Prognostic impact of hemoglobin level prior to radiotherapy on survival in patients with glioblastoma.
OBJECTIVE
To evaluate prognostic factors in patients with glioblastoma treated with postoperative or primary radiotherapy.


METHODS
From 1989 to 2000, a total of 100 patients underwent irradiation as part of their initial treatment for glioblastoma. All patients had undergone surgery or biopsy followed by conventional external-beam radiotherapy. 85 patients who received the planned dose of irradiation (60 Gy in 30 fractions) were analyzed for the influence of prognostic factors. 73/85 (86%) of patients were given postoperative irradiation, while 12/85 (14%) of patients were primarily treated with radiotherapy after biopsy.


RESULTS
The median overall survival was 10.1 months (range, 3.7-49.8 months), the 1- and 2-year survival rates were 41% and 5%, respectively. Univariate analysis revealed age < or = 55 years (p < 0.001), pre-radiotherapy hemoglobin (Hb) level > 12 g/dl (p = 0.009), and pre-radiotherapy dose of dexamethasone < or = 2 mg/day (p = 0.005) to be associated with prolonged survival. At multivariate analysis, younger age (p < 0.001), higher Hb level (p = 0.002), lower dose of dexamethasone (p = 0.026), and a hemispheric tumor location (p = 0.019) were identified as independent prognostic factors for longer survival. The median survival for patients with an Hb level > 12 g/dl was 12.1 months compared to 7.9 months for those with a lower Hb level. Contingency-table statistics showed no significant differences for the two Hb groups in the distribution of other prognostic factors.


CONCLUSIONS
The results indicate that lower Hb level prior to radiotherapy for glioblastoma can adversely influence prognosis. This finding deserves further evaluation.
Odrazka
Karel
K
Department of Oncology and Radiotherapy, Charles University Hospital, Hradec Kralove, Czech Republic. odrazka@fnhk.cz
Petera
Jiri
J
Kohlova
Tereza
T
Dolezel
Martin
M
Vaculikova
Miloslava
M
Zouhar
Milan
M
Malek
Vaclav
V
Hobza
Vladimir
V
Latr
Ivan
I
Nemecek
Stanislav
S
Sercl
Miroslav
M
Ryska
Pavel
P
Blaha
Milan
M
Cermakova
Eva
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D005260:Female; D005909:Glioblastoma / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000893:Anti-Inflammatory Agents; D018931:Antineoplastic Agents, Hormonal; D006454:Hemoglobins; D003907:Dexamethasone