(0631) Cross-Sectional Area of Skeletal Muscle Is Associated With Swallowing Function in Oral Cancer

Introduction: Dysphagia is a frequent complication of resection with free-flap reconstruction for oral cancer with significant impact on patient quality of life and recovery. Past studies in head and neck cancer patients have demonstrated an association between skeletal muscle mass and treatment outcomes such as chemotherapy and radiation-related toxicity, overall survival, and disease-free survival. The relationship between skeletal muscle mass and swallowing function in head and neck cancer merits further investigation.

Methods: In total, 52 patients were identified who underwent primary resection and free-flap reconstruction for squamous cell carcinoma of the oral cavity. Swallowing function was assessed by speech pathologists preoperatively and 6 and 12 months postoperatively using the Functional Oral Intake Score (FOIS). Preoperative CT scans were analyzed using LifeX software and cross-sectional area (CSA) of the sternocleidomastoid (SCM) and paraspinal muscles were measured at the C3 level. Statistical comparisons were drawn between CSA and FOIS scores, duration of gastrostomy tube and tracheostomy dependence, and survival.

Results: CSA of the right SCM (p = 0.01) and left SCM (p = 0.01) was significantly different between patients requiring some tube feeds (FOIS < 4) and those requiring no tube feeds (FOIS ≥ 4) 6 months postoperatively. There was no difference between CSAs across FOIS groups 12 months postoperatively. CSA was not associated with duration of gastrostomy tube dependence, tracheostomy dependence, time to oral intake, or survival.

Conclusions: This study demonstrates the potential utility of CSA in assessing risk for the development of dysphagia following resection and free flap reconstruction of oral cancer. To our knowledge, this is the first report of the association between cervical skeletal muscle area and objective functional swallowing outcomes in head and neck cancer, offering an avenue for personalization in treatment algorithms for oral cancer that utilizes routine imaging and free, easy-to-use software.