INTRODUCTION
Preoperative, long-course chemoradiotherapy is recommended for rectal cancers involving or threatening the mesorectal resection margin, but tumor response is variable. Some highly radiosensitive cancers completely regress, leading to reduced local recurrence and improved survival. This study was designed to evaluate the influence of anemia during chemoradiotherapy on tumor response, local and distant recurrence, and overall survival.
METHODS
Mean hemoglobins during chemoradiotherapy of consecutive patients with rectal cancer undergoing chemoradiotherapy and surgery were calculated and ranked. Anemia was defined as lowest quartile for males and females. Tumor response was histologically quantified using rectal cancer regression grade.
RESULTS
Of 100 patients, 5 females and 20 males were anemic. Nonanemic patients achieved better tumor response (54 percent regression Grade 1) than anemic patients (28 percent, P = 0.028). There were more locally advanced cancers in anemic (48 percent T4) compared with nonanemic patients (21 percent T4), but radiologic T stage did not influence tumor response (50 percent T3 vs. 43 percent T4 regression Grade 1, P = 0.53) or overall survival. Mesorectal margin positivity was less in nonanemic (15 percent) compared with anemic patients (36 percent, P = 0.021). At median follow-up of 39 months, nonanemic patients (7 percent) suffered less local recurrence than anemic patients did (38 percent, P = 0.003). Overall survival at two years was improved in nonanemic (91 percent) compared with anemic patients (64 percent, P = 0.021), but was similar for T3 and T4 patients.
CONCLUSIONS
Patients with normal hemoglobin during chemoradiotherapy achieved better tumor response, less local recurrence, and improved overall survival compared with anemic patients, independent of radiologic T stage. Correcting anemia before chemoradiotherapy might improve tumor response and oncologic outcomes.
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REFERENCES
T Buroker N Nigro J Correa VK Vaitkevicius M Samson B Considine (1976) ArticleTitleCombination preoperative radiation and chemotherapy in adenocarcinoma of the rectum Dis Colon Rectum 19 660–3 Occurrence Handle991708
BD Minsky AM Cohen N Kemeny et al. (1994) ArticleTitleEfficacy of preoperative 5-FU, high dose leucovorin, and sequential radiation therapy for unresectable rectal cancer Cancer 73 273–80 Occurrence Handle1:STN:280:ByuC38zit1c%3D Occurrence Handle8293388
J Garcia-Aguilar E Hernandez de Anda P Sirivongs S-H Lee RD Madoff DA Rothenberger (2003) ArticleTitleA pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision Dis Colon Rectum 46 298–304 Occurrence Handle10.1007/s10350-004-6545-x Occurrence Handle12626903
JM Wheeler BF Warren NJ Mortensen et al. (2002) ArticleTitleQuantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system Dis Colon Rectum 45 1051–6 Occurrence Handle10.1007/s10350-004-6359-x Occurrence Handle1:STN:280:DC%2BD38vjslSgtg%3D%3D Occurrence Handle12195189
JM Wheeler BF Warren et al. (2004) ArticleTitlePreoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade Dis Colon Rectum 47 2025–31 Occurrence Handle10.1007/s10350-004-0713-x Occurrence Handle1:STN:280:DC%2BD2M%2FjtVSqsg%3D%3D Occurrence Handle15657650
P Luna-Pérez J Segura I Alvarado S Labastida H Santiago-Payán A Quintero (2000) ArticleTitleSpecific c-K-ras gene mutations as a tumor-response marker in locally advanced rectal cancer treated with preoperative chemoradiotherapy Ann Surg Oncol 7 727–31 Occurrence Handle10.1007/s10434-000-0727-0 Occurrence Handle11129419
A Grann P Zauber (2002) ArticleTitleIs there a predictive value for molecular markers in predicting response to radiation and chemotherapy in rectal cancer? Int J Radiat Oncol Biol Phys 54 1286–7 Occurrence Handle10.1016/S0360-3016(02)03024-9
P Vaupel O Thews M Hoeckel (2001) ArticleTitleTreatment resistance of solid tumours: role of hypoxia and anaemia Med Oncol 18 243–59 Occurrence Handle10.1385/MO:18:4:243 Occurrence Handle1:CAS:528:DC%2BD38Xmt1agt7k%3D Occurrence Handle11918451
JC Evans P Begsjö (1965) ArticleTitleThe influence of anaemia on the results of radiotherapy in carcinoma of the cervix Radiology 84 709–17 Occurrence Handle1:STN:280:CCqD2sbptVc%3D Occurrence Handle14275339
TJ Littlewood (2001) ArticleTitleThe impact of hemoglobin levels on treatment outcomes in patients with cancer Semin Oncol 28(Suppl 8) 49–53 Occurrence Handle10.1053/sonc.2001.25397
G Thomas (2001) ArticleTitleThe effect of hemoglobin level on radiotherapy outcomes: The Canadian Experience Semin Oncol 28(Suppl 8) 60–5 Occurrence Handle10.1053/sonc.2001.25400
H Frommhold R Guttenberger M Henke (1998) ArticleTitleThe impact of blood hemoglobin content on the outcome of radiotherapy. The Freiberg experience Strahlenther Onkol 174(Suppl 4) 31–4
G Hutchinson AG Renehan E Levine R James ST O’Dwyer (2002) ArticleTitleImpact of hemoglobin level on treatment response in patients with anal carcinoma Colorectal Dis 4(Suppl 1) 1
JH Donohue S Williams S Cha et al. (1995) ArticleTitlePerioperative blood transfusions do not affect disease recurrence in patients undergoing curative resection of colorectal carcinoma: a Mayo/North Central Cancer Treatment Group study J Clin Oncol 13 1671–8 Occurrence Handle1:STN:280:ByqA38rovVE%3D Occurrence Handle7602357
EA Levine C Laborde E Hambrick C McKnight S Vijayakumar (1998) ArticleTitleInfluence of erythropoietin on transfusion requirement in patients receiving preoperative chemoradiotherapy for rectal cancer Dis Colon Rectum 8 1065–71
B Leyland-Jones (2003) ArticleTitleBreast cancer trial with erythropoietin terminated unexpectedly Lancet Oncol 4 459–60 Occurrence Handle10.1016/S1470-2045(03)01163-X Occurrence Handle12901958
M Henke R Laszig C Rube et al. (2003) ArticleTitleErythropoitin to treat head and neck cancer patients with anemia undergoing radiotherapy: randomised, double-blind placebo-controlled trial Lancet 362 1255–60 Occurrence Handle10.1016/S0140-6736(03)14567-9 Occurrence Handle1:CAS:528:DC%2BD3sXot1Cjt7o%3D Occurrence Handle14575968
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Box, B., Lindsey, I., Wheeler, J. et al. Neoadjuvant Therapy for Rectal Cancer: Improved Tumor Response, Local Recurrence, and Overall Survival in Nonanemic Patients. Dis Colon Rectum 48, 1153–1160 (2005). https://doi.org/10.1007/s10350-004-0939-7
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DOI: https://doi.org/10.1007/s10350-004-0939-7