title: Negative impact of pretreatment anemia on local control after neoadjuvant chemoradiotherapy and surgery for rectal cancer.
abstract: OBJECTIVE
  Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear.
  
  
  METHODS
  We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery.
  
  
  RESULTS
  The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control.
  
  
  CONCLUSIONS
  Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyebin
authors.initials: H
authors.lastname: Lee
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Park
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.forename: Doo Ho
authors.initials: DH
authors.lastname: Choi
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Park
authors.forename: Joon Oh
authors.initials: JO
authors.lastname: Park
authors.forename: Ho-Kyung
authors.initials: HK
authors.lastname: Chun
authors.forename: Woo-Yong
authors.initials: WY
authors.lastname: Lee
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Seong Hyeon
authors.initials: SH
authors.lastname: Yun
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Cho
authors.forename: Yoon Ah
authors.initials: YA
authors.lastname: Park