title: Prognostic impact of hemoglobin levels on treatment outcome in patients with nasopharyngeal carcinoma treated with sequential chemoradiotherapy or radiotherapy alone.
abstract: BACKGROUND
  The goal of the current study was to investigate the impact of hemoglobin (Hb) levels on treatment outcome in a randomized Phase III trial of patients with nasopharyngeal carcinoma (NPC) treated with induction chemotherapy followed by radiotherapy or with radiotherapy alone.
  
  
  METHODS
  Between September 1989 and August 1993, 334 patients with advanced NPC were entered into a randomized trial comparing 3 cycles of induction chemotherapy (cisplatin and epirubicin) followed by radiotherapy with radiotherapy alone. Only evaluable patients who completed radiation were included in the analysis (n = 286). Patients were stratified into normal and low Hb groups according to baseline, preradiation, and midradiation Hb levels. Local recurrence-free, distant metastasis-free, and disease-specific survival rates were estimated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox model.
  
  
  RESULTS
  In the chemotherapy arm, the mean baseline, preradiation, and midradiation Hb levels were 13.6, 11.0, and 11.8 g/dL, respectively. In the radiotherapy arm, the mean baseline/preradiation and midradiation Hb levels were 13.7 and 12.9 g/dL, respectively. A midradiation Hb level < or = 11 g/dL was associated with significantly poorer 5-year local recurrence-free (60% vs. 80%; P = 0.0059) and disease-specific survival rates (51% vs. 68%; P = 0.001), with no difference in distant metastasis-free rates (69% vs. 67%; P = 0.83). No significant difference in treatment outcome according to baseline or preradiation Hb levels was noted. Multivariate analysis showed that a low midradiation Hb level, but not a low baseline or preradiation Hb level, was an independent predictor of local disease recurrence and malignancy-related death.
  
  
  CONCLUSIONS
  The current study showed that midradiation Hb level was an important prognostic factor with respect to local control and survival in patients with NPC. The high incidence of anemia after chemotherapy has a negative impact on treatment outcome, and this condition may reduce the benefit of induction chemotherapy. Attempts to correct anemia during radiation and the impact of anemia on treatment outcome requires further study.
authors.affiliation: Department of Clinical Oncology, The University of Hong Kong Queen Mary Hospital, Hong Kong SAR, China. dttchua@hkucc.hku.hk
authors.forename: Daniel T T
authors.initials: DT
authors.lastname: Chua
authors.forename: Jonathan S T
authors.initials: JS
authors.lastname: Sham
authors.forename: Damon T K
authors.initials: DT
authors.lastname: Choy
mesh_terms: D000368:Aged; D000740:Anemia / Q000139:chemically induced*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy*; D009362:Neoplasm Metastasis; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins