Epoetin alfa improves survival after chemoradiation for stage III esophageal cancer: final results of a prospective observational study.
OBJECTIVE
This prospective, nonrandomized study evaluates the effectiveness of epoetin alfa to maintain the hemoglobin levels at 12 to 14 g/dL (optimal range for tumor oxygenation) during chemoradiation for Stage III esophageal cancer and its impact on overall survival (OS), metastatic-free survival (MFS), and locoregional control (LC).


METHODS
Ninety-six patients were included. Forty-two patients received epoetin alfa (150 IU/kg, 3 times a week) during radiotherapy, which was started at hemoglobin less than 13 g/dL and stopped at 14 g/dL or higher. Hemoglobin levels were measured weekly during RT.


RESULTS
Both groups were balanced for age, sex, performance status, tumor length/location, histology, grading, T-stage/N-stage, chemotherapy, treatment schedule, and hemoglobin before RT. Median change of hemoglobin was +0.3 g/dL/wk with epoetin alfa and -0.5 g/dL/wk without epoetin alfa. At least 60% of hemoglobin levels were 12 to 14 g/dL in 64% and 17% of the patients, respectively (p < 0.001). Patients who received epoetin alfa had better OS (32% vs. 8% at 2 years, p = 0.009) and LC (67% vs. 15% at 2 years, p = 0.001). MFS was not significantly different (42% vs. 18% at 2 years, p = 0.09).


CONCLUSIONS
The findings suggest that epoetin alfa when used to maintain the hemoglobin levels at 12 to 14 g/dL can improve OS and LC of Stage III esophageal cancer patients.
Department of Radiation Oncology, University Hospital, Hamburg, Germany.
Dirk
D
Rades
Silke
S
Tribius
Emre F
EF
Yekebas
Roia
R
Bahrehmand
Ingeborg
I
Wildfang
Ergin
E
Kilic
Ulrich
U
Muellerleile
Eberhard
E
Gross
Steven E
SE
Schild
Winfried
W
Alberti
D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D011994:Recombinant Proteins
D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D002945:Cisplatin; D005472:Fluorouracil