title: Anemia before and during concurrent chemoradiotherapy in patients with cervical carcinoma: Effect on progression-free survival.
abstract: To determine the impact of anemia before and during chemoradiation in patients with cervical cancer, we collected data on hemoglobin (Hb) levels before and during treatment from 60 unselected patients with cervical carcinoma. All patients had FIGO stage IB to IVA disease and were treated with concurrent chemoradiation for the aim of cure. Patients with an Hb value below or equal to the lower 25th quartile were considered anemic. Progression-free survival (PFS) was evaluated by univariate and multivariate analyses. After a median follow-up of 26.3 months, 20 patients developed disease progression. The lowest Hb during chemoradiation (nadir Hb), the stage of disease, and parametrial involvement were correlated significantly with PFS. On multivariate analysis, the nadir Hb (relative risk [RR] 0.29) and tumor stage (RR 3.4) remained the only prognostically relevant factors predicting PFS. At 60 months the PFS was 39.1% for anemic patients and 48.0% for nonanemic patients (P < 0.0002). In patients undergoing chemoradiation for cervical carcinoma, a low nadir Hb is highly predictive of shortened PFS, whereas the Hb before treatment is prognostically not significant.
authors.affiliation: Queensland Center for Gynaecological Cancer, Royal Women's Hospital, Queensland University of Technology, School of Public Health, Brisbane, Australia. andreas_obermair@health.qld.gov.au
authors.forename: A
authors.initials: A
authors.lastname: Obermair
authors.forename: R
authors.initials: R
authors.lastname: Cheuk
authors.forename: K
authors.initials: K
authors.lastname: Horwood
authors.forename: M
authors.initials: M
authors.lastname: Neudorfer
authors.forename: M
authors.initials: M
authors.lastname: Janda
authors.forename: G
authors.initials: G
authors.lastname: Giannis
authors.forename: J L
authors.initials: JL
authors.lastname: Nicklin
authors.forename: L C
authors.initials: LC
authors.lastname: Perrin
authors.forename: A J
authors.initials: AJ
authors.lastname: Crandon
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications / Q000401:mortality*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006454:Hemoglobins; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy*
chemical_list: D006454:Hemoglobins