Locally advanced stage IV squamous cell carcinoma of the head and neck: impact of pre-radiotherapy hemoglobin level and interruptions during radiotherapy.
OBJECTIVE
Stage IV head and neck cancer patients carry a poor prognosis. Clear understanding of prognostic factors can help to optimize care for the individual patient. This study investigated 11 potential prognostic factors including pre-radiotherapy hemoglobin level and interruptions during radiotherapy for overall survival (OS), metastases-free survival (MFS), and locoregional control (LC) after radiochemotherapy.


METHODS
Eleven factors were investigated in 153 patients receiving radiochemotherapy for Stage IV squamous cell head and neck cancer: age, gender, Karnofsky performance score (KPS), tumor site, grading, T stage, N stage, pre-radiotherapy hemoglobin level, surgery, chemotherapy type, and interruptions during radiotherapy>1 week.


RESULTS
On multivariate analysis, improved OS was associated with KPS 90-100 (relative risk [RR], 2.36; 95% confidence interval [CI], 1.20-4.93; p=.012), hemoglobin>or=12 g/dL (RR, 1.88; 95% CI, 1.01-3.53; p=.048), and no radiotherapy interruptions (RR, 2.59; 95% CI, 1.15-5.78; p=.021). Improved LC was significantly associated with lower T stage (RR, 2.17; 95% CI, 1.16-4.63; p=.013), hemoglobin>or=12 g/dL (RR, 4.12; 95% CI, 1.92-9.09; p<.001), surgery (RR, 2.67; 95% CI, 1.28-5.88; p=.008), and no radiotherapy interruptions (RR, 3.32; 95% CI, 1.26-8.79; p=.015). Improved MFS was associated with KPS 90-100 (RR, 3.41; 95% CI, 1.46-8.85; p=.012).


CONCLUSIONS
Significant predictors for outcome in Stage IV head and neck cancer were performance status, stage, surgery, pre-radiotherapy hemoglobin level, and interruptions during radiotherapy>1 week. It appears important to avoid anemia and radiotherapy interruptions to achieve the best treatment results.
Rades
Dirk
D
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. Rades.Dirk@gmx.net
Stoehr
Monika
M
Kazic
Nadja
N
Hakim
Samer G
SG
Walz
Annette
A
Schild
Steven E
SE
Dunst
Juergen
J
D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006441:Hemoglobin A / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models
D006441:Hemoglobin A