title: Prolonged radiation time and low nadir hemoglobin during postoperative concurrent chemoradiotherapy are both poor prognostic factors with synergistic effect on locally advanced head and neck cancer patients.
abstract: BACKGROUND
  Anemia, a common complication of head and neck cancer treatment, is regarded as a poor prognostic factor. We evaluated the impact of low hemoglobin (Hb) levels, measured at different time points, on a consecutive cohort of patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) who underwent postoperative concurrent chemoradiotherapy (CCRT).
  
  
  METHODS
  From 2002 to 2009, 140 patients were enrolled and reviewed retrospectively. Preoperative (pre-op Hb), pre-CCRT Hb, and nadir Hb during CCRT were measured and recorded. The three Hb parameters were analyzed against several well-established pathologic risk factors and radiation-associated variables. Prognostic impacts were investigated with multivariate analysis by Cox proportional hazards model.
  
  
  RESULTS
  On Cox regression analysis, significantly higher risk of death was associated with pre-op Hb ≦13 g/dL (hazard ratio [HR] =1.8; 95% confidence interval [CI], 1.1-3.1; P=0.023), nadir Hb ≦11 g/dL (HR =1.9; 95% CI, 1.1-3.3; P=0.020), radiation treatment time (RTT) >7 weeks (HR =1.9; 95% CI, 1.1-3.3; P=0.022), and multiple positive lymph nodes (HR =2.1; 95% CI, 1.2-3.7; P=0.010), after adjusting for primary tumor site and pathologic lymphovascular invasion. Patients with poor prognosticators including low nadir Hb ≦11 g/dL and RTT >7 weeks had a higher risk of death (HR =4.0; 95% CI =1.6-10.2; P=0.004).
  
  
  CONCLUSIONS
  In the treatment setting of LA-SCCHN patients who underwent postoperative CCRT, coexistance of lower nadir Hb during CCRT and prolonged RTT resulted in reduced survival.
authors: Division of Medical Oncology and Hematology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Nai-Wen
authors: NW
authors: Su
authors: Department of Oral and Maxillofacial Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Chung-Ji
authors: CJ
authors: Liu
authors: Department of Otorhinolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Yi-Shing
authors: YS
authors: Leu
authors: Department of Otorhinolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Jehn-Chuan
authors: JC
authors: Lee
authors: Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Yu-Jen
authors: YJ
authors: Chen
authors: Division of Medical Oncology and Hematology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan ; Good Clinical Research Center, Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Yi-Fang
authors: YF
authors: Chang
keywords: anemia; concurrent chemoradiotherapy; head and neck cancer; hemoglobin; radiation time