title: Anemia in patients with locally advanced cervical carcinoma administered preoperative radiochemotherapy: association with pathological response to treatment and clinical outcome.
abstract: OBJECTIVE
  The aim of this study was to investigate the role of anemia at presentation (basal HB) and during treatment (nadir HB) as predictor of pathological response, as well as disease-free (DFS) and overall survival (OS) in LACC patients undergoing chemoradiation followed by radical surgery.
  
  
  METHODS
  114 consecutive LACC patients were accrued at the Gynecologic Oncology Unit, Catholic University, Rome and at the Department of Oncology, Catholic University of Campobasso, Italy. Neoadjuvant treatment included chemotherapy with cisplatin (20 mg/m2) and 5-fluorouracil (1000 mg/m2, 24-h infusion) (both on days 1-4 and 27-30) and external radiotherapy to the whole pelvic region (22 fractions, 1.8 Gy/day, totaling 39.6 Gy). Clinical responders underwent radical surgery. Hemoglobin levels were recorded and expressed in gram per literx10(-2) (g/dl). The value of 10 g/dl was arbitrarily chosen as cut-off value.
  
  
  RESULTS
  In cases showing high basal HB status, the percentage of pathological response was significantly higher than in patients showing low HB status (76.3% versus 46.7%) (P value=0.027). When logistic regression was applied, only advanced stage remained associated with a poor chance of response to treatment. Cases with low basal HB status had a shorter DFS and OS than cases with a high HB status (P value=0.0001 and 0.0022, respectively). Similar results were obtained when analyzing nadir HB status. In multivariate analysis, high basal HB status, and advanced stage, retained an independent negative prognostic role for DFS and OS.
  
  
  CONCLUSIONS
  Anemia identifies LACC patients administered preoperative radiochemotherapy, who are at higher risk of recurrence and death of disease.
authors: Gynecologic Oncology Unit, Catholic University of Rome, Italy. gabriella.ferrandina@libero.it
authors: Gabriella
authors: G
authors: Ferrandina
authors: Mariagrazia
authors: M
authors: Distefano
authors: Daniela
authors: D
authors: Smaniotto
authors: Alessio
authors: A
authors: Morganti
authors: Amelia
authors: A
authors: Paglia
authors: Gabriella
authors: G
authors: Macchia
authors: Barbara
authors: B
authors: Corvari
authors: Domenica
authors: D
authors: Lorusso
authors: Giovanni
authors: G
authors: Scambia