{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:55:50Z","timestamp":1781254550265,"version":"3.54.1"},"reference-count":42,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Anthracycline- and taxane-based chemotherapy regimens are widely used in the treatment of breast cancer; however, their effects on body composition and fluid distribution are not fully elucidated. Conventional assessment methods are often insufficient to distinguish true tissue changes from treatment-related fluid shifts. The primary objective of this study was to evaluate longitudinal changes in body composition and fluid distribution during chemotherapy in breast cancer patients using bioelectrical impedance spectroscopy. The secondary objective was to investigate the impact of anthracycline and docetaxel exposure on these changes and to identify patterns suggestive of masked sarcopenia. Methods: This prospective, single-center, longitudinal observational study was conducted between October 2024 and October 2025. Follow-up assessments at 3 and 6 months were completed by October 2025. A total of 51 female breast cancer patients undergoing systemic chemotherapy were evaluated using multifrequency bioelectrical impedance spectroscopy (BCM\u00ae). Measurements were performed at baseline, 3 months, and 6 months. Changes in total body water (TBW), extracellular water (ECW), intracellular water (ICW), extracellular-to-intracellular water ratio (E\/I), lean tissue mass (LTM), adipose tissue mass (ATM), and volume status were analyzed longitudinally and according to treatment exposure. Results: The cohort consisted of 51 women (median age, 55 years), of whom 70.6% were postmenopausal, and the majority had stage II\u2013III disease. While TBW remained stable, significant alterations in fluid distribution and body composition were observed. ECW increased, and ICW decreased, resulting in a significant rise in the E\/I ratio. LTM declined significantly, particularly during the first 3 months, whereas ATM showed a gradual increase. Volume status increased progressively over time, indicating fluid accumulation. Anthracycline exposure was associated with greater reductions in LTM, while docetaxel treatment was linked to significant increases in extracellular fluid and volume, especially during the 3\u20136-month interval. At 6 months, a median increase of +1100 mL in volume was observed alongside a decrease in muscle mass (\u22121.4 kg), consistent with a pattern of masked sarcopenia. Conclusions: Chemotherapy in breast cancer patients is associated with concurrent muscle loss and fluid redistribution, which may obscure clinically relevant changes in body composition. Bioelectrical impedance spectroscopy enables differentiation between fluid and tissue compartments and provides a more accurate assessment than conventional methods. Early recognition of these changes may facilitate timely nutritional support and appropriate fluid management strategies.<\/jats:p>","DOI":"10.3390\/jcm15124556","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T06:53:10Z","timestamp":1781247190000},"page":"4556","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Changes in Body Composition and Fluid Distribution During Chemotherapy in Breast Cancer Patients: A Prospective Single-Center Longitudinal Observational Study Using Bioimpedance Spectroscopy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3922-3845","authenticated-orcid":false,"given":"Aysun Fatma","family":"Akku\u015f","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6353-5825","authenticated-orcid":false,"given":"G\u00f6khan","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5938-2371","authenticated-orcid":false,"given":"\u00d6mer Ferudun","family":"Akku\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Edirne Sultan 1. Murat State Hospital, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130lhan","family":"Kurultak","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0064-954X","authenticated-orcid":false,"given":"Tayyip \u0130lker","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7399-2360","authenticated-orcid":false,"given":"Ahmet","family":"K\u00fc\u00e7\u00fckarda","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8490-3239","authenticated-orcid":false,"given":"Muhammet Bekir","family":"Hac\u0131o\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5387-8309","authenticated-orcid":false,"given":"Sernaz","family":"Topalo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00fclent","family":"Erdo\u011fan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1093\/annonc\/mdz173","article-title":"Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"30","author":"Cardoso","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2838","DOI":"10.1158\/1078-0432.CCR-19-3492","article-title":"Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: A comprehensive meta-analysis","volume":"26","author":"Spring","year":"2020","journal-title":"Clin. Cancer Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"De Kruif, J.T.C., Visser, M., Van Den Berg, M., Derks, M., De Boer, M., Van Laarhoven, H., De Vries, J., De Vries, Y., Kampman, E., and Winkels, R. (2019). A longitudinal mixed methods study on changes in body weight, body composition, and lifestyle in breast cancer patients during chemotherapy and in a comparison group of women without cancer: Study protocol. BMC Cancer, 19.","DOI":"10.1186\/s12885-018-5207-7"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Grupi\u0144ska, J., Wlaz\u0142o, M., Grajek, M., Budzy\u0144, M., Malchrowicz-Mo\u015bko, E., and Jurys, T. (2025). Body Composition Analysis in Postoperative Breast Cancer Patients Undergoing Chemotherapy and Its Association with Physical Activity and Quality of Life: A Longitudinal Pilot Study. Nutrients, 17.","DOI":"10.3390\/nu17213352"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s13058-025-02079-6","article-title":"Long-term weight change among breast cancer patients treated with chemotherapy: A longitudinal study over 13 years","volume":"27","author":"His","year":"2025","journal-title":"Breast Cancer Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s10549-021-06284-7","article-title":"A randomized trial of exercise and diet on body composition in survivors of breast cancer with overweight or obesity","volume":"189","author":"Brown","year":"2021","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2920","DOI":"10.1158\/1078-0432.CCR-08-2242","article-title":"Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment","volume":"15","author":"Prado","year":"2009","journal-title":"Clin. Cancer Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1200\/JCO.20.00611","article-title":"Management of cancer cachexia: ASCO guideline","volume":"38","author":"Roeland","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.tem.2021.03.007","article-title":"Cancer-mediated muscle cachexia: Etiology and clinical management","volume":"32","author":"Siff","year":"2021","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"355","DOI":"10.12788\/jcso.0078","article-title":"Weight change associated with third-generation adjuvant chemotherapy in breast cancer patients","volume":"12","author":"Chaudhary","year":"2014","journal-title":"J. Community Support. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"171","DOI":"10.14735\/amko2020171","article-title":"Levels of NT-proBNP and troponin T in cancer patients-mini-review","volume":"33","author":"Chovanec","year":"2020","journal-title":"Klin. Onkol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ozer, M.T., Bayram, E., Paydas, S., and Paydas, S. (2025). Clinical Evaluation of Patients Using Antineoplastic Chemotherapeutic Agents with Body Composition Monitor Measurement Before and at 3 Months of Treatment. J. Clin. Med., 14.","DOI":"10.3390\/jcm14207148"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40959-025-00335-4","article-title":"Effects of taxane-anthracycline and taxane only treatment on cardiac function in breast cancer\u2014A retrospective cohort study","volume":"11","author":"Szelke","year":"2025","journal-title":"Cardio-Oncology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1159\/000313727","article-title":"Bioelectric impedance measurement for fluid status assessment","volume":"164","author":"Piccoli","year":"2010","journal-title":"Contrib. Nephrol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1159\/000167013","article-title":"Importance of whole-body bioimpedance spectroscopy for the management of fluid balance","volume":"27","author":"Wabel","year":"2009","journal-title":"Blood Purif."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bossi, P., Delrio, P., Mascheroni, A., and Zanetti, M. (2021). The spectrum of malnutrition\/cachexia\/sarcopenia in oncology according to different cancer types and settings: A narrative review. Nutrients, 13.","DOI":"10.3390\/nu13061980"},{"key":"ref_18","first-page":"168","article-title":"Malnutrition and cancer, diagnosis and treatment","volume":"14","author":"Beirer","year":"2021","journal-title":"Memo-Mag. Eur. Med. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/jamaoncol.2019.4668","article-title":"Body composition, adherence to anthracycline and taxane-based chemotherapy, and survival after nonmetastatic breast cancer","volume":"6","author":"Chen","year":"2020","journal-title":"JAMA Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s12672-025-01999-1","article-title":"Association of skeletal muscle quantity and quality with mortality in women with nonmetastatic breast cancer","volume":"16","author":"Mialich","year":"2025","journal-title":"Discov. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3537","DOI":"10.1158\/1078-0432.CCR-16-2266","article-title":"Body composition as a predictor of toxicity in patients receiving anthracycline and taxane\u2013based chemotherapy for early-stage breast cancer","volume":"23","author":"Shachar","year":"2017","journal-title":"Clin. Cancer Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s12094-018-1963-8","article-title":"Status of hydration assessed by bioelectrical impedance analysis: A valuable predictive factor for radiation-induced oral mucositis in head and neck cancer patients","volume":"21","author":"Brzozowska","year":"2019","journal-title":"Clin. Transl. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chae, B., Shin, Y.S., Hong, S.-I., Kim, S.M., Kim, Y.-J., Ryoo, S.M., and Kim, W.Y. (2021). Extracellular water to total body water ratio in septic shock patients receiving protocol-driven resuscitation bundle therapy. J. Clin. Med., 10.","DOI":"10.21203\/rs.3.rs-252663\/v1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1002\/ijc.35432","article-title":"Body mass index as a predictive factor for efficacy of adjuvant taxane-based chemotherapy in early-stage breast cancer patients: A pooled analysis from adjuvant GEICAM Spanish Breast Cancer Group and TRIO Translational Research in Oncology Group studies","volume":"157","author":"Spera","year":"2025","journal-title":"Int. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"44707","DOI":"10.2340\/1651-226X.2025.44707","article-title":"Body composition changes in women with early breast cancer after adjuvant treatment: A systematic review","volume":"64","author":"Mendez","year":"2025","journal-title":"Acta Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.ejphar.2017.10.043","article-title":"Molecular mechanism of doxorubicin-induced cardiomyopathy\u2013An update","volume":"818","author":"Renu","year":"2018","journal-title":"Eur. J. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1124\/pr.56.2.6","article-title":"Anthracyclines: Molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity","volume":"56","author":"Minotti","year":"2004","journal-title":"Pharmacol. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"25714","DOI":"10.18632\/oncotarget.25394","article-title":"Lean body mass wasting and toxicity in early breast cancer patients receiving anthracyclines","volume":"9","author":"Mazzuca","year":"2018","journal-title":"Oncotarget"},{"key":"ref_29","first-page":"50","article-title":"Reduced body mass index but not fat mass in anthracycline-based chemotherapy of locally advanced breast cancer patients","volume":"6","author":"Rachmawati","year":"2023","journal-title":"Indones. J. Clin. Nutr. Physician"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.annfar.2006.10.024","article-title":"Docetaxel-induced acute pulmonary capillary-leak syndrome mimicking cardiogenic oedema","volume":"26","author":"Amathieu","year":"2006","journal-title":"Ann. Fr. D\u2019anesthesie Reanim."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1159\/000056300","article-title":"Chemotherapy-induced noncardiogenic pulmonary edema related to gemcitabine plus docetaxel combination with granulocyte colony-stimulating factor support","volume":"67","author":"Briasoulis","year":"2000","journal-title":"Respiration"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3426","DOI":"10.1200\/JCO.1998.16.10.3426","article-title":"Capillary protein leak syndrome appears to explain fluid retention in cancer patients who receive docetaxel treatment","volume":"16","author":"Semb","year":"1998","journal-title":"J. Clin. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1200\/JCO.1996.14.2.422","article-title":"Docetaxel in patients with metastatic breast cancer: A phase II study of the National Cancer Institute of Canada-Clinical Trials Group","volume":"14","author":"Trudeau","year":"1996","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e1093","DOI":"10.1016\/j.clbc.2018.06.010","article-title":"Weight evolution during endocrine therapy for breast cancer in postmenopausal patients: Effect of initial fat mass percentage and previous adjuvant treatments","volume":"18","author":"Ginzac","year":"2018","journal-title":"Clin. Breast Cancer"},{"key":"ref_35","first-page":"1685","article-title":"Changes in body composition during and after adjuvant or neo-adjuvant chemotherapy in women with breast cancer stage I\u2013IIIB compared with changes over a similar timeframe in women without cancer","volume":"28","author":"Kok","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"10028","DOI":"10.1038\/s41598-019-46428-w","article-title":"Changes in DXA-derived lean mass and MRI-derived cross-sectional area of the thigh are modestly associated","volume":"9","author":"Tavoian","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"253","DOI":"10.2147\/CMAR.S40601","article-title":"Presentation and management of docetaxel-related adverse effects in patients with breast cancer","volume":"6","author":"Ho","year":"2014","journal-title":"Cancer Manag. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2165\/00003088-200544010-00003","article-title":"Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids","volume":"44","author":"Czock","year":"2005","journal-title":"Clin. Pharmacokinet."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1210\/jcem-55-4-762","article-title":"Prednisolone clearance at steady state in man","volume":"55","author":"Legler","year":"1982","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000094869","article-title":"Cytotoxicity of docetaxel (Taxotere\u00ae) used as a single agent and in combination with radiation in human gastric, cervical and pancreatic cancer cells","volume":"52","author":"Attarpour","year":"2006","journal-title":"Chemotherapy"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3149","DOI":"10.1200\/JCO.1997.15.9.3149","article-title":"Corticosteroids significantly delay the onset of docetaxel-induced fluid retention: Final results of a randomized study of the European Organization for Research and Treatment of Cancer Investigational Drug Branch for Breast Cancer","volume":"15","author":"Piccart","year":"1997","journal-title":"J. Clin. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100455","DOI":"10.1016\/j.ynstr.2022.100455","article-title":"Mineralocorticoid receptor and glucocorticoid receptor work alone and together in cell-type-specific manner: Implications for resilience prediction and targeted therapy","volume":"18","author":"Daskalakis","year":"2022","journal-title":"Neurobiol. Stress"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4556\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T07:57:49Z","timestamp":1781251069000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124556"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124556","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}