Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. 
Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer (OC).  Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers, with worser effects in sarcopenic obesity.  In this study the association between sarcopenia and/or sarcopenic obesity and dose limiting toxicity (DLT) during cycle one chemotherapy in resectable OC patients was evaluated.  Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients.  Lean body mass and body fat mass were estimated.  Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia, and as underweight/normal (BMI < 25) or overweight/obese (BMI ≥ 25).  Sarcopenic obesity was defined as sarcopenia combined with overweight and obesity.  DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects.  Odds ratios for developing toxicity were ascertained using multiple logistic regression.  Of 72 patients, 85% (n = 61) were males.  Sarcopenia and sarcopenic obesity were present in 31 (43%) and 10 (14%), respectively, prior to chemotherapy.  Sarcopenic patients had significantly lower adipose tissue index (p = 0.02) compared to non-sarcopenic patients.  Patients with DLT (n = 24) had lower skeletal muscle mass (p = 0.04) than those without DLT.  Sarcopenic patients (OR = 2.47; 95% CI: 0.88-6.93) showed a trend towards increased DLT risk (p < 0.10).  Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI (OR = 1.60; 95% CI 0.30-8.40), but was non-significant.  In the sarcopenic obese, risk of DLT increased significantly (OR = 5.54; 95% CI 1.12-27.44).  Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients.