TITLE:
Impact of Pre-Radiotherapy and/or Chemoradiotherapy Hemoglobin Level on Response to Treatment in Laryngeal and Hypophayrngeal Squamous Cell Carcinoma
AUTHORS:
Dina Ragab Diab Ibrahim, Mohamed Saad Hasaballah, Marwa Mohamed El-Begermy, Ahmed Abdel Aziz Ahmed, Soha Ahmed Abuelela
KEYWORDS:
Hemoglobin, Radiotherapy, Chemotherapy, Tumor Hypoxia, Local Control, Survival
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.9 No.4,
April
30,
2018
ABSTRACT: Background: Anemia is reported by many
studies as an important risk factor for poor locoregional disease control and
survival in head and neck carcinoma. We aimed to study the frequency and
prognostic effect of low hemoglobin (Hb) level in head and neck squamous cell
carcinoma (HNSCC) before radiotherapy (RT) and/or chemoradiotherapy (CRT). Material and Methods: We retrospectively studied the charts of 86 patients
diagnosed with laryngeal and hypopharyngeal SCC in a university hospital in
Cairo, Egypt. Based on the World Health Organization (WHO), anemia was
diagnosed in males at Hb levels Results: The median age
was 56 years. 75/86 (87.2%) patients were males with performance status1 in
73/86 (84.9%) patients. The median Hb level was 13.1 g/dl. The pre-RT/CRT Hb
level in female patients (n = 11) was 12 g/dl
in 7/11 (63.6%) patients. Pre-RT/CRT Hb level in male patients was 13 g/dl in 44/75 (58.7%). Tumor sites were larynx in
77 (89.5%) and hypopharynx in 9 (10.5%) patients. Disease stage 3, 4 was common
in 59/86 (68.6%) patients. Thirty-six (41.8%) patients had surgery. 13/86
(15.1%) patients received induction chemotherapy, while 31/86 (36.0%) had
concomitant chemoradiotherapy. Radiotherapy was given in 65/86 (75.58%)
patients. The mean RT dose was 66 Gy. Non-anemic patients had significant
higher inci-dence of complete response (CR) to treatment (p = 0.034). 25.8% of
male pa-tients with Hb 13 g/dl
(p = 0.403). Female patients whether anemic or non-anemic had no recurrence (p
= 0.036 and p = 0.403 respectively). The median duration of DFS and OS was 6.52
and 9.33 months respectively. Pretreatment Hb level had statistical significant
effect on response to treatment and overall survival, but not disease free
survival. Conclusion: Nutritional anemia is common in developing countries. Our
results support the positive prognostic effect of Hb level > 12 g/dl and
>13 g/dl before radiation therapy and/or chemoradiotherapy on response to
treatment and overall survival but not the disease free survival.