Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-05-15T09:43:24.398Z Has data issue: false hasContentIssue false

Pre-treatment anaemia alters outcome in early squamous cell carcinoma of the larynx treated by radical radiotherapy

Published online by Cambridge University Press:  29 June 2007

D. G. Grant
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
A. Hussain*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
D. Hurman
Affiliation:
Department of Radiotherapy and Oncology, Aberdeen Royal Infirmary, Aberdeen, UK.
*
Address for correspondence: Mr A. Hussain, F.R.C.S., Department of Otolaryngology-HNS, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN Fax: (01224) 840900

Abstract

The purpose of this study was to examine the effect of pre-treatment anaemia on tumour recurrence and survival in patients treated with primary radiotherapy for early squamous cell carcinoma of the larynx. A retrospective analysis of 117 patients with previously untreated T1N0M0 and T2N0M0 squamous cell carcinoma of the larynx was carried out. Patients were considered anaemic if their pre-treatment haemoglobin levels were below 13 g/dl in males and 11.5 g/dl in females. The influence of pre-treatment haemoglobin levels on local control and survival were evaluated using Cox proportional hazards regression models.

Two- and five-year local-regional control estimates for anaemic patients were 58 per cent and 53 per cent respectively while patients with normal haemoglobin levels had two and five-year local-regional control rates of 90 per cent and 81 per cent respectively (p = 0.002). Multivariate Cox regression analysis showed pre-treatment haemoglobin significantly influencing recurrence-free survival (p = 0.0094).

Patients with a low haemoglobin level prior to radiation therapy suffered higher levels of local-regional failure.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

van Acht, M. J. J., Hermans, J., Bokd, D. E. S., Leer, J. W. H. (1992) The prognostic value of haemoglobin and a decrease in haemoglobin during radiotherapy in laryngeal carcinoma. Radiotherapy and Oncology 23(4): 229235.CrossRefGoogle Scholar
Barton, M. B., Morgan, G., Smee, R., Tiver, K. W., Hamilton, C., Gebski, V. (1997) Does waiting time effect the outcome of larynx cancer treated by radiotherapy? Radiotherapy and Oncology 44(2): 137141.CrossRefGoogle Scholar
Bentzen, S. M., Johansen, L. V., Overgaard, J., Thames, H. D. (1991) Clinical radiobiology of squamous cell carcinoma of the oropharynx. International Journal of Radiation Oncology, Biology, Physics 20(6): 1197–206.CrossRefGoogle ScholarPubMed
Blitzer, P. H., Wang, C. C., Suit, H. D. (1984) Blood pressure and haemoglobin concentration: multivariate analysis of local control after irradiation for head and neck cancer (abstract). International Journal of Radiation Oncology, Biology, Physics 10 (suppl 2): 98.CrossRefGoogle Scholar
Blumberg, N., Heal, J. M., Murphy, P., Agarwal, M. M., Chuang, C. (1986) Association between transfusion of whole blood and recurrence of cancer. British Medical Journal 293: 530533.CrossRefGoogle ScholarPubMed
Bush, R. S. (1986) The significance of anaemia in clinical radiation therapy. International Journal of Radiation Oncology, Biology, Physics 12: 20472050.CrossRefGoogle ScholarPubMed
Cox, D. (1972) Regression models for life tables. Journal of the Royal Statistical Society 34: 187220.Google Scholar
Cumming, P. L., Wallace, E. L., Schoor, J. B. (1989) Exposure of patients to human immunodeficiency virus through the transfusion of blood products that test antibody negative. New England Journal of Medicine 321: 941.CrossRefGoogle ScholarPubMed
Danilidis, J., Nikolau, A., Symeonidis, V. (1990) Our experience in the surgical treatment of the vocal cord. Journal of Laryngology and Otolaryngology 104: 222224.CrossRefGoogle Scholar
Dische, S. (1991) What have we learnt from hyperbaric oxygen? Radiotherapy and Oncology 20 (suppl): 7174.CrossRefGoogle ScholarPubMed
Dubray, B., Mosseri, V., Brunin, F., Jaulerry, C., Poncet, P., Rodriguez, J., Brugere, J., Point, D., Giraud, P., Cosset, J. (1996) Anaemia is associated with lower local-regional control and survival after radiation therapy for head and neck cancer: a prospective study. Therapeutic Radiology 201: 553558.CrossRefGoogle ScholarPubMed
Dusenberry, K. E., McGuire, W. A., Holt, P. J., Carson, L. F., Fowler, J. M., Twiggs, L. B., Potish, R. A. (1994) Erythropoietin increases hemoglobin during radiation therapy for cervical cancer. International Journal of Radiation Oncology, Biology, Physics 29(5): 10791084.CrossRefGoogle Scholar
Fein, D. A., Mendenhall, W. M., Parsons, J. T., Million, R. R. (1993) T1-T2 squamous cell carcinoma of the glottic larynx treated with radiotherapy: a multivariate analysis of variables potentially influencing local control. International Journal of Radiation Oncology, Biology, Physics 25(4): 605611.CrossRefGoogle ScholarPubMed
Fein, D. A., Lee, W. R., Hanlon, A. L., Ridge, J. A., Langer, C. J., Curren, W. J. Jr., Coia, L. R. (1995) Pretreatment haemoglobin level influences local control and survival of T1-T2 squamous cell carcinoma of the glottic larynx. Journal of Clinical Oncology 13(8): 20772083.CrossRefGoogle ScholarPubMed
Freedman, L. S., Honess, D. J., Bleehan, N. M., Adams, G. E., Dische, S., Henk, J. M. (1987) Does initial haemoglobin level modify the efficacy of radiosensitizers) An analysis of the MRC misonidazole studies in head and neck cancer and cervix cancer. International Journal of Radiation Oncology, Biology, Physics 52(6): 965967.Google ScholarPubMed
Gatenby, R. A., Kessler, H. B., Rosenblum, J. S., Coia, L. R., Moldofsky, P. J., Hartz, W. H., Broder, G. J. (1988) Oxygen distribution in squamous cell carcinoma metastases and its relationship to outcome of radiation therapy. International Journal of Radiation Oncology, Biology, Physics 14(5): 831838.CrossRefGoogle ScholarPubMed
International Union Against Cancer (UICC) (1978) TNM Classification of Malignant Tumours. 3rd Edition (HarmerM., H. M., H. ed.) Geneva.Google Scholar
International Union Against Cancer (UICC) (1987) TNM Classification of Malignant Tumours. 4th Edition (Hermanek, P., Sobin, L. H. eds.) Springverlag: Berlin.CrossRefGoogle Scholar
Johnson, A. (1994) Laryngeal cancer: variations in treatment. Lancet 344(8931): 11731174.CrossRefGoogle ScholarPubMed
Kaplan, E., Meier, P. (1958) Nonparametric estimation from incomplete observations. Journal of the American Statistical Association 53: 457481.CrossRefGoogle Scholar
Lartigau, E., Le Ridant, A. M., Lambin, P., Weeger, P., Martin, L., Sigal, R., Lusinchi, A., Luboinski, B., Eschwege, F., Guichard, M. (1993) Oxygenation of head and neck tumors. Cancer 71(7): 23192325.3.0.CO;2-C>CrossRefGoogle ScholarPubMed
Lavey, R. S., Dempsey, W. H. (1993) Erythropoietin increases hemoglobin in cancer patients during radiation therapy. International Journal of Radiation Oncology, Biology, Physics 27(5): 11471152.CrossRefGoogle ScholarPubMed
Lesnicar, H., Smid, L., Zakotnik, B. (1996) Early glottic cancer: the influence of primary treatment on voice preservation. International Journal of Radiation Oncology, Biology, Physics 36(5): 10251032.CrossRefGoogle ScholarPubMed
McCormack, M., Smith, E. (1990) Chronic anaemia, hyperbaric oxygen and tumour radiosensitivity. British Journal of Radiology 63: 752759.CrossRefGoogle ScholarPubMed
Mendenhall, W. M., Parsons, J. T., Million, R. R., Fletcher, G. H. (1988) T1-T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy: relationship of dose-fractionation factors to local control and complications. International Journal of Radiation Oncology, Biology, Physics 15(6): 12671273.CrossRefGoogle ScholarPubMed
Pradier, R., Gonzalez, A., Matos, E., Loria, D., Adan, R., Saco, P., Califano, L. (1992) Prognostic factors in laryngeal carcinoma. Cancer 71(8): 24722476.3.0.CO;2-Y>CrossRefGoogle Scholar
Rothfield, R. E., Johnson, J. T., Myers, E. N., Wagner, R. L. (1989) The role of hemilaryngectomy in the management of T1 vocal cord cancer. Archives of Otolaryngology – Head and Neck Surgery 115(6): 677680.CrossRefGoogle ScholarPubMed
Rudoltz, M. S., Benammar, A., Mohiuddin, M. (1993) Prognostic factors for local control and survival in T1 squamous cell carcinoma of the glottis. International Journal of Radiation Oncology, Biology, Physics 26(5): 767772.CrossRefGoogle ScholarPubMed
Sakata, K., Aoki, Y., Karasawa, K., Hasezawa, K., Muta, N., Nakagawa, K., Terahara, A., Onogi, Y., Sasaki, Y., Akanuma, A. (1994) Radiation therapy in early glottic carcinoma: uni- and multivariate analysis of prognostic factors affecting local control. International Journal of Radiation Oncology, Biology, Physics 39(5): 10591064.CrossRefGoogle Scholar
Scottish Oncology and Radiology Group. (1997) An audit of the importance of fractionation regimen and treatment gaps in the treatment of carcinoma of the larynx. CA95/14.Google Scholar
Sealy, R. (1991) Hyperbaric oxygen in the radiation treatment of head and neck cancers. Radiotherapy and Oncology 20(suppl): 7579.CrossRefGoogle ScholarPubMed
Small, W. Jr., Mittal, B. B., Brand, W. N., Shetty, R. M., Rademaker, A. W., Beck, G. G., Hoover, S. V. (1992) Results of radiation treatment in early glottic carcinoma; multivariate analysis of prognostic and variation therapy variables. Radiology 183(3): 789794.CrossRefGoogle Scholar
Spivak, J. L. (1994) Cancer-related anaemia: its causes and characteristics. Seminal Oncology 21: 38.Google ScholarPubMed
Sweeney, P. J., Nicolae, D., Ignacio, L., Chen, L., Roach, M. IIIrd., Wara, W., Marcus, K. C., Vijayakumar, S. (1998) Effect of subcutaneous recombinant human erythropoietin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial. British Journal of Cancer 77(11): 19962002.CrossRefGoogle ScholarPubMed