title: Prognostic significance of blood transfusions in patients with esophageal cancer treated with combined chemoradiotherapy.
abstract: OBJECTIVE
  Anemia occurs commonly in patients with esophageal cancer. This study evaluates the effect of blood transfusion on survival outcomes in patients with esophageal cancer treated with combined chemoradiotherapy (CRT).
  
  
  METHODS
  Fifty-six consecutive patients with unresectable esophageal cancer received 50 Gy in 25 fractions over 5 weeks concurrent with cycles 2 and 3 of cisplatin and 5-fluorouracil chemotherapy. Data on hemoglobin before and during radiation therapy (RT) and blood transfusion use were abstracted by chart review. Each patient had a blood count before every chemotherapy cycle, and the test was repeated if the blood count was low. Five-year Kaplan-Meier overall survival (OS) and relapse-free survival (RFS) estimates were compared according to pre-RT hemoglobin levels and transfusion use. Multivariate analysis using Cox regression modeling was performed to determine the prognostic significance of pre-RT hemoglobin and transfusion use on survival outcomes.
  
  
  RESULTS
  The 5-year OS and RFS rates were 30% and 37%, respectively. Seventeen patients (30%) received transfusions during CRT. Among 18 patients (32%) with a hemoglobin of < or =12 g/dL at the start of RT, 9 received transfusions. Pre-RT hemoglobin levels of < or =12 g/dL were strongly associated with the use of blood transfusions (P = 0.03). Five-year Kaplan-Meier OS was 65% versus 21% in patients treated with, versus without, a transfusion (P = 0.006). On multivariate analysis, the use of blood transfusion was associated with improved OS (hazard ratio, 0.26; 95% confidence interval, 0.09-0.75, P = 0.01).
  
  
  CONCLUSIONS
  The use of blood transfusion is a significant treatment-related factor associated with improved survival in patients undergoing CRT for esophageal cancer.
authors.affiliation: Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, and the University of British Columbia, British Columbia, Canada.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kader
authors.forename: Jan T W
authors.initials: JT
authors.lastname: Lim
authors.forename: Eric
authors.initials: E
authors.lastname: Berthelet
authors.forename: Ross
authors.initials: R
authors.lastname: Petersen
authors.forename: David
authors.initials: D
authors.lastname: Ludgate
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors
chemical_list: D006454:Hemoglobins