Effects of Electrical Muscle Stimulation Against Acute Adverse Effect and Cancer Cachexia During Non-small Cell Lung Cancer Chemo-Radiotherapy

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  • SAITO ANNEYUKO I
    Division of Radiation Oncology, Department of Radiology, Juntendo University Faculty of Medicine
  • NATSUME TOSHIHARU
    Institute of Health and Sports Science & Medicine, Juntendo University
  • INOUE TATSUYA
    Division of Radiation Oncology, Department of Radiology, Juntendo University Faculty of Medicine
  • SASAI KEISUKE
    Division of Radiation Oncology, Department of Radiology, Juntendo University Faculty of Medicine
  • NAITO HISASHI
    Institute of Health and Sports Science & Medicine, Juntendo University

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<p>Objective: To determine feasibility and effect of electrical muscle stimulation (EMS) against acute adverse effects and cancer cachexia in patients with non-small cell lung cancer (NSCLC) receiving concomitant chemo-radiotherapy (CCRT).</p><p>Materials and Methods: Between August 2014 and July 2016 patients of NSCLC receiving CCRT were assigned to undergo EMS during CCRT. Eligibility criteria were histologically proofed NSCLC, CCRT for curative intent, performance status (PS) 2 or better, platinum based chemotherapy concomitant to radiotherapy, and age 20 or older. We compared the data of these patients (EG) with data of patients who came to our clinic for radiotherapy after the study recruitment has closed (August 2016-April 2017) and met the eligibility criteria (CG). The intervention to the EG was stimulation of the quadriceps muscle of both legs using biphasic pulsed current, constant current impulses with a pulse width of 400 μs and a frequency of 75 Hz for 18 min, twice daily every day through the whole CCRT period. The patients were allowed to raise the electrical current of the machine as high as possible.</p><p>Weekly blood sampling of complete blood count and serum albumin, and patients weight check was performed. Also, acute adverse effects were evaluated referring to CTCAE v4.0. Besides, whether there would be any correlation between the strength of the electrical current, and the acute adverse effects was investigated.</p><p>Results: The number of patients in EG was 18 and CG was 21. Gender, age and PS were balanced well between the two groups; gender (EG, male: female =16: 2; CG, male: female =16: 5), age { EG, median 66 (58～76); CG, median 68 (45～78)}, and PS (EG: PS0, n=17; PS1, n=0; PS2, n=1: CG: PS0, n=18, PS1, n=2, PS2, n=1). Concomitant to chemotherapy, all patients received 60 Gy radiotherapy in 30 fractions to the lung. Regarding acute adverse effects (dermatitis, esophagitis and pneumonitis), no statistically significant difference was observed between the two groups. However, the serum albumin decrease during the CCRT period was statistically significantly more in the CG { EG, median -0.3 (-1～0.5); CG, median -0.5 (-1.5～-0.1), p=0.02 }. The median current strength was 41.2 (18.6～140) mA. There was statistically significant correlation between current strength and serum albumin loss (p=0.05) and weight loss (p=0.03). Namely, patients with higher current strength showed fewer albumin loss and weight loss. Noteworthy, as all patients in CG showed serum albumin loss and weight loss, in EG there were one patient where both the serum albumin level and weight gained, and five patients where the serum albumin level gained during CCRT.</p><p>Conclusion: EMS is feasible and could be effective in preventing cancer cachexia in NSCLC patients receiving CCRT; a definitive trial is warranted.</p>

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