title: Prognostic value of hemoglobin concentrations in patients with advanced head and neck cancer treated with combined radio-chemotherapy and surgery.
abstract: OBJECTIVE
  Hemoglobin levels are currently the focus of interest as prognostic factors in patients with head and neck cancer. Most published clinical trials have confirmed hemoglobin to possess a significant influence on survival in patients treated with radiotherapy. In our study we have investigated the prognostic value of hemoglobin in a combined modality schedule.
  
  
  METHODS
  Forty-three patients with advanced head and neck tumors were treated with combined radio-chemotherapy. The therapy comprised 2 courses of induction chemotherapy with ifosfamide (1,500 mg/m2, day 1 to 5) and cisplatin (60 mg/m2, day 5) followed by hyperfractionated accelerated radiotherapy with a total dose of only 30 Gy. Surgery involved tumor resection and neck dissection.
  
  
  RESULTS
  The 1-year overall survival rate and the 2-year survival rate were 79% and 56%, respectively. The 1- and 2-year recurrence-free survival rates were 68% and 49%, respectively. Prognostic factors with an impact on survival were seen in tumor size (T3 vs T4, p = 0.0088), response to radio-chemotherapy at the primary site (no vital tumor rest vs vital tumor rest, p = 0.045), response to lymph node radio-chemotherapy (no vital tumor cells vs vital tumor cells, p = 0.013) and level of hemoglobin after radio-chemotherapy (Hb > or = 11.5 g/dl vs < 11.5 g/dl, p = 0.0084).
  
  
  CONCLUSIONS
  In our study hemoglobin level after radio-chemotherapy was identified for the first time to be also a significant prognostic factor (univariate analysis) in head and neck cancer patients who underwent combined radio-chemotherapy. Besides chemotherapy plus low-dose irradiation achieved similar results in comparison with radical resection and high-dose radiotherapy at least for the first 2 years after therapy. Relapsing disease could be treated with 1 additional course of radiotherapy which is supposed to be well tolerated.
authors.affiliation: Paracelsus-Strahlenklinik Osnabrück, Marienhospital Osnabrück, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Wagner
authors.forename: R
authors.initials: R
authors.lastname: Hermann
authors.forename: J
authors.initials: J
authors.lastname: Hartlapp
authors.forename: E
authors.initials: E
authors.lastname: Esser
authors.forename: B
authors.initials: B
authors.lastname: Christoph
authors.forename: M K
authors.initials: MK
authors.lastname: Müller
authors.forename: R
authors.initials: R
authors.lastname: Krech
authors.forename: O
authors.initials: O
authors.lastname: Koch
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006454:Hemoglobins / Q000032:analysis* / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010315:Particle Accelerators; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins