title: Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck.
abstract: Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radical chemo-radiation (CRT) frequently receive transfusion with packed red cells (PRCT) during radiotherapy on the basis that PRCT increases tumour oxygenation and overcomes hypoxia-induced radio-resistance. This is likely to be a significant oversimplification given the fact that tumour hypoxia is the result of several intrinsic and extrinsic factors, including many that are not directly related to serum haemoglobin (Hb). Therefore, we have studied the effect of PRCT on tumour oxygenation in a prospective cohort of patients who developed low Hb during radical CRT for HNSCC.
  
  
  
  This was a prospective study of 20 patients with HNSCC receiving radical CRT undergoing PRCT for Hb<11.5 g dl-1. Patients underwent pretransfusion and posttransfusion intrinsic susceptibility-weighted (SWI) MRI and dynamic contrast-enhanced (DCE) MRI. Blood samples were obtained at the time of MRI scanning and two further time points for measuring Hb and a panel of serum cytokine markers of tumour hypoxia. 3D T2* and Ktransmaps were calculated from the MRI data for primary tumours and cervical lymph node metastases.
  
  
  
  PRCT produced no change (11 patients) or reduced (1 patient) T2* (tumour oxygenation) in 12 of the 16 (75%) evaluable primary tumours. Three of the four patients with improved tumour oxygenation progressed or had partial response following treatment completion. There were variable changes in Ktrans(tumour perfusion or vessel permeability) following PRCT that were of small magnitude for most tumours. Pre- and Post-PRCT levels of measured cytokines were not significantly different.
  
  
  
  This study suggests that PRCT during radical CRT for HNSCC does not improve tumour oxygenation. Therefore, oncologists should consider changing practice according to NICE and American Association of Blood Banks guidelines on PRCT for anaemia.
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Welsh
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Rafal
authors.initials: R
authors.lastname: Panek
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Riddell
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Kee
authors.initials: K
authors.lastname: Wong
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Martin O
authors.initials: MO
authors.lastname: Leach
authors.affiliation: King's College, Floor 2, Hodgkin Building, Guy's, London SE1 9RT, UK.
authors.forename: Mahvash
authors.initials: M
authors.lastname: Tavassoli
authors.affiliation: King's College, Floor 2, Hodgkin Building, Guy's, London SE1 9RT, UK.
authors.forename: Durdana
authors.initials: D
authors.lastname: Rahman
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.
authors.forename: Tara
authors.initials: T
authors.lastname: Hurley
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Grove
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Richards
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Dow-Mu
authors.initials: DM
authors.lastname: Koh
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nutting
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Harrington
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Newbold
authors.affiliation: The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.|The Royal Marsde Hospital, Downs Road, Sutton SM2 5PT, UK.|Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Shreerang
authors.initials: S
authors.lastname: Bhide
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000077195:Squamous Cell Carcinoma of Head and Neck; D000072258:Tumor Hypoxia / Q000187:drug effects