{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:41:48Z","timestamp":1791895308972,"version":"4.3.4"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Sarcopenia, a condition characterized by muscle mass loss, is prevalent in up to 68% of rectal cancer patients and has been described as a negative prognostic factor, impacting overall survival and tumor response. While there are extensive data on rectal cancer globally, only a handful of studies have evaluated the role of sarcopenia in locally advanced rectal cancer (LARC). Our study aimed to investigate the relationship between sarcopenia, overall response rate, and toxicity in patients who underwent total neoadjuvant treatment (TNT) for LARC. Materials and Methods: We performed a retrospective study of patients with rectal cancer treated with TNT and surgery with curative intent between 2021 and 2023 at Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca. Sarcopenia was assessed on MRI images by measuring the psoas muscle area (PMA) at the level of the L4 vertebra before and after neoadjuvant therapy. The primary endpoints were the overall complete response rate (oCR) and acute toxicity. Results: This study included 50 patients with LARC. The oCR rate was 18% and was significantly associated with post-treatment sarcopenia (OR 0.08, p = 0.043). Patients who did not achieve a clinical or pathologic complete response had, on average, an 8% muscle loss during neoadjuvant therapy (p = 0.022). Cystitis and thrombocytopenia were significantly associated with post-treatment sarcopenia (p = 0.05 and p = 0.049). Conclusions: Sarcopenia and loss of psoas muscle during neoadjuvant therapy were negatively associated with tumor response in locally advanced rectal cancer. Thrombocytopenia and cystitis are more frequent in sarcopenic than non-sarcopenic patients undergoing neoadjuvant chemoradiation for rectal cancer.<\/jats:p>","DOI":"10.3390\/medicina60101606","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T03:57:52Z","timestamp":1727755072000},"page":"1606","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Sarcopenia on Treatment Outcomes and Toxicity in Locally Advanced Rectal Cancer"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7256-461X","authenticated-orcid":false,"given":"Sebastian","family":"Curcean","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Radiation Oncology, \u201cProf. Dr. Ion Chiricuta\u201d Oncology Institute, 34\u201336 Republicii Street, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4629-3713","authenticated-orcid":false,"given":"Alexandra","family":"Gherman","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Medical Oncology, \u201cProf. Dr. Ion Chiricuta\u201d Oncology Institute, 34\u201336 Republicii Street, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0307-7111","authenticated-orcid":false,"given":"Alexandru","family":"Tipcu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3386-8263","authenticated-orcid":false,"given":"Zsolt","family":"Fekete","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Radiation Oncology, \u201cProf. Dr. Ion Chiricuta\u201d Oncology Institute, 34\u201336 Republicii Street, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina-Simona","family":"Muntean","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, \u201cProf. Dr. Ion Chiricuta\u201d Oncology Institute, 34\u201336 Republicii Street, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2385-2954","authenticated-orcid":false,"given":"Andra","family":"Curcean","sequence":"additional","affiliation":[{"name":"Department of Imaging, Affidea Center, 15c Ciresilor Street, 400487 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-8630","authenticated-orcid":false,"given":"Rares","family":"Craciun","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania"},{"name":"Gastroenterology Department, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Irimie","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery and Gynecological Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Oncological Surgery, \u201cProf. Dr. Ion Chiricuta\u201d Oncology Institute, 34\u201336 Republicii Street, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.clcc.2022.07.005","article-title":"Outcomes of Locally Advanced Rectal Cancer Patients Treated with Total Neoadjuvant Treatment: A Meta-Anaysis of Randomized Controlled Trials","volume":"21","author":"Gabbani","year":"2022","journal-title":"Clin. Colorectal Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.3109\/0284186X.2015.1034876","article-title":"Nationwide Improvement of Rectal Cancer Treatment Outcomes in Norway, 1993\u20132010","volume":"54","author":"Guren","year":"2015","journal-title":"Acta Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E766","DOI":"10.1097\/SLA.0000000000005799","article-title":"Locoregional Failure During and After Short-Course Radiotherapy Followed by Chemotherapy and Surgery Compared With Long-Course Chemoradiotherapy and Surgery: A 5-Year Follow-up of the RAPIDO Trial","volume":"278","author":"Dijkstra","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.annonc.2024.06.019","article-title":"Total Neoadjuvant Therapy with MFOLFIRINOX versus Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer: Long-Term Results of the UNICANCER-PRODIGE 23 Trial","volume":"35","author":"Conroy","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","article-title":"Sarcopenia","volume":"393","author":"Sayer","year":"2019","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1002\/jcsm.12483","article-title":"Sarcopenia: A Time for Action. An SCWD Position Paper","volume":"10","author":"Bauer","year":"2019","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European Consensus on Definition and Diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A Review of the Measurement of Grip Strength in Clinical and Epidemiological Studies: Towards a Standardised Approach","volume":"40","author":"Roberts","year":"2011","journal-title":"Age Ageing"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Derstine, B.A., Holcombe, S.A., Ross, B.E., Wang, N.C., Su, G.L., and Wang, S.C. (2018). Skeletal Muscle Cutoff Values for Sarcopenia Diagnosis Using T10 to L5 Measurements in a Healthy US Population. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-29825-5"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.cger.2016.08.002","article-title":"Pathogenesis and Management of Sarcopenia","volume":"33","author":"Dhillon","year":"2017","journal-title":"Clin. Geriatr. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s13539-011-0046-2","article-title":"The ACT-ONE Trial, a Multicentre, Randomised, Double-Blind, Placebo-Controlled, Dose-Finding Study of the Anabolic\/Catabolic Transforming Agent, MT-102 in Subjects with Cachexia Related to Stage III and IV Non-Small Cell Lung Cancer and Colorectal Cancer: Study Design","volume":"2","author":"Srinivasan","year":"2011","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"110539","DOI":"10.1016\/j.nut.2019.06.020","article-title":"Effects of Weight Loss and Sarcopenia on Response to Chemotherapy, Quality of Life, and Survival","volume":"67\u201368","author":"Ryan","year":"2019","journal-title":"Nutrition"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Zhu, Y., Guo, X., Zhang, Q., and Yang, Y. (2022). Prognostic Value of Sarcopenia in Patients with Rectal Cancer: A Meta-Analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270332"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/jso.27251","article-title":"Can Sarcopenia Predict Complete Response after Total Neoadjuvant Therapy in Advanced Rectal Cancer? A Multicentre Observational Cohort Study","volume":"128","author":"Bedrikovetski","year":"2023","journal-title":"J. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00423-020-01983-z","article-title":"The Impact of Sarcopenia on Pathologic Complete Response Following Neoadjuvant Chemoradiation in Rectal Cancer","volume":"405","author":"Olmez","year":"2020","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1097\/DCR.0000000000002451","article-title":"Does Sarcopenia Predict Local Response Rates after Chemoradiotherapy for Locally Advanced Rectal Cancer?","volume":"66","author":"Bedrikovetski","year":"2023","journal-title":"Dis. Colon Rectum"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1038\/s41571-021-00538-5","article-title":"International Consensus Recommendations on Key Outcome Measures for Organ Preservation after (Chemo)Radiotherapy in Patients with Rectal Cancer","volume":"18","author":"Fokas","year":"2021","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E230146","DOI":"10.1001\/jamasurg.2023.0146","article-title":"Long-Term Quality of Life and Functional Outcome of Patients With Rectal Cancer Following a Watch-and-Wait Approach","volume":"158","author":"Custers","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1111\/ans.18913","article-title":"Loss of Psoas Muscle during Neoadjuvant Treatment for Rectal Cancer Is Associated with Poor Oncological and Surgical Outcomes","volume":"94","author":"Yassaie","year":"2024","journal-title":"ANZ J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.soc.2010.08.001","article-title":"Complete Clinical Response after Neoadjuvant Chemoradiation for Distal Rectal Cancer","volume":"19","author":"Perez","year":"2010","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1148\/radiol.2503080310","article-title":"Locally Advanced Rectal Cancer: MR Imaging in Prediction of Response after Preoperative Chemotherapy and Radiation Therapy","volume":"250","author":"Barbaro","year":"2009","journal-title":"Radiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/S1470-2045(10)70172-8","article-title":"Long-Term Outcome in Patients with a Pathological Complete Response after Chemoradiation for Rectal Cancer: A Pooled Analysis of Individual Patient Data","volume":"11","author":"Maas","year":"2010","journal-title":"Lancet. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1002\/ijc.29355","article-title":"Adjuvant Chemotherapy in Rectal Cancer: Defining Subgroups Who May Benefit after Neoadjuvant Chemoradiation and Resection: A Pooled Analysis of 3,313 Patients","volume":"137","author":"Maas","year":"2015","journal-title":"Int. J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e252","DOI":"10.1016\/S1470-2045(20)30024-3","article-title":"Outcome Measures in Multimodal Rectal Cancer Trials","volume":"21","author":"Fokas","year":"2020","journal-title":"Lancet. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1200\/JCO.22.00032","article-title":"Organ Preservation in Patients with Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy","volume":"40","author":"Patil","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1016\/S0140-6736(18)31078-X","article-title":"Long-Term Outcomes of Clinical Complete Responders after Neoadjuvant Treatment for Rectal Cancer in the International Watch & Wait Database (IWWD): An International Multicentre Registry Study","volume":"391","author":"Hilling","year":"2018","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2414702","DOI":"10.1001\/jamanetworkopen.2024.14702","article-title":"Treatment of Locally Advanced Rectal Cancer in the Era of Total Neoadjuvant Therapy: A Systematic Review and Network Meta-Analysis","volume":"7","author":"Turri","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1111\/ans.18512","article-title":"Can Sarcopenia Predict Survival in Locally Advanced Rectal Cancer Patients?","volume":"93","author":"Gartrell","year":"2023","journal-title":"ANZ J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Su, Q., and Shen, J. (2024). Predictive Role of Preoperative Sarcopenia for Long-Term Survival in Rectal Cancer Patients: A Meta-Analysis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0303494"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"26","DOI":"10.25259\/JCIS_43_2024","article-title":"Does Computed Tomography-Derived Volumometry and Densitometry of Psoas Muscle Really Correlate with Complications in Rectal Cancer Patients after Elective Surgery?","volume":"14","author":"Kotek","year":"2024","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1093\/annonc\/mdx271","article-title":"Forcing the Vicious Circle: Sarcopenia Increases Toxicity, Decreases Response to Chemotherapy and Worsens with Chemotherapy","volume":"28","author":"Bozzetti","year":"2017","journal-title":"Ann. Oncol. Off. J. Eur. Soc. Med. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1200\/JCO.2019.37.4_suppl.687","article-title":"Impact of Sarcopenia on Outcomes in Patients with Rectal Carcinoma Treated with Trimodality Therapy","volume":"37","author":"Sandoval","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1093\/oxfordjournals.aje.a009520","article-title":"Epidemiology of Sarcopenia among the Elderly in New Mexico","volume":"147","author":"Baumgartner","year":"1998","journal-title":"Am. J. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"100540","DOI":"10.1016\/j.ctarc.2022.100540","article-title":"Clinico-Pathological Predictors of Clinical Complete Response in Rectal Cancer","volume":"31","author":"Mbanu","year":"2022","journal-title":"Cancer Treat. Res. Commun."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"171","DOI":"10.15403\/jgld.2014.1121.232.zf1","article-title":"Neoadjuvant Conformal Chemoradiation with Induction Chemotherapy for Rectal Adenocarcinoma. A Prospective Observational Study","volume":"23","author":"Fekete","year":"2014","journal-title":"J. Gastrointestin. Liver Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1016\/j.ejso.2017.07.022","article-title":"Impact of Body Mass Index on Treatment Outcome of Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer","volume":"43","author":"Sun","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Yang, X., Zhuang, Z., Wei, M., Meng, W., Deng, X., and Wang, Z. (2023). The Effect of BMI on Long-Term Outcome in Patients with Rectal Cancer and Establishment of a Nomogram Prediction Model. BMC Gastroenterol., 23.","DOI":"10.1186\/s12876-023-02638-1"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/10\/1606\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:08:26Z","timestamp":1760112506000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/10\/1606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,1]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["medicina60101606"],"URL":"https:\/\/doi.org\/10.3390\/medicina60101606","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,1]]}}}