title: Anemia during sequential induction chemotherapy and chemoradiation for head and neck cancer: the impact of blood transfusion on treatment outcome.
abstract: OBJECTIVE
  Sequential treatment (chemotherapy followed by concomitant chemoradiation; CCRT) is increasingly being used for radical treatment of squamous cell cancer of the head and neck (SCCHN), which results in increased myelosuppression. In this study, we review the incidence of anemia and the effect of a policy of hemoglobin (Hb) maintenance by blood transfusion on disease outcomes in these patients.
  
  
  METHODS
  Retrospective review of the records of patients with SCCHN treated with sequential CCRT formed the basis of this study. The incidence of anemia and statistics on blood transfusion were documented. For the purpose of outcome analyses, patients were divided into four categories by (1) transfusion status, (2) nadir Hb concentration, (3) number of transfusion episodes, and (4) number of units of blood transfused (NOUT). Data on 3-year locoregional control (LRC), relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were analyzed.
  
  
  RESULTS
  One hundred and sixty-nine patients were identified. The median follow-up was 23.6 months. The RFS (52% vs. 41%, p = 0.03), DSS (71% vs. 66%, p = 0.02), and OS (58% vs. 42% p = 0.005) were significantly better for patients who did not have a transfusion vs. those who did. The LRC, RFS, DSS, and OS were also significantly better for patients with nadir Hb level >12 vs. <12 g/dL and NOUT 1-4 vs. >4.
  
  
  CONCLUSIONS
  Our study seems to suggest that blood transfusion during radical treatment for SCCHN might be detrimental. Further research should be undertaken into the complex interactions among tumor hypoxia, anemia, and the treatment of anemia before making treatment recommendations.
authors.affiliation: The Institute of Cancer Research, The Royal Marsden National Health Service Foundation Trust Hospital, London, United Kingdom.
authors.forename: Shreerang A
authors.initials: SA
authors.lastname: Bhide
authors.forename: Merina
authors.initials: M
authors.lastname: Ahmed
authors.forename: Vijayan
authors.initials: V
authors.lastname: Rengarajan
authors.forename: Ceri
authors.initials: C
authors.lastname: Powell
authors.forename: Aisha
authors.initials: A
authors.lastname: Miah
authors.forename: Kate
authors.initials: K
authors.lastname: Newbold
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Nutting
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Harrington
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy; D003131:Combined Modality Therapy / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy; D006441:Hemoglobin A / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: D006441:Hemoglobin A