title: Haemoglobin levels may predict toxicities in patients on pelvic chemoradiation for carcinoma of the cervix-experience of a regional cancer centre.
abstract: BACKGROUND
  Haemoglobin levels and tissue oxygenation influence tumour outcome in carcinoma cervix radiotherapy. The clinical impact of haemoglobin levels on acute normal tissue toxicity during radiation and interaction with chemotherapy in carcinoma of the cervix is underexplored. This paper aims to explore this issue.
  
  
  METHODS
  Treatment toxicity among 227 patients with squamous cell carcinoma of the cervix stages II B-IV A, receiving pelvic radiotherapy or chemoradiation at our institute, were studied prospectively. The baseline and weekly haemoglobin levels during treatment were recorded. Acute toxicities were recorded using Radiation Therapy Oncology Group (RTOG) acute toxicity and Common Terminology Criteria for Adverse Events (CTCAE) criteria, version 4. For the analysis, patients were divided into two groups, depending on nadir haemoglobin levels. A cut-off value for anaemia was selected at 12 gm/dL. Toxicity was compared between anaemic and non-anaemic groups.
  
  
  RESULTS
  Patients on chemoradiation and having haemoglobin levels >12 gm/dL suffered significantly higher dermatitis (two-tailed p value = 0.0288) and vaginal mucositis (two-tailed p value = 0.0187) of at least RTOG acute toxicity grade 2, compared with the anaemic group. In contrast patients receiving radiotherapy alone did not experience any significantly greater mucocutaneous toxicity if haemoglobin was >12 gm/dL. Anaemia had significantly greater impact on malaise and neutropenia (two-tailed p value <0.0001) of CTCAE grade 1 and above among chemoradiation patients, as opposed to those receiving radiotherapy alone (two-tailed p values = 0.0012 for neutropenia and 0.0422 for malaise).
  
  
  CONCLUSIONS
  Haemoglobin values >12 gm/dL significantly worsen acute mucocutaneous toxicity in locally advanced cervical cancer patients receiving chemoradiation. Similar effects are not observed in the absence of chemotherapy.
authors: Department of Radiation Oncology Chittaranjan National Cancer Institute, 37 SP Mukherjee Road, Kolkata 700026, India.
authors: Aparna
authors: A
authors: Gangopadhyay
authors: Department of Radiation Oncology Chittaranjan National Cancer Institute, 37 SP Mukherjee Road, Kolkata 700026, India.
authors: Joydeep
authors: J
authors: Das
authors: Department of Medical Oncology, Chittaranjan National Cancer Institute, 37 SP Mukherjee Road, Kolkata 700026, India.
authors: Partha
authors: P
authors: Nath
authors: Department of Medical Oncology, Chittaranjan National Cancer Institute, 37 SP Mukherjee Road, Kolkata 700026, India.
authors: Jaydip
authors: J
authors: Biswas