title: Severe anemia is associated with poor tumor oxygenation in head and neck squamous cell carcinomas.
abstract: OBJECTIVE
  To investigate the relationship between tumor oxygenation and the blood hemoglobin (Hb) concentration in patients with squamous cell carcinoma of the head and neck (SCCHN).
  
  
  METHODS
  A total of 133 patients with SCCHN underwent pretreatment polarographic pO2 measurements of their tumors. In 66 patients measurements were also made in sternocleidomastoid muscles. The patients were divided into three groups according to their Hb concentration-severe anemia (Hb < 11.0 g/dl), mild anemia (female: Hb 11.0-11.9 g/dl; male: Hb 11.0-12.9 g/dl), and normal Hb concentration (female: Hb > or =12.0 g/dl; male: > or =13.0 g/dl).
  
  
  RESULTS
  No significant difference in tumor oxygenation could be detected between mildly anemic patients and patients with a normal Hb level. However, the tumor oxygenation in the severely anemic group was significantly below that of each of the other two groups (p < 0.0001). There was no significant difference between the Hb groups in oxygenation of sternocleidomastoid muscles. In a multivariate analysis including Hb group, tumor volume, smoking habits, gender, T-stage, N-stage, and histologic grade a Hb level < 11 g/dl was found to be the strongest predictor for a poor tumor oxygenation. Smoking also had a marginal influence on median pO2.
  
  
  CONCLUSIONS
  Our data suggest that a low Hb concentration and cigarette smoking contribute to inadequate oxygenation of SCCHN and thus for increased radioresistance. Consequently, Hb correction and abstinence from smoking may significantly improve tumor oxygenation.
authors.affiliation: Department of Radiooncology, Martin Luther University, Halle-Wittenberg, Germany. axel.becker@medizin.uni.halle.de
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.forename: P
authors.initials: P
authors.lastname: Stadler
authors.forename: R S
authors.initials: RS
authors.lastname: Lavey
authors.forename: G
authors.initials: G
authors.lastname: Hänsgen
authors.forename: T
authors.initials: T
authors.lastname: Kuhnt
authors.forename: C
authors.initials: C
authors.lastname: Lautenschläger
authors.forename: H J
authors.initials: HJ
authors.lastname: Feldmann
authors.forename: M
authors.initials: M
authors.lastname: Molls
authors.forename: J
authors.initials: J
authors.lastname: Dunst
mesh_terms: D000740:Anemia / Q000097:blood* / Q000209:etiology; D001785:Blood Gas Monitoring, Transcutaneous; D002294:Carcinoma, Squamous Cell / Q000097:blood*; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood*; D006441:Hemoglobin A / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism; D010100:Oxygen / Q000097:blood*; D012737:Sex Factors
chemical_list: D006441:Hemoglobin A; D010100:Oxygen