Sarcopenia has recently emerged as a new condition that, independently from malnutrition, may adversely affect the prognosis of cancer patients. Purpose of this narrative review is to define the prevalence of sarcopenia in different primaries, its role in leading to chemotherapy toxicity and decreased compliance with the oncological therapy and the effect of some drugs on the onset of sarcopenia. Finally, the review aims to describe the current approaches to restore the muscle mass through nutrition, exercise and anti-inflammatory agents or multimodal programmes with a special emphasis on the results of randomized controlled trials. The examination of the computed tomography scan at the level of the third lumbar vertebra—a common procedure for staging many tumours—has allowed the oncologist to evaluate the muscle mass and to collect many retrospective data on the prevalence of sarcopenia and its clinical consequences. Sarcopenia is a condition affecting a high percentage of patients with a range depending on type of primary tumour and stage of disease. It is noteworthy that patients may be sarcopenic even if their nutritional status is apparently maintained or they are obese. Sarcopenic patients exhibited higher chemotherapy toxicity and poorer compliance with oncological treatments. Furthermore, several antineoplastic drugs appeared to worsen the sarcopenic status. Therapeutic approaches are several and this review will focus on those validated by randomized controlled trials. They include the use of ω-3-enriched oral nutritional supplements and orexigenic agents, the administration of adequate high-protein regimens delivered enterally or parenterally, and programmes of physical exercise. Better results are expected combining different procedures in a multimodal approach. In conclusion, there are several premises to prevent/treat sarcopenia. The oncologist should coordinate this multimodal approach by selecting priorities and sequences of treatments and then involving a nutrition health care professional or a physical therapist depending on the condition of the single patient.

中文翻译：

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强迫恶性循环：肌肉减少症会增加毒性，降低对化学疗法的反应，并因化学疗法而恶化

肌肉减少症最近已成为一种新的病状，与营养不良无关，它可能会对癌症患者的预后产生不利影响。这篇叙述性综述的目的是确定少肌症在不同原发中的患病率，其在导致化学疗法毒性和降低对肿瘤疗法的依从性方面的作用以及某些药物对少肌症发作的影响。最后，本综述旨在描述当前通过营养，运动和抗炎药或多峰计划恢复肌肉质量的方法，其中特别强调随机对照试验的结果。对第三腰椎水平进行计算机断层扫描的检查（这是治疗许多肿瘤的常用方法），使肿瘤科医生能够评估肌肉质量并收集有关肌肉减少症患病率及其临床后果的许多回顾性数据。肌肉减少症是一种影响高比例患者的疾病，其程度取决于原发肿瘤的类型和疾病的阶段。值得注意的是，即使患者的营养状况得到明显维持或肥胖，也可能患有肌肉减少症。肌肉减少症患者表现出较高的化学疗法毒性和较差的肿瘤治疗依从性。此外，几种抗肿瘤药似乎使肌少症状态恶化。治疗方法很多，本文将重点关注那些通过随机对照试验验证的方法。这些措施包括使用富含ω-3-的口服营养补充剂和致癌剂，通过肠胃外或胃肠外途径给予适当的高蛋白方案，以及进行体育锻炼。预期在多模式方法中结合不同的程序会获得更好的结果。总之，有几个前提可以预防/治疗肌肉减少症。肿瘤科医生应通过选择治疗的优先级和顺序来协调这种多模式方法，然后根据单个患者的状况让营养保健专业人员或物理治疗师参与进来。肠内或肠胃外给药的适当高蛋白方案的管理，以及体育锻炼的程序。预期在多模式方法中结合不同的程序会获得更好的结果。总之，有几个前提可以预防/治疗肌肉减少症。肿瘤科医生应通过选择治疗的优先级和顺序来协调这种多模式方法，然后根据单个患者的状况让营养保健专业人员或物理治疗师参与进来。肠内或肠胃外给药的适当高蛋白方案的管理，以及体育锻炼的程序。预期在多模式方法中结合不同的程序会获得更好的结果。总之，有几个前提可以预防/治疗肌肉减少症。肿瘤科医生应通过选择治疗的优先级和顺序来协调这种多模式方法，然后根据单个患者的状况让营养保健专业人员或物理治疗师参与进来。