Radiation and Chemotherapy

Case Report

Patient data

Patient data

Age: 56 years
Gender: female
Height: 1.65 m
Initial weight: 58.00 kg
Initial BMI: 21.30 kg/m²


Medical history / diagnosis

Medical history / diagnosis

A 56 year-old female patient has endometrial cancer. A combined treatment involving chemotherapy (Taxol and Carboplatin) and radiotherapy is being implemented. In the process, the patient’s state of nutrition is to be monitored and improved if necessary with the aid of parenteral nutrition (PN).


Graphs of measuring results

Graphs of measuring results

Weight
The patient loses weight after every chemotherapy or radiotherapy treatment. Parenteral nutrition following each treatment enabled the weight to be stabilized again. The weight graph over 26 weeks with a total of seven measured data is shown below:
 

  • Measurement 1 (Week 1): 58.00 kg
  • Measurement 2 (Week 3): 57.50 kg
  • Measurement 3 (Week 6): 58.50 kg
  • Measurement 4 (Week 9): 57.50 kg
  • Measurement 5 (Week 13): 58.50 kg
  • Measurement 6 (Week 22): 57.00 kg
  • Measurement 7 (Week 26): 58.00 kg

Graphs of measuring results

Bioelectrical impedance vector analysis (BIVA)
The progress in the state of nutrition can be followed in the BIVA: 

  • Measurement 1: start of chemotherapy
  • Measurement 2: 0.50 kg lost, loss of appetite, PN started
  • Measurement 3: 1.00 kg gained, PN stopped, radiotherapy started
  • Measurement 4: 1.00 kg lost, loss of appetite, diarrhea, PN started
  • Measurement 5: 1.00 kg gained, PN stopped
  • Measurement 6: 1.50 kg lost, metastases in peritoneum, PN started
  • Measurement 7: 1.00 kg gained

 

 


Summary

Summary

The treatment of endometrial cancer in a 56 year-old female patient shows clear changes in the state of nutrition. BIVA allows the interaction of therapy and parenteral nutrition to be tracked and assessed very well. Following the start of treatment, there is a reduction in body cell mass. It was possible to halt this reduction by means of parenteral nutrition, and body cell mass rises again. The BIVA graph also shows the continuous deterioration in body composition. This might not be detected using weight alone, which demonstrates the necessity for a seca mBCA measurement to assess the nutritional state correctly.

The changes in the state of nutrition caused by chemotherapy and radiotherapy can be visualized with the aid of the seca mBCA, in particular by considering the BIVA; parenteral nutrition measures can be derived from this to offer the patient the best possible quality of life.


Tumor Cachexia

Case Report

Patient data

Patient data

Age: 59 years
Gender: male
Height: 1.66 m
Initial weight: 69.00 kg
Initial BMI: 25.00 kg/m²


Medical history / diagnosis

Medical history / diagnosis

A 59-year old Caucasian male suffering from bronchial carcinoma shows the following development of weight after tumor removal by “lobectomy”:

  • March 14, 2012: 78.00 kg
  • May 18, 2012: 69.00 kg

Thus, a clinically relevant weight loss is indicated.


Graphs of measuring results

Graphs of measuring results

Body Mass Index (BMI)

The BMI and the fat mass are slightly increased but not remarkable.

  • Height: 1.66 m
  • Weight: 69.00 kg
  • BMI: 25.00 kg/m2

Graphs of measuring results

Fat mass

The increased fat percentage can be explained by the missing physical activity which the patients states.

  • Fat mass (FM): 20.50 kg
  • Fat percentage (FM %): 30.00 %
  • Fat mass index (FMI): 7.40 kg/m²

Graphs of measuring results

Body composition chart (BCC)

The BCC, however, indicates the assumed decreased muscle mass (weight loss, tumor and missing physical activity).

  • Fat Free Mass Index (FFMI): 17.70 kg/m2
  • Fat Mass Index (FMI): 7.50 kg/m2

Graphs of measuring results

Bioelectrical impedance vector analysis (BIVA)

The subject stands out in the BIVA graph due to his measuring point beyond the 95th tolerance ellipse which indicates a low proportion of cells.

  • Resistance R (50kHz): 536.9 Ω
  • Reactance Xc (50kHz): 35.9 Ω

Graphs of measuring results

Phase angle

The phase angle value of 3.8° thus lies well below the normal values that apply for him.

  • Phase angle φ: 3.8°

Summary

Summary

Due to the bad prognosis deriving from the phase angle, an early nutritional therapy and treatment of the tumor cachexia is required (see Fearons International Cachexia Lancet Oncology). Although the BMI value seems normal, the weight loss can be clearly seen in his body composition: reduced muscle mass and cell mass. Due to the planned chemotherapy it is necessary to improve and closely monitor the nutritional state (see Andreyev, Ross) in order to offer the patient the best possible quality of life. Without having had access to a fast, clinically precise and differentiated body composition measurement this therapy recommendation would not have been possible.

Despite unremarkable BMI and fat mass values, the seca mBCA detected the cachectic state caused by the tumor disease and thus allows to define a nutritional therapy.