title: The effect of anaemia on efficacy and normal tissue toxicity following radiotherapy for locally advanced squamous cell carcinoma of the head and neck.
abstract: OBJECTIVE
  The aims of this analysis were to determine the effect of anaemia on loco-regional control, relapse-free survival, cause-specific survival, overall survival, and acute and late radiation therapy toxicity in patients with Stage III and IV squamous cell carcinoma of the head and neck treated with radiotherapy.
  
  
  METHODS
  Between 1991 and 1998, 350 patients were randomly assigned to either conventional radiotherapy, (70 Gy in 35 fractions in 49 days) or to accelerated radiotherapy (59.4 Gy in 33 fractions in 24 days). Patients were divided into two groups according to their haemoglobin level: a normal haemoglobin group (>/=13 g/dl in males, >/=12 g/dl in females) and a low haemoglobin group (<13 g/dl in males, <12 g/dl in females). The influence of anaemia on cause-specific survival and the development of confluent mucositis independent of other variables was tested using Cox proportional hazards model.
  
  
  RESULTS
  Of 350 patients recruited to the trial, 238 had haemoglobin measurements and were eligible for inclusion in this secondary analysis. One hundred and ninety-three were considered to have normal haemoglobin, and 45 patients were considered to be anaemic. There were significant differences between the groups in loco-regional control, relapse-free survival, cause-specific survival and overall survival, with hazards ratios of 0.56 (95% confidence interval (CI) 0.34-0.94), 0.57 (95% CI 0.35-0.92), 0.49 (95% CI 0.29-0.85) and 0.43 (95% CI 0.26-0.70) in favour of the normal haemoglobin group. Using Cox proportional hazards modelling, haemoglobin level was a significant predictor of cause-specific survival in addition to disease site, stage, and Eastern Cooperative Oncology Group status. There were no statistically significant differences between the groups in the development of acute or late reactions.
  
  
  CONCLUSIONS
  Significant reductions in loco-regional control, disease-free survival, cause-specific survival and overall survival occur in the presence of anaemia. No significant differences in normal tissue toxicity have been identified in this analysis.
authors.affiliation: Division of Oncology Incorporating Queensland Radium Institute, Royal Brisbane Hospital, Herston, QLD 4029, Australia.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Daly
authors.forename: Michael G
authors.initials: MG
authors.lastname: Poulsen
authors.forename: James W
authors.initials: JW
authors.lastname: Denham
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Peters
authors.forename: David S
authors.initials: DS
authors.lastname: Lamb
authors.forename: Hedley
authors.initials: H
authors.lastname: Krawitz
authors.forename: Chris
authors.initials: C
authors.lastname: Hamilton
authors.forename: Jacqui
authors.initials: J
authors.lastname: Keller
authors.forename: Lee
authors.initials: L
authors.lastname: Tripcony
authors.forename: Quenten
authors.initials: Q
authors.lastname: Walker
mesh_terms: D000740:Anemia / Q000097:blood / Q000150:complications*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007830:Larynx / Q000528:radiation effects; D008297:Male; D009092:Mucous Membrane / Q000528:radiation effects; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D011832:Radiation Injuries; D011878:Radiotherapy / Q000009:adverse effects; D012867:Skin / Q000528:radiation effects; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins