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. 2015 Jan 28:8:251-8.
doi: 10.2147/OTT.S70204. eCollection 2015.

Prolonged radiation time and low nadir hemoglobin during postoperative concurrent chemoradiotherapy are both poor prognostic factors with synergistic effect on locally advanced head and neck cancer patients

Nai-Wen Su  1 , Chung-Ji Liu  2 , Yi-Shing Leu  3 , Jehn-Chuan Lee  3 , Yu-Jen Chen  4 , Yi-Fang Chang  5
Affiliations

Prolonged radiation time and low nadir hemoglobin during postoperative concurrent chemoradiotherapy are both poor prognostic factors with synergistic effect on locally advanced head and neck cancer patients

Nai-Wen Su et al. Onco Targets Ther. .

Abstract

Background: Anemia, a common complication of head and neck cancer treatment, is regarded as a poor prognostic factor. We evaluated the impact of low hemoglobin (Hb) levels, measured at different time points, on a consecutive cohort of patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) who underwent postoperative concurrent chemoradiotherapy (CCRT).

Materials and methods: From 2002 to 2009, 140 patients were enrolled and reviewed retrospectively. Preoperative (pre-op Hb), pre-CCRT Hb, and nadir Hb during CCRT were measured and recorded. The three Hb parameters were analyzed against several well-established pathologic risk factors and radiation-associated variables. Prognostic impacts were investigated with multivariate analysis by Cox proportional hazards model.

Results: On Cox regression analysis, significantly higher risk of death was associated with pre-op Hb ≦13 g/dL (hazard ratio [HR] =1.8; 95% confidence interval [CI], 1.1-3.1; P=0.023), nadir Hb ≦11 g/dL (HR =1.9; 95% CI, 1.1-3.3; P=0.020), radiation treatment time (RTT) >7 weeks (HR =1.9; 95% CI, 1.1-3.3; P=0.022), and multiple positive lymph nodes (HR =2.1; 95% CI, 1.2-3.7; P=0.010), after adjusting for primary tumor site and pathologic lymphovascular invasion. Patients with poor prognosticators including low nadir Hb ≦11 g/dL and RTT >7 weeks had a higher risk of death (HR =4.0; 95% CI =1.6-10.2; P=0.004).

Conclusion: In the treatment setting of LA-SCCHN patients who underwent postoperative CCRT, coexistance of lower nadir Hb during CCRT and prolonged RTT resulted in reduced survival.

Keywords: anemia; concurrent chemoradiotherapy; head and neck cancer; hemoglobin; radiation time.

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Figures

Figure 1
Figure 1
Kaplan–Meier curve of overall survival according to pre-op Hb level (g/dL) (A), nadir Hb (g/dL) during CCRT (B), and RTT (C). Abbreviations: pre-op, preoperative; Hb, hemoglobin; CCRT, concurrent chemoradiotherapy; RTT, radiation treatment time.
Figure 2
Figure 2
Adverse survival outcome interaction between lower nadir Hb (≦11 g/dL) and the presence of prolonged RTT (>7 weeks) during postoperative CCRT. Abbreviations: Hb, hemoglobin; RTT, radiation treatment time; CCRT, concurrent chemoradiotherapy.
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