title: The effect of low hemoglobin levels on outcomes of radiotherapy following microscopically complete resection of locally advanced SCCHN: Implications for the future.
abstract: This study investigated the prognostic implications of pre-radiotherapy hemoglobin levels after microscopically complete (R0) resection of locally advanced squamous cell carcinoma of the head-and-neck (SCCHN) and reviewed the question "should anemia be corrected?". A total of 225 patients receiving R0-resection and postoperative irradiation were retrospectively evaluated. Pre-radiotherapy hemoglobin levels (<12 vs. ≥12 g/dl) plus eight factors (T-/N-category, AJCC-stage, performance score, gender, age, tumor site, and histologic grading) were analyzed for locoregional control and survival. Hemoglobin levels of <12 and ≥12 g/dl were associated with 3-year locoregional control rates of 67% and 84%, respectively, and 5-year locoregional control rates of 63% and 74%, respectively (p = 0.029). On multivariate analysis of locoregional control, hemoglobin levels achieved significance (hazard ratio [HR] 1.97; 95%-confidence interval [95%-CI] 1.02-3.81; p = 0.043). Hemoglobin levels of <12 and ≥12 g/dl were associated with 3-year survival rates of 55% and 87%, respectively, and 5-year survival rates of 25% and 71%, respectively (p < 0.001). On multivariate analysis of survival, hemoglobin levels were significant (HR 2.91; 95%-CI 1.67-5.22; p < 0.001). Thus, pre-radiotherapy hemoglobin is an independent predictor for outcomes after R0-resection of SCCHN. Levels <12 g/dl were associated with worse outcomes than ≥12 g/dl. Tumor cell oxygenation and correction of anemia appear important also after R0-resection.
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. Electronic address: Rades.Dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seidl
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany; Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wollenberg
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Lübeck, Germany.
authors.forename: Samer G
authors.initials: SG
authors.lastname: Hakim
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Scottsdale, AZ, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood* / Q000532:radiotherapy* / Q000601:surgery; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins
keywords: Hemoglobin levels; Locally advanced SCCHN; Locoregional control; R0-resection; Survival