Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer

Prosnitz, Robert G.; Yao, Bin; Farrell, Catherine L.; Clough, Robert; Brizel, David M.

doi:10.1016/j.ijrobp.2004.07.710

Cited by 76 publications

(61 citation statements)

References 27 publications

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“…It has been shown that pretreatment Hb levels equate with a poor OS and local control in patients with HNSCC, although the definition of anemia varies widely. 41,42 Although the majority of studies in HNSCC have examined the outcome after RT, 11 1 study in patients with laryngeal cancer retrospectively reviewed 258 patients who underwent surgery. The authors reported that 10% of their patients presented with pretreatment anemia and that this was associated with decreased locoregional control in a multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

The relation between hypoxia‐inducible factor (HIF)‐1α and HIF‐2α expression with anemia and outcome in surgically treated head and neck cancer

Winter

Shah

Han

et al. 2006

Cancer

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BACKGROUND.Hypoxia promotes tumorigenesis through the hypoxia‐inducible factor (HIF) pathway. There are 2 main homologues of the regulatory proteins, HIF‐1α and HIF‐2α, which have different effects in genetic knock‐out experiments. Anemia may contribute to hypoxia by reducing oxygen delivery, but it is not known whether this influences HIF‐α expression in tumors.METHODS.The expression of HIF‐1α, HIF‐2α, carbonic anhydrase‐9 (CA‐9), and peripheral hemoglobin (Hb) levels in 151 patients who underwent surgery for head and neck squamous cell carcinoma (HNSCC) were analyzed and related to outcome.RESULTS.High HIF‐1α was expressed in 45 of 140 tumors (30%), HIF‐2α was expressed in 21 of 139 tumors (14%), and CA‐9 was expressed in 56 of 149 tumors (62%). There was a positive correlation between HIF‐1α expression and HIF‐2α expression (P = .0001). HIF‐1α alone was associated with a worse disease‐specific survival (DSS) (P = .05) and disease‐free survival (DFS) (P = .03) in multivariate analyses. Nine percent of tumors expressed both high HIF‐1α and high HIF‐2α. High HIF‐1α/high HIF‐2α expression was an independent prognostic factors in DSS (P = .04) and DFS (P = .005) in multivariate analyses. There was no correlation noted between Hb and HIF‐1α, HIF‐2α, or CA‐9.CONCLUSIONS.HIF‐1α alone was correlated with DSS and DFS. The additive effect of HIF‐2α on poor prognosis suggested that different pathways may be regulated by HIF‐2α. Anemia that was not related to HIF‐α expression suggests that tumor intrinsic factors regulate HIF‐α; therefore, anemia may be a surrogate marker for other factors that affect outcome. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

The relation between hypoxia‐inducible factor (HIF)‐1α and HIF‐2α expression with anemia and outcome in surgically treated head and neck cancer

Winter

Shah

Han

et al. 2006

Cancer

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“…Randomized trials exploring the role of chemotherapy in addition to radiotherapy for patients presenting with anemia are lacking. However, prospective and retrospective studies indicate that the poor prognosis of patients presenting with anemia cannot be improved by a chemoradiotherapy approach (19,20). The "reduced cord radius" model described by Hirst and colleagues could explain the success of ARCON in patients with anemia (21).…”

Section: Dfs (%) Dfs (%)mentioning

confidence: 99%

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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“…Baş boyun kanserli hastalarda aneminin kötü prognostik faktör olduğu birçok çalışmada gösterilmiştir [12,13]. Çalışmamızda radyoterapi başlangıcında anemisi olan hastalarda 2 yıllık genel sağkalım oranı %41 olarak bulunmuştur ve bunun 2 yıllık genel sağkalımı olumsuz yönde etkilediği tespit edilmiştir.…”

Section: Discussionunclassified

“…Çalışmamızda radyoterapi başlangıcında anemisi olan hastalarda 2 yıllık genel sağkalım oranı %41 olarak bulunmuştur ve bunun 2 yıllık genel sağkalımı olumsuz yönde etkilediği tespit edilmiştir. Birçok maligniteye benzer biçimde, baş boyun kanserli hastalarda tedavi öncesi performans durumunun tedavi sonuçlarını etkilediği gösterilmiştir [12,13]. Çalışmamızda 2 yıllık genel sağkalım oranının ECOG performans durumu 0 olan hastalarda %94, 1 olan hastalarda ise %41 olarak bulunması performans durumunun sağkalımı etkilediğini göstermektedir.…”

Section: Discussionunclassified

“…Konvansiyonel fraksiyon ile radyoterapi günde 1,8-2 Gy, haftada 5 fraksiyon, hiperfraksiyon şeması ile radyoterapi günde 2 kez 1,2 Gy, haftada 10 fraksiyon şeklinde uygulanmıştı. Radyoterapi planlaması 3 boyutlu konformal olarak Eclipse programı ile tedavi ise lineer hızlandırıcıda 6 MV veya 18 MV foton enerjisi ve gerektiğinde uygun elektron enerjisi (9,12,16 Hastaların 6'sına (%7) cerrahi, 33'üne (%40) cerrahi+radyoterapi/kemoradyoterapi, 16'sına (%20) indüksiyon kemoterapi+kemoradyoterapi, 12'sine (%15) kemoradyoterapi, 11'ine (%13) radyoterapi ve 4'üne (%5) kemoterapi uygulanmıştır.…”

Section: Gereç Ve Yöntemunclassified

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Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler

Akkaş¹,

Yücel²,

Kılıçkap³

et al. 2013

CMJ

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Amaç. Merkezimizde takip ve tedavi edilen baş boyun kanseri hastalarında klinikopatolojik özelliklerin, tedavi sonuçlarının ve sağkalımı etkileyen prognostik faktörlerin incelenmesi amaçlanmıştır. Yöntem. 2007-2010 tarihleri arasında merkezimize başvuran ve baş boyun kanseri tanısı ile izlenmekte olan hastalara ait demografik, klinik ve histopatolojik veriler hasta dosya ve hastane kayıtları incelenerek elde edildi. Bulgular. Seksen iki hastaya ait veriler analiz edildi. 72 erkek (%88) ve 10 kadın (%12) hasta mevcuttu. Hastaların ortanca yaşı 57 (20-80) idi. En genç hastalar nazofarenks, parahipofarenks ve paranazal sinüs tümörü olan hastalardı. En yaygın malignensi 37 hastada (%45) bulunan larenks kanseri idi. Elli beş hasta (%67) Eastern Cooperative Oncology Group 1 idi. En sık evre 51 hasta (%62) ile lokal ileri evre idi. Tanı anında 60 (%75) hastada anemi, 30 (%60) hastada C-reaktif protein yüksekliği, 72 (%89) hastada kilo kaybı tespit edildi. Yassı hücreli karsinom 69 (%84) hasta ile en sık izlenen histopatolojik tip idi. On yedi (%47) hastada perinöral invazyon, 17 (%47) hastada lenfovasküler invazyon, 12 (%32) hastada ekstrakapsüler invazyon tespit edildi. Hastalar arasında en sık izlenen grade 34 (%42) hasta ile grade II idi. Tüm hastalar için ortanca sağkalım 34 aydı. İki yıllık genel sağkalım oranı erken evre (I-II) hastalarda %75, lokal ileri hastalarda (III-IVA ve B) %51 iken, metastatik hastalık varlığında ise ortanca sağkalım 10 ay idi. Eşlik eden hipertansiyon varlığı, performans durumu, kanserin lokalizasyonu ve evresi, T ve N evresi, radyoterapiye ara verilmesi, C-reaktif protein düzeyi ve anemi sağkalımı belirleyen faktörler idi. Sonuç. Hipertansiyon varlığı, performans durumu, kanserin lokalizasyon ve evresi, T ve N evresi, radyoterapiye ara verilmesi, C-reaktif protein düzeyi ve anemi baş boyun kanserli hastalarda sağkalımı etkileyen prognostik faktörler olarak belirlendi.Anahtar sözcükler: Baş boyun kanseri, radyoterapi, kemoterapi, prognoz Abstract Aim. Our aim was to investigate the clinicopathological features, the treatment outcome and the prognostic factors affecting survival in patients with head and neck cancer followed and treated in our center. Methods. The demographic, clinical and the histopathological data of the patients who were admitted to our center between 2007 and 2010 with a diagnosis of head and neck cancer were examined using the medical records. Results. The data from 82 patients were analyzed. There were 72 men (88%) and 10 women (12%). The median age of the patients was 57 (20-80) years. The youngest patients had nasopharyngeal, parahypopharyngeal and paranasal sinus tumors. The most commonly encountered malignancy was the laryngeal cancer, which was found in 37 patients (45%). Fifty-five patients (67%) were Eastern Cooperative Oncology Group 1. The most common grade was the locally advanced stage with 51 patients (62%). At time of the diagnosis, 60 (75%) patients had anemia, 30 (60%) patients had an elevated C-reactive protein, and 72 (89%) patients had weight loss....

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Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer

Cited by 76 publications

References 27 publications

The relation between hypoxia‐inducible factor (HIF)‐1α and HIF‐2α expression with anemia and outcome in surgically treated head and neck cancer

The relation between hypoxia‐inducible factor (HIF)‐1α and HIF‐2α expression with anemia and outcome in surgically treated head and neck cancer

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

Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler

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