Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: a secondary analysis of RTOG 85-27

Lee, William R.; Berkey, Brian; Marcial, Víctor A.; Fu, Karen K.; Cooper, Jay S.; Bhatia, Vikram; Coia, Lawrence R.; Rotman, Marvin; Ortíz, H.

doi:10.1016/s0360-3016(98)00348-4

Cited by 189 publications

(112 citation statements)

References 19 publications

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“…Among several methods of assessment, Karnofsky's Scale Performance Status (KPS) and ECOG Scale of Performance Status are widely used. A study by Lee et al [38] demonstrated that KPS is an independent prognostic factor in the treatment of HNSCC. In the study of La et al [12], KPS was also found to be a predictive factor for DFS and OS.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Locally Advanced Head and Neck Squamous Cell Carcinomas Treated by Surgery

Choi

Yoo

Han

et al. 2010

Nucl Med Mol Imaging

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Purpose We assessed the prognostic value of metabolic tumor volume (MTV) measured using 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) inpatients with locally advanced head and neck squamous cell carcinoma (HNSCC). Methods We retrospectively reviewed 56 patients (51 men, five women; mean age 56.0±8.8years) who had locally advanced HNSCC and underwent FDG PET/CT for initial evaluation. All patients had surgical resection and radiotherapy with or without concurrent chemotherapy. The peak standardized uptake value (SUV peak ) and MTV of the target lesion, including primary HNSCC andmetastatic cervical lymph nodes, were measured from FDG PET/CT images. We compared SUV peak , MTV, and clinicopathologic variables such as age, Eastern Cooperative Oncology Group (ECOG) performance status, pN stage, pT stage, TNM stage, histologic grade and treatment modality to disease-free survival (DFS) and overall survival (OS). Results On the initial FDG PET/CT scans, the median SUV peak was 7.8 (range, 1.8-19.0) and MTV was17.0 cm 3 (range, 0.1-131.0 cm 3 ). The estimated 2-year DFS and OS rates were 67.2% and 81.8%. The cutoff points of SUV peak 6.2 and MTV 20.7 cm 3 were the best discriminative values for predicting clinical outcome. MTV and ECOG performance status were significantly related to DFS and OS on univariate and multivariate analyses (p<0.05). Conclusion The MTV obtained from initial FDG PET/CT scan is a significant prognostic factor for disease recurrence and mortality in locally advanced HNSCC treated with surgery and radiotherapy with or without chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Locally Advanced Head and Neck Squamous Cell Carcinomas Treated by Surgery

Choi

Yoo

Han

et al. 2010

Nucl Med Mol Imaging

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“…The maintenance of normal or near-normal Hb concentrations in patients undergoing chemotherapy and/or radiotherapy may not only significantly improve the patient's quality of life (Demetri, 2001), but may also improve the probability of a successful outcome from their therapy (Dusenbery et al, 1994;Tarnawski et al, 1997;Lee et al, 1998;Warde et al, 1998;Canaday et al, 1999;Grogan et al, 1999;Obermair et al, 2000;Phan et al, 2001;Pangalis et al, 2002). Several options exist to support Hb levels during cancer treatment, including blood transfusions and the administration of rHuEPO.…”

Section: Discussionmentioning

confidence: 99%

“…Anaemia in cancer patients results from a complex combination of factors including processes resulting from both the disease itself and from its treatment (Spivak, 1994;Mercadante et al, 2000). The control of anaemia in cancer patients is important not only for the immediate well-being of the patient but may also be linked to treatment outcome (Tarnawski et al, 1997;Lee et al, 1998;Warde et al, 1998;Canaday et al, 1999;Grogan et al, 1999;Obermair et al, 2000;Phan et al, 2001;Pangalis et al, 2002). We have attempted to create a model of multicycle, multiagent chemotherapy in mice in order to gain insight into potential new strategies for the management of the progressive anaemia in patients undergoing repeated cycles of chemotherapy with either curative or palliative intent.…”

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confidence: 99%

Kinetics of haematopoietic recovery after dose‐intensive chemo/radiotherapy in mice: optimized erythroid support with darbepoetin alpha

et al. 2003

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Summary. Despite its frequency and impact on clinical outcomes, anaemia in cancer patients remains poorly understood and suboptimally treated. The definition of optimum treatment schedules with erythropoietic agents requires a suitable model of chemotherapy-induced progressive anaemia. This study investigated novel strategies such as once-per-chemotherapy-cycle dosing, synchronization between erythroid supportive care and chemotherapy, and definition of the optimum timing of erythroid support. A murine model of carboplatin chemotherapy/radiotherapy (CRT)-induced anaemia was used, which caused progressive anaemia across multiple cycles. Weekly administration of recombinant human erythropoietin (rHuEPO) was effective, but the longer-acting darbepoetin alpha resulted in superior responses. In all animals, anaemia became progressive and more refractory across cycles because of accumulated bone marrow damage. Exploiting a specific enzyme-linked immunosorbent assay, which could distinguish between darbepoetin alpha and endogenous erythropoietin, the effect of CRT upon the pharmacokinetics of darbepoetin alpha showed that clearance of darbepoetin alpha, and presumably erythropoietin, was at least partially dependent on a chemotherapy-sensitive pathway. Scheduling data suggested that administration of erythropoietic agents prior to chemotherapy was more effective than administration after chemotherapy. There was no evidence that erythropoietic agents exacerbated anaemia, even when administered immediately prior to CRT in an attempt to 'prime' erythroid cells for the effects of CRT.

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“…Locoregional failure at five years differed significantly between patients with or without anemia. Patients with normal hemoglobin levels experienced locoregional failure at a rate of 52% compared with 68% for anemic patients (p = 0.00028) [3]. Again, the addition of etanidazole did not significantly affect locoreHarrison, Shasha, White et al All 6 g/dl-7 g/dl-8 g/dl-9 g/dl-10 g/dl-11 g/dlPatients 6.9 g/dl 7.9 g/dl 8.9 g/dl 9.9 g/dl 10.9 g/dl 11.9 g/dl gional control among any group of patients.…”

Section: Understanding the Impact Of Anemiamentioning

confidence: 99%

“…Although anemia is a recognized cancer-related disorder, recent studies have focused on its impact rather than its prevalence among patients undergoing radiotherapy [1,3,4]. The radiation oncology community, in general, has not placed a significant effort into the global problem of anemia in our patients, or its correction.…”

Section: Radiotherapy-related Anemia: the Beth Israel/st Luke's-roosmentioning

confidence: 99%

Radiotherapy-Associated Anemia: The Scope of the Problem

et al. 2000

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The impact of anemia on cancer patients undergoing chemotherapy is well established, but only recently has the prevalence of anemia in patients receiving radiotherapy received much attention. Many cancer patients present with anemia prior to radiotherapy, and even more experience anemia or a worsening of anemia at some point during treatment. However, the problem of anemia is often ignored because patients may experience only functional anemia, defined as a hemoglobin level less than 12 g/dl. Unless physiologic anemia (hemoglobin = 8 g/dl) is discovered, efforts to correct anemia are often not made. Because hemoglobin levels <12 g/dl seem to be associated with tumor hypoxia and poorer outcomes of radiotherapy in a number of patient populations, ignoring even modest anemia can result in decreased locoregional control, overall survival, and quality of life (QOL). Because increasing hemoglobin levels 1-2 g/dl is usually easily accomplished, there exists the potential for improving outcomes by paying greater attention to this problem. This article focuses on the prevalence of anemia, particularly functional anemia, and discusses the impact of anemia on locoregional control, overall survival, and QOL. INTRODUCTIONContinuing advances in oncology care, including new radiotherapy technologies and recent developments with multimodal therapies, have significantly improved clinical outcomes and quality of life (QOL) for many patients with cancer. However, the prevalence and impact of cancer-associated anemia is not widely appreciated. Emerging data demonstrate that cancer-related anemia is unexpectedly common in cancer patients receiving radiotherapy and/or chemotherapy and that even modest anemia (hemoglobin <12 g/dl) substantially impairs QOL. In addition, a growing body of literature suggests that hemoglobin concentrations of less than 12-13 g/dl during cancer therapy are associated with reduced local tumor control and decreased survival [1,2]. Although anemia of this magnitude can be easily managed, it is often overlooked or considered clinically insignificant. However, restoration of normal hemoglobin concentrations in patients undergoing radiotherapy has the potential to improve local tumor control and survival and produce sizable improvements in patient QOL.

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Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: a secondary analysis of RTOG 85-27

Cited by 189 publications

References 19 publications

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Locally Advanced Head and Neck Squamous Cell Carcinomas Treated by Surgery

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Locally Advanced Head and Neck Squamous Cell Carcinomas Treated by Surgery

Kinetics of haematopoietic recovery after dose‐intensive chemo/radiotherapy in mice: optimized erythroid support with darbepoetin alpha

Radiotherapy-Associated Anemia: The Scope of the Problem

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