Prognostic value of hemoglobin concentrations in patients with advanced head and neck cancer treated with combined radio-chemotherapy and surgery

• Published in: Strahlentherapie und Onkologie 2000-02, Vol.176 (2), p.73-80
• Main Authors: WAGNER, W, HERMANN, R, HARTLAPP, J, ESSER, E, CHRISTOPH, B, MÜLLER, M. K, KRECH, R, KOCH, O
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease-Free Survival; Dose Fractionation; Female; Head & neck cancer; Head and Neck Neoplasms - blood; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Hemoglobins - analysis; Hemoglobins - drug effects; Hemoglobins - radiation effects; Humans; Male; Medical sciences; Middle Aged; Neoplasm Staging; Particle Accelerators; Pharmacology. Drug treatments; Prognosis; Radiation therapy; Radiation therapy and radiosensitizing agent; Time Factors; Treatment Outcome; Treatment with physical agents; Treatment. General aspects; Tumors
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/PL00002331

Hemoglobin levels are currently the focus of interest as prognostic factors in patients with head and neck cancer. Most published clinical trials have confirmed hemoglobin to possess a significant influence on survival in patients treated with radiotherapy. In our study we have investigated the prognostic value of hemoglobin in a combined modality schedule. Forty-three patients with advanced head and neck tumors were treated with combined radio-chemotherapy. The therapy comprised 2 courses of induction chemotherapy with ifosfamide (1,500 mg/m2, day 1 to 5) and cisplatin (60 mg/m2, day 5) followed by hyperfractionated accelerated radiotherapy with a total dose of only 30 Gy. Surgery involved tumor resection and neck dissection. The 1-year overall survival rate and the 2-year survival rate were 79% and 56%, respectively. The 1- and 2-year recurrence-free survival rates were 68% and 49%, respectively. Prognostic factors with an impact on survival were seen in tumor size (T3 vs T4, p = 0.0088), response to radio-chemotherapy at the primary site (no vital tumor rest vs vital tumor rest, p = 0.045), response to lymph node radio-chemotherapy (no vital tumor cells vs vital tumor cells, p = 0.013) and level of hemoglobin after radio-chemotherapy (Hb > or = 11.5 g/dl vs < 11.5 g/dl, p = 0.0084). In our study hemoglobin level after radio-chemotherapy was identified for the first time to be also a significant prognostic factor (univariate analysis) in head and neck cancer patients who underwent combined radio-chemotherapy. Besides chemotherapy plus low-dose irradiation achieved similar results in comparison with radical resection and high-dose radiotherapy at least for the first 2 years after therapy. Relapsing disease could be treated with 1 additional course of radiotherapy which is supposed to be well tolerated.