Prognostic Value of Hemoglobin Concentrations in Patients with Advanced Head and Neck Cancer Treated with Combined Radio-Chemotherapy and Surgery

Wagner, W.; Hermann, Robert Michael; Hartlapp, J. H.; Eßer, E; Christoph, Bernhard; Müller, Michael; Krech, Rainer; Koch, Olaf

doi:10.1007/pl00002331

Cited by 33 publications

(18 citation statements)

References 28 publications

(40 reference statements)

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“…Several studies of head and neck carcinomas have also reported the negative effects of a decrease in Hb levels during or after radiotherapy. [23][24][25] Therefore, when the prognostic value of Hb level is being evaluated in patients treated with sequential chemoradiotherapy, midradiation Hb levels are a more reliable indicator of anemia than are pretreatment levels and thus should also be monitored. Nonetheless, the current study does not exclude the possibility that preradiation Hb level is also a useful prognostic factor for patients with NPC, as only a limited number of patients treated with radiotherapy alone had preradiation Hb levels that were less than the threshold value.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of hemoglobin levels on treatment outcome in patients with nasopharyngeal carcinoma treated with sequential chemoradiotherapy or radiotherapy alone

Chua

Sham

Choy

2004

Cancer

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BACKGROUNDThe goal of the current study was to investigate the impact of hemoglobin (Hb) levels on treatment outcome in a randomized Phase III trial of patients with nasopharyngeal carcinoma (NPC) treated with induction chemotherapy followed by radiotherapy or with radiotherapy alone.METHODSBetween September 1989 and August 1993, 334 patients with advanced NPC were entered into a randomized trial comparing 3 cycles of induction chemotherapy (cisplatin and epirubicin) followed by radiotherapy with radiotherapy alone. Only evaluable patients who completed radiation were included in the analysis (n = 286). Patients were stratified into normal and low Hb groups according to baseline, preradiation, and midradiation Hb levels. Local recurrence–free, distant metastasis–free, and disease‐specific survival rates were estimated using the Kaplan–Meier method. Multivariate analysis was performed using the Cox model.RESULTSIn the chemotherapy arm, the mean baseline, preradiation, and midradiation Hb levels were 13.6, 11.0, and 11.8 g/dL, respectively. In the radiotherapy arm, the mean baseline/preradiation and midradiation Hb levels were 13.7 and 12.9 g/dL, respectively. A midradiation Hb level ≤ 11 g/dL was associated with significantly poorer 5‐year local recurrence–free (60% vs. 80%; P = 0.0059) and disease‐specific survival rates (51% vs. 68%; P = 0.001), with no difference in distant metastasis–free rates (69% vs. 67%; P = 0.83). No significant difference in treatment outcome according to baseline or preradiation Hb levels was noted. Multivariate analysis showed that a low midradiation Hb level, but not a low baseline or preradiation Hb level, was an independent predictor of local disease recurrence and malignancy‐related death.CONCLUSIONSThe current study showed that midradiation Hb level was an important prognostic factor with respect to local control and survival in patients with NPC. The high incidence of anemia after chemotherapy has a negative impact on treatment outcome, and this condition may reduce the benefit of induction chemotherapy. Attempts to correct anemia during radiation and the impact of anemia on treatment outcome requires further study. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Prognostic impact of hemoglobin levels on treatment outcome in patients with nasopharyngeal carcinoma treated with sequential chemoradiotherapy or radiotherapy alone

Chua

Sham

Choy

2004

Cancer

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“…Whether Hb levels at the start of therapy (or at presentation, e.g., [14,22,25,28,46,62]), at the nadir during therapy (e.g., [26,81]), at the peak during therapy (e.g., [41]), or at the end of (radio)therapy (e.g., [81,94]) are of prognostic value in terms of better disease-free and overall survival is still being assessed in ongoing studies.…”

Section: Tumor Hypoxia and Anemia As Adverse Prognostic Factorsmentioning

confidence: 99%

Impact of Hemoglobin Levels on Tumor Oxygenation: the Higher, the Better?

2006

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Review of relevant clinical data suggests that a maximum oxygenation status in solid tumors is to be expected in the range 12 g/dl < cHb < 14 g/dl for women and 13 g/dl < cHb < 15 g/dl for men. Considering the "optimal" cHb range with regard to tumor oxygenation, the concept of "the higher, the better" is therefore no longer valid. This finding has potentially far-reaching implications in the clinical setting (e. g., inappropriate erythropoietin treatment of nonanemic tumor patients).

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“…Radiotherapy alone versus surgery alone can only be compared indirectly since there are no randomized clinical trials. Controlled clinical trials do not show any survival bene t for patients treated postoperatively with 30 Gy (27) or [49][50][51][52][53][54][55][56]29). Radiotherapy can thus not be recommended as a single modality treatment or as the only adjuvant therapy with surgery in a curative approach.…”

Section: Radiotherapymentioning

confidence: 99%

“…Both cisplatin and 5-FU seem to be synergistic with radiation. There is also less risk of accelerated repopulation of tumor cells during treatment, which is an important cause of local failure in cancer of the head and neck (49) and cervix (50). Even if the acute esophageal toxicity is greater with the concurrent treatment, late toxicity seems to remain the same (51,11).…”

Section: Non-surgical Treatmentmentioning

confidence: 99%

Chemoradiotheraphy of Esophageal Cancer

Albertsson

2002

Acta Oncologica

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Prognostic Value of Hemoglobin Concentrations in Patients with Advanced Head and Neck Cancer Treated with Combined Radio-Chemotherapy and Surgery

Cited by 33 publications

References 28 publications

Prognostic impact of hemoglobin levels on treatment outcome in patients with nasopharyngeal carcinoma treated with sequential chemoradiotherapy or radiotherapy alone

Prognostic impact of hemoglobin levels on treatment outcome in patients with nasopharyngeal carcinoma treated with sequential chemoradiotherapy or radiotherapy alone

Impact of Hemoglobin Levels on Tumor Oxygenation: the Higher, the Better?

Chemoradiotheraphy of Esophageal Cancer

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