title: Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx.
abstract: OBJECTIVE
  We assessed the influence of hemoglobin level and r-HuEPO administration on response to chemoradiotherapy, locoregional tumor control, and overall survival in patients treated with neoadjuvant chemoradiotherapy and surgery for a squamous cell carcinoma of the oral cavity or oropharynx.
  
  
  METHODS
  The 191 study patients were treated with mitomycin C (15 mg/m(2) day 1), 5-fluorouracil (750 mg/m(2)/day, days 1-5), and radiotherapy (50 Gy in 25 fractions weeks 1-5), followed by resection of the primary tumor bed and neck dissection at the General Hospital Vienna, Austria, between November 1989 and October 1998 for a T2-4, N0-3, M0 SCC of the oral cavity or oropharynx. Starting in May 1996, patients with a low hemoglobin (Hgb) before or during chemoradiotherapy received r-HuEPO 10,000 IU/kg s.c. 3-6 times/week until the week of surgery.
  
  
  RESULTS
  On multivariate analysis, Hgb level and use of r-HuEPO were independent prognostic factors for response to chemoradiotherapy and locoregional tumor control (p < 0.01). Pathologic response to neoadjuvant therapy was also predictive of locoregional control (p < 0.001). Patients with a pretreatment Hgb > or = 14.5 g/dL had significantly higher complete response, locoregional control, and survival rates than the patients with a pretreatment Hgb < 14.5 g/dL who did not receive r-HuEPO (p < 0.05). The response, control, and survival rates in patients with a pretreatment Hgb < 14.5 g/dL given r-HuEPO were significantly higher than in low Hgb patients not given r-HuEPO (p < or = 0.001) and equivalent to patients with a pretreatment Hgb > 14.5 g/dL (p > or = 0.3).
  
  
  CONCLUSIONS
  Low pretreatment Hgb is a negative prognostic factor for oral cavity and oropharyngeal SCCA patients, but was completely abrogated by r-HuEpo administration during neoadjuvant chemoradiotherapy. Randomized trials of radiation and/or chemotherapy with or without r-HuEPO for patients whose Hgb level is either low at the start of therapy or is anticipated to become low during therapy are indicated.
authors.affiliation: University Clinics for Oral and Maxillofacial Surgery, General Hospital, Vienna, Austria. christoph.glaser@univie.ac.at
authors.forename: C M
authors.initials: CM
authors.lastname: Glaser
authors.forename: W
authors.initials: W
authors.lastname: Millesi
authors.forename: G V
authors.initials: GV
authors.lastname: Kornek
authors.forename: S
authors.initials: S
authors.lastname: Lang
authors.forename: B
authors.initials: B
authors.lastname: Schüll
authors.forename: F
authors.initials: F
authors.lastname: Watzinger
authors.forename: E
authors.initials: E
authors.lastname: Selzer
authors.forename: R S
authors.initials: RS
authors.lastname: Lavey
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects; D009062:Mouth Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D011300:Preoperative Care; D011994:Recombinant Proteins; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D016685:Mitomycin; D005472:Fluorouracil