Association between anemia arising during therapy and outcomes of chemoradiation for limited small-cell lung cancer.
BACKGROUND
Anemia during chemoradiation is associated with poorer outcomes in various cancers. Concurrent chemoradiation (CCRT) is standard therapy for fit patients with limited small-cell lung cancer (LD-SCLC). The objective of this study was to explore the relationship between anemia and treatment outcomes in patients with LD-SCLC treated with CCRT.


METHODS
Charts of all patients with LD-SCLC receiving CCRT at The Ottawa Hospital Regional Cancer Centre between January 1996 and December 2002 were reviewed. Information extracted included demographics, known prognostic factors, treatment details, and hemoglobin values from diagnosis until the completion of therapy. Factors associated with outcomes were determined by Cox regression analyses.


RESULTS
One hundred thirty patients were eligible for inclusion, and their median survival was 18.1 months (95% CI, 14.8-25.1 months). By univariate analysis, poorer outcome was associated with Eastern Cooperative Oncology Group performance status > or =2, supraclavicular adenopathy, and pre-radiotherapy hemoglobin <100 g/liter. Pre-radiotherapy hemoglobin <100 g/liter was associated with both an increased risk of progression (hazard ratio 1.8; P = 0.04) and death (hazard ratio 1.9; P = 0.02) by multivariate analysis.


CONCLUSIONS
Anemia during CCRT for LD-SCLC is common and may be associated with poorer outcome. Whether this association is causative or simply prognostic is unclear, and it is not known whether correction or prevention of anemia will improve outcome. Clinical trials evaluating different target hemoglobin levels and the roles of transfusion or erythropoietin during CCRT are needed.
Laurie
Scott A
SA
Division of Medical Oncology, The Ottawa Hospital Regional Cancer Centre and the University of Ottawa, Ottawa, Ontario, Canada. slaurie@ottawahospital.on.ca
Jeyabalan
Neera
N
Nicholas
Garth
G
MacRae
Robert
R
Dahrouge
Simone
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D002945:Cisplatin / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005047:Etoposide / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D005047:Etoposide; D002945:Cisplatin