Decrease in Hemoglobin Levels Following Surgery Influences the Outcome in Head and Neck Cancer Patients Treated with Accelerated Postoperative Radiotherapy
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To assess the influence of hemoglobin (Hb) levels in locally advanced head and neck cancer (LAHNC) patients treated with surgery and postoperative radiotherapy (PORT).
Material and Methods
Pre- and postoperative Hb levels were collected in 79 patients treated with surgery followed by accelerated PORT for LAHNC. Median follow-up was 52 months (range 12–95 months).
Results and Discussion
Four-year overall survival (OS) rate was 51%. Neither pre- nor postoperative Hb level (<120 or 130 g/l in women or men, respectively) influenced the outcome. However, when Hb decrease between pre- and postoperative Hb values was taken into account, 4-year OS was significantly higher in patients with Hb difference less than 38 g/l (quartile value) compared with those with Hb decrease 38 g/l or more (61% versus 16%, P = 0.008).
Decrease in Hb level by more than 38 g/l after surgery secondary to blood loss influences the outcome when postoperative RT is indicated.
- Tarnawski R, Skladowski K, Maciejewski B. Prognostic value of hemoglobin concentration in radiotherapy for cancer of supraglottic larynx. Int J Radiat Oncol Biol Phys. 1997;38:1007–11.
- Scott SN, Boeve TJ, McCulloch TM, Fitzpatrick KA, Karnell LH. The effects of epoetin alfa on transfusion requirements in head and neck cancer patients: a prospective randomised, placebo-controlled study. Laryngoscope. 2002;112:1221–9. CrossRef
- Overgaard J, Horsman MR. Modification of hypoxia-induced radioresistance in tumors by the use of oxygen and sensitizers. Semin Radiat Oncol. 1996;6:10–21. CrossRef
- Vaupel P, Mayer A, Höckel M. Impact of hemoglobin levels on tumor oxygenation: the higher, the better? Strahlenther Onkol. 2006;182:63–71. CrossRef
- Lee WR, Berkey B, Marcial V, Fu KK, Cooper JS, Vikram B, et al. 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. Int J Radiat Oncol Biol Phys. 1998;42:1069–75.
- Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998; 338:1798–1804. CrossRef
- Nordsmark M, Bentzen SM, Rudat V, Brizel D, Lartigau E, Stadler P, et al. Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy: an international multi-center study. Radiother Oncol. 2005;77:18–24. CrossRef
- Sobin LH, Wittekind C. International Union Against Cancer (UICC): TNM classification of malignant tumors, 6th ed. New York: Wiley-Liss; 2002. p 19–47.
- Kaplan EL, Meier P. Non parametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81. CrossRef
- Peto P, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, et al. Design and analysis of randomised clinical trials requiring prolonged observation of each patients: part II. Br J Cancer. 1977;35:1–39.
- Cox DR. Regression models and life tables. J R Stat Soc. 1972;34:187–200.
- Zouhair A, Azria D, Pasche P, Stupp R, Chevalier J, Betz M, et al. Accelerated postoperative radiotherapy with weekly concomitant boost in patients with locally advanced head and neck cancer. Radiother Oncol. 2004;70:183–8. CrossRef
- Bernier J, Domenge C, Ozsahin M, Matuszewksa K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945–52. CrossRef
- Mirimanoff RO, Wang CC, Doppke KP. Combined surgery and postoperative radiation therapy for advanced laryngeal and hypopharyngeal carcinomas. Int J Radiat Oncol Biol Phys. 1985;11:499–504.
- Carter RL, Tanner NSB, Clifford P, Shaw HJ. Perineural spread in squamous cell carcinomas of the head and neck: a clinicopathological study. Clin Otolaryngol. 1979:4:271–81. CrossRef
- Olsen KD, Caruso M, Foote RL, Stanley RJ, Lewis JE, Buskirk SJ, et al. Primary head and neck cancer: histopathologic predictors of recurrence after neck dissection in patients with lymph node involvement. Arch Otolaryngol Head Neck Surg. 1994;120:1370–4.
- Johnson JT, Barnes EL, Myers EN, Schramm VL Jr, Borochovitz D, Sigler BA. The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol. 1981;107:725–9.
- Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck. 2005;27:843–50. CrossRef
- Ozsahin M, Azria D, Beer K, Mirimanoff RO, Zouhair A. External radiotherapy and anemia treatment: state of the art. Swiss Med Wkly. 2005;135:4–10.
- Rades D, Stoehr M, Kazic N, Hakim SG, Walz A, Schild SE, et al. Locally advanced stage IV squamous cell carcinoma of the head and neck: impact of pre-radiotherapy hemoglobin level and interruptions during radiotherapy. Int J Radiat Oncol Biol Phys. 2008;70:1108–14.
- Clark JR, McCluskey SA, Hall F, Lipa J, Neligan P, Brown D, et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck. 2007;29:1090–1101. CrossRef
- Höckel MP, Vaupel P. Biological consequences of tumor hypoxia. Semin Oncol. 2001;28(2 suppl 8):36–41. CrossRef
- Richard DE, Berra E, Pouyssegur J. Angiogenesis: how a tumor adapts to hypoxia. Biochem Biophys Res Commun. 1999:266:718–22. CrossRef
- Double-blind, placebo-controlled study of the therapeutic use of recombinant human erythropoietin for anemia associated with chronic renal failure in predialysis patients. The US Recombinant Human Erythropoietin Predialysis Study Group. Am J Kidney Dis. 1991;18:50–9.
- Henke M, Laszig R, Rübe C, Schäfer U, Hasse KD, Schilcher B, et al. Erythropoietin to treat head and neck cancer patients with anemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial. Lancet 2003;362:1255–60. CrossRef
- Overgaard J, Hoff C, Sand Hansen H, Specht L, Overgaard M, Grau C, et al. Randomized study of the importance of Novel Erythropoiesis Stimulating Protein (Aranesp) for the effect of radiotherapy in patients with primary squamous cell carcinoma of the head and neck (HNSCC): the Danish Head and Neck Cancer Group DAHANCA 10 randomized trial. Eur J Cancer. 2007;5(suppl):7.
- Decrease in Hemoglobin Levels Following Surgery Influences the Outcome in Head and Neck Cancer Patients Treated with Accelerated Postoperative Radiotherapy
Annals of Surgical Oncology
Volume 16, Issue 5 , pp 1331-1336
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- Author Affiliations
- 1. Radiation Oncology, University Hospital Center, University of Lausanne, Lausanne, Switzerland
- 2. Medical Oncology, University Hospital Center, University of Lausanne, Lausanne, Switzerland
- 3. Otolaryngology-Head and Neck Surgery, University Hospital Center, University of Lausanne, Lausanne, Switzerland