The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix

Grogan, Michelle; Thomas, Gillian; Melamed, Iris; Wong, Frances; Pearcey, R.; Joseph, Paul; Portelance, Lorraine; Crook, Juanita; Jones, Kyle M.

doi:10.1002/(sici)1097-0142(19991015)86:8<1528::aid-cncr20>3.0.co;2-e

Cited by 398 publications

(278 citation statements)

References 28 publications

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“…Other studies have shown a statistically significant association between anaemia and reduced local control or survival in cervical cancer or head and neck cancer (Fein et al, 1995;Dubray et al, 1996;Warde et al, 1998;Grogan et al, 1999). Dubray et al (1996) found that even moderate anaemia significantly correlated with a worse treatment outcome in squamous cell carcinoma of the head and neck (Figure 2).…”

Section: Possibilities For Improved Treatment Outcomesmentioning

confidence: 88%

“…Many studies have found that inadequate oxygenation at the tumour site and/or low haemoglobin values are associated with poor treatment outcome after curative radiotherapy (Fein et al, 1995;Dubray et al, 1996;Fyles et al, 1998;Grogan et al, 1999). Adequate tumour oxygenation is known to be necessary for an optimal response to radiotherapy (Glaspy and Cavill, 1999), thus it is theoretically possible that decreased haemoglobin (which may contribute to lowered oxygenation at the tumour site) may also have an effect on the success of therapy.…”

Section: Possibilities For Improved Treatment Outcomesmentioning

confidence: 99%

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Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy

Demetri

2001

Br J Cancer

100

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Anaemia is a common occurrence in patients with cancer and contributes to the clinical symptomatology and reduced quality of life (QOL) seen in cancer patients. Many aspects of reduced QOL, including fatigue, are known to be associated with suboptimally low levels of haemoglobin. Even mild-to-moderate anaemia adversely affects patient-reported QOL parameters. Red blood cell transfusions are associated with many real and perceived risks, inconveniences, costs, and only temporary benefits. Recombinant human erythropoietin (rHuEPO) is an effective therapy to increase haemoglobin values in over half of anaemic cancer patients receiving concurrent chemotherapy. These increased haemoglobin values are closely correlated with improvements in QOL. Despite these objectively defined benefits, less than 50% of anaemic patients undergoing cytotoxic chemotherapy receive rHuEPO, in contrast to patients with chronic renal failure on dialysis, where anaemia is universally and aggressively treated to more optimal haemoglobin values. However, there are several barriers that may limit more widespread use of rHuEPO. These include inconvenience associated with frequent dosing; failure of a large proportion (40 to 50%) of patients to respond; relatively slow time to response; absence of reliable early indicators of response; and current lack of rigorous pharmacoeconomic data demonstrating cost-effectiveness. Darbepoetin alfa is a novel erythropoiesis stimulating protein (NESP) that is biochemically distinct from rHuEPO, and which has been proven to stimulate red blood cell production. The molecule has a 3-fold longer half-life and increased biological activity that will allow less frequent dosing, facilitating improved management of the anaemia of cancer. With this new option for therapy, further avenues of investigation should lead to renewed interest in the clinical benefits of optimal haemoglobin levels for patients with cancer. © 2001 Cance Cancer Research Campaign

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Section: Possibilities For Improved Treatment Outcomesmentioning

confidence: 88%

Section: Possibilities For Improved Treatment Outcomesmentioning

confidence: 99%

Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy

Demetri

2001

Br J Cancer

100

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“…[5][6][7][8] However, the mechanism remains unclear especially in view of the fact that anemia has also been associated with a poorer prognosis in general for patients with advanced cancer. 9 It is intriguing, however, to believe that outcome could be effected by simply returning the Hgb level to normal before the start of RT through the use of growth factor or transfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, as noted in Table 3, the median Hgb level in failing patients at the start of RT and at 1 month after the start of RT was 12.2 and 11.7 g/dL, respectively. In other disease sites, [5][6][7][8] an Hgb level less than 10 g/dL has been noted before clinical outcomes declined significantly. When subject to multivariable analysis examining the predictors of time to PSA failure, the Hgb level at the start of RT approached but did not reach statistical significance (P ϭ 0.11) when evaluated in conjunction with the initial rate of decline in the serum Hgb level.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been established that during adolescence, the mean hemoglobin (Hgb) level increases from 13 to 15 g/dL in males and that hypogonadism is associated with a mild normochromic normocytic anemia that can be corrected with androgen replacement therapy. 4 The results of other clinical studies have shown that anemia at the start of RT has been associated with both decreased local control and overall survival in patients with carcinoma of the cervix 5,6 and head and neck. 7,8 The precise mechanism by which this occurs is still being debated.…”

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confidence: 99%

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Initial decline in hemoglobin during neoadjuvant hormonal therapy predicts for early prostate specific antigen failure following radiation and hormonal therapy for patients with intermediate and high‐risk prostate cancer

D’Amico

Saegaert

Chen

et al. 2002

Cancer

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BACKGROUNDDeclines in serum hemoglobin (Hgb) levels occur from the use of androgen suppression therapy (AST) in the treatment of prostate cancer patients. We studied whether time to prostate specific antigen (PSA) failure following external beam radiation therapy (RT) and AST could be predicted by the rate of decline in the Hgb level following the administration of neoadjuvant AST or by the Hgb level at presentation or at the start of RT.METHODSThe study cohort comprised 110 intermediate or high‐risk prostate cancer patients who were managed using three‐dimensional conformal RT (70 Gy) and 6 months of AST (2 months neoadjuvant, concurrent, and adjuvant). A Cox regression multivariable analysis was performed to evaluate the ability of the rate of decline of the Hgb from baseline to the start of RT, baseline PSA level, Gleason score, percent positive biopsies, and T‐category to predict time to PSA failure.RESULTSA decline in the Hgb level of 1 g/dL or more during the first month of AST was the only significant predictor of time to PSA failure (P = 0.02) on multivariable analysis. The relative risk of PSA failure (95% confidence interval) for patients with a decline in Hgb level during the first month (≥ 1 g/dL vs. < 1 g/dL) was 6.3 (2.4, 8.3) and the 3‐year estimate of PSA outcome was 66% versus 82% (P = 0.04), respectively. There were no imbalances in the pretreatment prognostic factors or length of follow‐up in each of these groups.CONCLUSIONA decline of 1 g/dL or more in Hgb level during the first month of neoadjuvant AST was a predictor of early PSA failure following RT and AST in intermediate and high‐risk prostate cancer patients. Cancer 2002;95:275–80. © 2002 American Cancer Society.DOI 10.1002/cncr.10673

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Anemia

Nissenson¹,

Goodnough²,

Dubois³

2003

Arch Intern Med

183

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The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix

Cited by 398 publications

References 28 publications

Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy

Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy

Initial decline in hemoglobin during neoadjuvant hormonal therapy predicts for early prostate specific antigen failure following radiation and hormonal therapy for patients with intermediate and high‐risk prostate cancer

Anemia

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