- Design
- Retrospective single-centre cohort with automated CT segmentation
- Population
- 1,187 patients having definitive radiotherapy for head and neck cancer (659 imaged)
- Primary outcome
- Overall survival
- Effect
- Skeletal muscle HR 0.67 (0.50-0.89); intermuscular fat HR 1.28 (1.03-1.58)
A single-centre retrospective cohort (JAMA Otolaryngology-Head & Neck Surgery, 8 October 2026) studied 1,187 patients receiving definitive radiotherapy for head and neck cancer, with automated three-dimensional body composition measured on the planning CT in 659.
Overweight and obesity by BMI were associated with better overall survival (HR 0.70 and 0.67). But the extra mass was mainly subcutaneous fat. Higher skeletal muscle was associated with better survival (HR 0.67, 95% CI 0.50-0.89), while more intermuscular fat was associated with worse survival (HR 1.28, 1.03-1.58).
The planning CT already exists for every patient, so automated measurement adds information at no extra imaging cost. The practical message is that low muscle may mark patients who need early dietetic and exercise support, even when their BMI looks reassuring. Whether intervening changes survival is not tested here.
- Do not take a normal or high BMI as reassurance about nutritional reserve
- Refer patients with low muscle mass early for dietetic and physical support
- Consider using the planning CT to assess body composition where tools are available
- Weigh patients weekly during radiotherapy and act early on loss
Why it matters
BMI hides the difference between muscle and fat that actually tracked survival.
Don't overread it
Associations only - this does not show that building muscle improves survival.
The statistics, in plain English
Hazard ratios below 1 mean lower risk of death: higher muscle (HR 0.67) was associated with about a third lower risk. These are associations from one centre and the imaging subgroup was about half the cohort, so selection may play a part.
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