Does transfusion improve the outcome for HNSCC patients treated with radiotherapy? – Results from the randomized DAHANCA 5 and 7 trials

Hoff, Camilla Molich; Lassen, P.; Eriksen, Jesper Grau; Hansen, Hanne Sand; Specht, Lena; Overgaard, Marie; Grau, C.; Johansen, Jørgen; Bentzen, Jens; Andersen, Lisbeth Juhler; Evensen, Jan F.; Overgaard, Jens

doi:10.3109/0284186x.2011.592650

Cited by 48 publications

(28 citation statements)

References 37 publications

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“…It has been demonstrated by numerous reports that anemia in patients with cancer of the cervix, head and neck, bladder, breast, and lung is associated with poor outcome (2)(3)(4). This is also found in the current study for patients with T2-4 laryngeal cancer treated with radiotherapy alone.…”

Section: Discussionsupporting

confidence: 85%

“…A wealth of data indicates that low pretreatment hemoglobin levels are a strong prognostic indicator of poor disease control and survival (2)(3)(4). To overcome the adverse impact of low pretreatment hemoglobin levels, correction strategies have been applied, such as administering erythropoietin and packed cell transfusions.…”

Section: Introductionmentioning

confidence: 99%

“…To overcome the adverse impact of low pretreatment hemoglobin levels, correction strategies have been applied, such as administering erythropoietin and packed cell transfusions. However, randomized trials failed to demonstrate the effectiveness of these approaches in patients with head and neck or breast cancer, and erythropoietin was even counterproductive in some studies (3,(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

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Improved Recurrence-Free Survival with ARCON for Anemic Patients with Laryngeal Cancer

Janssens

Rademakers

Terhaard

et al. 2014

Clinical Cancer Research

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Purpose: Anemia is associated with poor tumor control. It was previously observed that accelerated radiotherapy combined with carbogen breathing and nicotinamide (ARCON) can correct this adverse outcome in patients with head and neck cancer. The purpose of this study was to validate this observation based on data from a randomized trial.Experimental Design: Of 345 patients with cT2-4 laryngeal cancer, 174 were randomly assigned to accelerated radiotherapy and 171 to ARCON. Hemoglobin levels, measured before treatment, were defined as low when <7.5 mmol/L for women and <8.5 mmol/L for men. The hypoxia marker pimonidazole was used to assess the oxygenation status in tumor biopsies. Data were analyzed 2 years after inclusion of the last patient.Results: Pretreatment hemoglobin levels were available and below normal in 27 of 173 (16%) accelerated radiotherapy and 27 of 167 (16%) ARCON patients. In patients with normal pretreatment, hemoglobin levels treatment with ARCON had no significant effect on 5-year loco-regional control (LRC, 79% versus 75%; P ¼ 0.44) and disease-free survival (DFS, 75% vs. 70%; P ¼ 0.46) compared with accelerated radiotherapy. However, in patients with low pretreatment, hemoglobin levels ARCON significantly improved 5-year LRC (79% vs. 53%; P ¼ 0.03) and DFS (68% vs. 45%; P ¼ 0.04). In multivariate analysis including other prognostic factors, pretreatment hemoglobin remained prognostic for LRC and DFS in the accelerated radiotherapy treatment arm. No correlation between pretreatment hemoglobin levels and pimonidazole uptake was observed.Conclusion: Results from the randomized phase III trial support previous observations that ARCON has the potential to correct the poor outcome of cancer patients with anemia (ClinicalTrials.gov number, NCT00147732). Clin Cancer Res; 20(5); 1345-54. Ó2014 AACR.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improved Recurrence-Free Survival with ARCON for Anemic Patients with Laryngeal Cancer

Janssens

Rademakers

Terhaard

et al. 2014

Clinical Cancer Research

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“…In our study females comprised almost one-third of the study population, and the mean age of them was not significantly different than for male patients as reported by others [20]. Women with laryngeal carcinoma generally do better than men [2,7,17,26]. The possible explanations of it involved among others less advanced disease and lower age at the time of diagnosis or more hygienic life style.…”

Section: Discussionsupporting

confidence: 43%

“…Considering this, although the correction of Hb concentration prior to radiotherapy remains controversial [26,27] monitoring of Hb concentration during RT may indicate patients with higher risk of failure.…”

Section: Discussionmentioning

confidence: 97%

Predictors of radiotherapy outcome in patients with T2 supraglottic carcinoma

Rutkowski

Wygoda

Składowski

et al. 2011

Eur Arch Otorhinolaryngol

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The decision regarding treatment of early supraglottic carcinoma remains controversial. Single institution clinical data of patients with T2 supraglottic carcinoma treated exclusively with radiotherapy in terms of prognostic factors and treatment results were analyzed. Patient-related factors that would potentially by useful for optimal therapeutic decision to be undertaken were especially investigated. Between 1994 and 2004, 78 patients with T2 supraglottic carcinoma underwent radiotherapy (RT) in Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Poland. There were 54 (69%) males and 24 (31%) females in the median age of 61 years. There were 17 (22%) patients with N+. Median body mass of patients before (BM0) and after RT (BM1) was 74 kg (range 45.2-130 kg) and 72.9 kg (range 49.9-122.5 kg), respectively. Median hemoglobin concentrations before (Hb0) and after (Hb1) RT were 14.3 and 13.4 g/dl, respectively. Median change of Hb concentration during RT (dHb) was -0.8 g/dl. All were treated up to total doses (TD) ranged from 62.5 to 72 Gy. The overall treatment time (OTT) ranged from 30 to 70 days. Estimates of local control (LC), ultimate local control (uLC), and overall survival (OS) were calculated using the Kaplan-Meier method. Log rank statistics, Cox proportional hazard model and step-wise Cox regression hazard model were employed to identify prognostic factors for LC, uLC, and OS in univariate and multivariate analyses. The 5-year LC, RC, uLC and OS rates were 85, 92, 88, and 56%, respectively. In multivariate analysis N+ (p = 0.01) and prolonged OTT (p = 0.03) significantly decreased LC. Females (p = 0.02), higher BM0 (p = 0.03), and HB0 (p = 0.006) significantly prolonged OS. Patient-related factors like gender, hemoglobin concentration, and body mass may predict treatment outcome. Radiotherapy is effective for T2 supraglottic carcinoma of the larynx unless higher dose intensity is provided. Involved regional lymph nodes significantly deteriorate locoregional cure.

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Red Blood Cell Transfusion Practices for Patients With Cervical Cancer Undergoing Radiotherapy

et al. 2021

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Key Points Question What is the hemoglobin transfusion threshold and target recommended for patients with cervical cancer undergoing curative-intent radiotherapy (RT)? Findings In this international Delphi consensus study, 39 experts in gynecologic radiation oncology did not agree on a hemoglobin transfusion threshold, highlighting significant variability in clinical practice. For both external beam RT and brachytherapy, a hemoglobin transfusion target of 9 or more g/dL and less than 12 g/dL, respectively, was agreed on by an 89% consensus. Meaning A liberal packed red blood cell transfusion strategy was recommended by consensus to overcome hypoxia-induced radioresistance in patients with cervical cancer receiving curative RT.

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Does transfusion improve the outcome for HNSCC patients treated with radiotherapy? – Results from the randomized DAHANCA 5 and 7 trials

Cited by 48 publications

References 37 publications

Improved Recurrence-Free Survival with ARCON for Anemic Patients with Laryngeal Cancer

Improved Recurrence-Free Survival with ARCON for Anemic Patients with Laryngeal Cancer

Predictors of radiotherapy outcome in patients with T2 supraglottic carcinoma

Red Blood Cell Transfusion Practices for Patients With Cervical Cancer Undergoing Radiotherapy

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