisiteleri de değerlendirecek şekilde genişletilmeye ihtiyacı vardır.

Anahtar Kelimeler:

Bulantı, Kusma, Kemoterapi, Vücut yağ oranı, Beden kütle indeksi

The Effect Of Body Fat Ratio On Chemotherapy-Induced Nause-Vomiting

Introduction: Chemotherapy still occupies an important place in cancer treatment, with the most common acute side effects of nausea and vomiting. Antineoplastic drug doses are adjusted according to the body surface area, calculated according to height and weight. The impact of the body-fat ratio on chemotherapy-induced nausea and vomiting was investigated in the study. Methods: Fifty-two patients who had received highly emetogenic chemotherapy without previous treatment were included in the study. Nausea and vomiting side effects were evaluated three weeks after the first chemotherapy under standard anti-emetic treatments before chemotherapy. Results: 75% of the patients were female, and the most common diagnosis was breast cancer. The most commonly used chemotherapy regimen was the combination of cyclophosphamide-doxorubicin-5-FU. The relationship between fat, fluid, and muscle tissue distributions was significantly correlated between SIRI and BCM methods. In 17 of 52 patients, nausea and vomiting developed due to chemotherapy. There was no significant effect of changes in body fat ratio (Siri method, p = 0.921), (BCM method, p = 0.783), body mass index (p=0.858), body surface area (p = 0.705), and body fluid compartment on nausea and vomiting after chemotherapy. Conclusion: Our study found no relationship between body composition and nausea and vomiting after chemotherapy. Therefore, especially in obese patients, it is recommended not to limit the dose by worrying about side effects and to give chemotherapy according to the actual results calculated.

Keywords:

Nausea Vomiting, Chemotherapy, Body fat ratio, Body surface area, Body mass index,

PDF

___

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians. 2021;71(3):209-249. doi:10.3322/CAAC.21660
2. Crawford S. Is it time for a new paradigm for systemic cancer treatment? Lessons from a century of cancer chemotherapy. Frontiers in Pharmacology. 2013;4 JUN. doi:10.3389/fphar.2013.00068
3. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO Guideline Update. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2020;38(24):2782-2797. doi:10.1200/JCO.20.01296
4. Gupta K, Walton R, Kataria SP. Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends. Cancer treatment and research communications. 2021;26. doi:10.1016/J.CTARC.2020.100278
5. Yokoe T, Hayashida T, Nagayama A, et al. Effectiveness of Antiemetic Regimens for Highly Emetogenic Chemotherapy-Induced Nausea and Vomiting: A Systematic Review and Network Meta-Analysis. The oncologist. 2019;24(6):e347-e357. doi:10.1634/THEONCOLOGIST.2018-0140
6. Portugal RD. Obesity and dose individualization in cancer chemotherapy: The role of body surface area and body mass index. Medical Hypotheses. 2005;65(4):748-751. doi:10.1016/j.mehy.2005.04.023
7. Siri WE, Lukaski HC. Body composition from fluid spaces and density: Analysis of methods ... Prospective Overview. In: Nutrition. Vol 9. ; 1993:224-244.
8. Haapala I, Hirvonen A, Niskanen L, et al. Anthropometry, bioelectrical impedance and dual-energy X-ray absorptiometry in the assessment of body composition in elderly Finnish women. Clinical Physiology and Functional Imaging. 2002;22(6):383-391. doi:10.1046/j.1475-097X.2002.00447.x
9. Jaffrin MY, Morel H. Body fluid volumes measurements by impedance: A review of bioimpedance spectroscopy (BIS) and bioimpedance analysis (BIA) methods. Medical Engineering and Physics. 2008;30(10):1257-1269. doi:10.1016/j.medengphy.2008.06.009
10. Deurenberg P, Weststrate JA, Hautvast JGAJ. Changes in fat-free mass during weight loss measured by bioelectrical impedance and by densitometry. American Journal of Clinical Nutrition. 1989;49(1):33-36. doi:10.1093/ajcn/49.1.33
11. Hanley MJ, Abernethy DR, Greenblatt DJ. Effect of obesity on the pharmacokinetics of drugs in humans. Clinical pharmacokinetics. 2010;49(2):71-87. doi:10.2165/11318100-000000000-00000
12. Prado CMM, Baracos VE, McCargar LJ, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clinical Cancer Research. 2007;13(11):3264-3268. doi:10.1158/1078-0432.CCR-06-3067
13. DEMİR H, BEYPINAR İ, BAYKARA M. The Effect of the Prognostic Nutritional Index on Chemoradiotherapy Response in Lung Cancer. Journal of Oncological Sciences. 2020;6(2):96-102. doi:10.37047/jos.2020-75476
14. Schwartz J, Toste B, Dizon DS. Chemotherapy toxicity in gynecologic cancer patients with a body surface area (BSA) > 2 m2. Gynecologic Oncology. 2009;114(1):53-56. doi:10.1016/j.ygyno.2009.03.010
15. Abdah-Bortnyak R, Tsalic M, Haim N. Actual Body Weight for Determining Doses of Chemotherapy in Obese Cancer Patients: Evaluation of Treatment Tolerability. Medical Oncology. 2003;20(4):363-367. doi:10.1385/MO:20:4:363
16. Raman R, Mott SL, Schroeder MC, Phadke S, el Masri J, Thomas A. Effect of Body Mass Index- and Actual Weight-Based Neoadjuvant Chemotherapy Doses on Pathologic Complete Response in Operable Breast Cancer. Clinical breast cancer. 2016;16(6):480-486. doi:10.1016/J.CLBC.2016.06.008
17. Budman DR, Berry DA, Cirrincione CT, et al. Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. Journal of the National Cancer Institute. 1998;90(16):1205-1211. doi:10.1093/jnci/90.16.1205
18. Lyman GH. Chemotherapy dose intensity and quality cancer care. Oncology (Williston Park, NY). 2006;20(14 Suppl 9):16-25.
19. Farker K, Merkel U, Wedding U, Hippius M, Höffken K, Hoffmann A. Chronomodulated chemotherapy with oxaliplatin, 5-FU and sodium folinate in metastatic gastrointestinal cancer patients: Analysis of non-hematological toxicity and patient characteristics in a pilot investigation. International Journal of Clinical Pharmacology and Therapeutics. 2006;44(1):31-37. doi:10.5414/cpp44031
20. Mosa ASM, Mosharraf Hossain A, Lavoie BJ, Yoo I. Patient-Related Risk Factors for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review. Frontiers in pharmacology. 2020;11. doi:10.3389/FPHAR.2020.00329