# Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma — GCMD Library Pradipta Debnath, Marissa Ray, Luke Pater, Alexandra O Glenn, Stephen Hartman, Elanchezhian Somasundaram, Todd Jenkins, Juan P Gurria, Katherine Somers, Andrew T Trout, Meera Kotagal

Background/objectives: Radiation therapy (RT) is part of standard-of-care therapy in high-risk neuroblastoma (HR-NBL) but can significantly affect nearby tissue. The objectives of this study were (1) to characterize changes in pancreas volume after RT and (2) to characterize changes in body composition, including body weight percentile, subcutaneous fat area, and total psoas muscle area (tPMA), after RT in children with abdominal HR-NBL.

Design/methods: This retrospective study included patients aged 0-17 years old with HR-NBL cared for at a quaternary pediatric hospital (January 2012-December 2022). Pre- to post-RT differences in outcomes were compared using paired t-test, then modeled using linear regression to adjust for covariates and additional variables.

Results: Fifty patients (median age 3 [IQR 2], 56% male) met the inclusion criteria. Median days from end of radiation to first post-radiation imaging was 15.5 days (IQR 14). Pre- to post-RT, mean pancreatic volume decreased significantly (from 16,731 mm3 [SD 7659] to 14,288 mm3 [SD 7418], p < 0.001) and patient body weight percentile declined significantly (48.4-44.9, p = 0.016), although neither was linearly associated with radiation dose. There were non-significant decreases in subcutaneous fat area standardized to height (38.6-36.9 cm2/m2, p = 0.41) and in tPMA z-scores (-1.56 to -2.09, p = 0.26).

Conclusions: Patients undergoing RT for abdominal HR-NBL experienced significant pancreatic volume loss. This may place them at risk for pancreatic insufficiency. Patients also had significant decreases in weight percentile with corresponding non-significant decreases in subcutaneous fat and psoas muscle area. Further research is needed to characterize the association of these findings with pancreatic function and nutritional status.
Type: video · 1 min · posted 2026-04-24 Canonical: https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866 ## Chapters - [0:00](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=0) Introduction and Study Context - [0:13](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=13) Study Design and Pancreatic Findings - [0:43](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=43) Body Composition Changes and Clinical Implications ## Statements - "Radiation improves survival in high-risk neuroblastoma" — Sophia Schermerhorn (clinical) [0:00](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=0) - "This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy" — Sophia Schermerhorn (clinical) [0:13](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=13) - "The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment" — Sophia Schermerhorn (clinical) [0:19](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=19) - "There was a significant decrease in pancreatic volume after radiation" — Sophia Schermerhorn (clinical) [0:27](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=27) - "Very few patients developed clinically apparent pancreatic insufficiency" — Sophia Schermerhorn (clinical) [0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31) - "Pancreatic insufficiency wasn't systematically screened for in this study" — Sophia Schermerhorn (clinical) [0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31) - "Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients" — Sophia Schermerhorn (opinion) [0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31) - "Pancreatic dysfunction could be an under-recognized late effect" — Sophia Schermerhorn (opinion) [0:43](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=43) - "Patients had a significant drop in weight percentile with smaller decreases in fat and muscle" — Sophia Schermerhorn (clinical) [0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48) - "Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone" — Sophia Schermerhorn (opinion) [0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48) - "These findings highlight the importance of nutritional screening during cancer treatments" — Sophia Schermerhorn (opinion) [0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48) - "As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself" — Sophia Schermerhorn (opinion) [1:03](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=63) ## Transcript So, we know radiation improves survival in high-risk neuroblastoma, but what does it do to the rest of the body? Hi, I'm Doctor Sophia Skermorn from Cincinnati Children's, and this study looks at how radiation affects the pancreas and body composition in children with neuroblastoma. This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy. The authors use CT and MRI body segmentation to measure pancreatic volume. Cutaneous fat, and so is muscle area before and after treatment. And the key finding was a significant decrease in pancreatic volume after radiation. While very few patients developed clinically apparent pancreatic insufficiency, the authors point out that this wasn't systematically screened for, and falloff may not be long enough to detect these effects, especially given the young average age of these patients. So this raises concern that pancreatic dysfunction could be an Recognized late effect. In terms of body composition, patients had a significant drop in weight percentile with smaller decreases in fat and muscle, and these likely reflect the overall impact of cancer therapy overall rather than radiation alone, but highlight the importance of nutritional screening during cancer treatments. So, as survival improves, understanding and screening for these long-term effects is becoming just as important as curing the cancer itself. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai