Resistance Training During Chemoradiotherapy Safe for Patients with HNSCC

Is progressive resistance training (PRT) feasible during concomitant chemoradiotherapy (CCRT) in patients with head and neck squamous cell carcinoma (HNSCC)?

Bottom line
PRT in a clinical setting is safe during CCRT for head and neck cancer, and is associated with high patient satisfaction.

Background: Patients with HNSCC undergoing CCRT frequently experience weight loss, especially loss of lean body mass (LBM), and reduced functional performance. Some data indicate that chemotherapy side effects may be ameliorated by exercise. In patients with head and neck cancer, exercise trials studying training intervention during radiotherapy or CCRT are sparse, but have been gaining ground. The trials all differ in type of intervention, intensity, and frequency, as well as outcome measures, but across these studies, changes in muscle strength, mobility, physical activity, fatigue, diet, and quality of life endpoints in favor of the training intervention group are reported.

Resistance training is an efficient way of maintaining or increasing muscle mass, and the authors of this study wanted to test the feasibility of a 12-week PRT program, as well as the entire study logistics with scans, questionnaires, and controls in their own clinic before launching a randomized trial. Difference in LBM was the primary outcome measure.

Study design: Prospective pilot study.

Synopsis: Twelve patients receiving CCRT participated in a 12-week PRT program. The primary endpoint was feasibility measured as attendance to training sessions. Secondary endpoints included changes in functional performance, muscle strength, and body composition measured by dual-energy X-ray absorptiometry (DXA) scans. Furthermore, sarcomeric protein content, pentose phosphate pathway (PPP) activity, and glycolysis were determined in muscle biopsies. Twelve patients with p16-positive oropharyngeal cancer were enrolled. The primary endpoint was met with nine of the 12 patients completing at least 25 of 36 planned training sessions. The mean attendance rate was 77%. Functional performance was maintained during the treatment period and increased during follow-up. Strength was regained after an initial dip during treatment, paralleling responses in LBM and sarcomeric protein content. LBM began to increase immediately after treatment. The PPP was upregulated after the treatment period, while glycolysis remained unchanged.

No adverse events were related to PRT and in questionnaires, patients emphasized the social and psychological benefits of attendance.

Citation: Lonkvist CK, Vinther A, Zerahn B, et al. Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy. Laryngoscope Invest Otol. [Published online July 19, 2017]. doi: 10.1002/lio.88.