Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy.
BACKGROUND
The objective was to investigate the possible prognostic value of blood hemoglobin concentration in the outcome of radical treatment for locally advanced esophageal carcinoma.


METHODS
This was a retrospective analysis of data for 85 patients treated for locally advanced esophageal carcinoma between January 1991 and January 1997 with chemoradiotherapy alone or as neoadjuvant therapy. All patients received chemotherapy (4 cycles of cisplatin 100 mg/m2 on day 1, and continuous infusion 5-fluorouracil 1 g/m2 per day on days 1-5) with concomitant radiotherapy (40 Gy at 2 Gy/session to the esophageal tumor and mediastinum). The response was evaluated after 4 weeks. 69 patients continued to receive chemoradiotherapy only to a total dose of 60-64 Gy to the esophageal tumor with a 2-cm margin. Sixteen patients underwent radical surgery. Hemoglobin levels were measured before combined treatment in all patients. The prognostic value of hemoglobin concentration was analyzed statistically, along with other patient-, tumor- and treatment-related factors.


RESULTS
Mean follow-up time: 82 months (range 60- 99 months). Chemoradiotherapy was followed by an overall clinical response of 69.4%, with complete clinical response in 24.7% of the patients. Mean survival time was 12 months, and overall likelihood of survival after 3 years was 13%. Mean time to progression: 5 months. Median survival time was 12 months in the 69 patients who underwent chemoradiotherapy alone, and 26 months in patients who underwent radical surgery. Univariate analysis showed a hemoglobin value of > 13 g/dl to be a prognostic factor for better survival, along with performance status according to the ECOG classification, weight loss < 10%, tumor stage, tumor length, and complete response to chemoradiotherapy. Multivariate analysis showed that only hemoglobin concentration was an independent prognostic factor: for each unit increase in hemoglobin level, the risk of death from esophageal carcinoma decreased by 5%. In the subgroup of patients who did not undergo surgery, hemoglobin concentration was also an independent prognostic factor along with complete clinical response.


CONCLUSIONS
As found for other solid tumors, hemoglobin level was a determining factor in the prognosis for treatment outcome in patients with esophageal carcinoma. Our findings require confirmation in randomized studies and further documentation of the probable benefits of correcting hemoglobin levels.
Valencia Julve
Javier
J
Department of Radiation Oncology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain. jvalenciaj@hotmail.com
Alonso Orduña
Vicente
V
Escó Barón
Ricardo
R
López-Mata
Miriam
M
Méndez Villamón
Agustina
A
D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D006454:Hemoglobins; D002945:Cisplatin; D005472:Fluorouracil