Haemoglobin monitoring in endometrial cancer patients undergoing radiotherapy

Abstract

Purpose: To evaluate the level of anaemia monitoring and to determine the prevalence of anaemia in patients with endometrial carcinoma (EC) undergoing postoperative pelvic radiotherapy (RT).

Methods: We evaluated 233 consecutive patients diagnosed with EC receiving RT in our institution between January 2011 and December 2015. One hundred and fifty-two patients (65.2%) received a combination of external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDR-BT) (mean dose 53.4 Gy, range 21-75), and 71 patients (30.5%) were exclusively treated with HDR-BT (mean dose 10.2 Gy, range 7-20). Blood test results with haemoglobin (Hb) levels were collected at three specific time points were: pre-RT (Hb1), during RT (Hb2) and post-RT (Hb3). Anaemia was defined as Hb <12 g/dL.

Results: Anaemia was detected in 54% of patients (67 patients) in the pre-RT analysis. Only 53.7% (n = 36) of the patients with anaemia detected pre-RT underwent subsequent Hb controls (during or post-RT). Blood tests were performed in 124 patients (53.20%) pre-RT, in 51 (17.59%) during RT and in 90 patients (38.62%) post-RT. Significant differences were observed between the mean Hb levels at Hb1-Hb3 (p = 0.001) and Hb2-Hb3 (p = 0.004). Patients with a pre-RT Hb level <12 g/dL presented a worse overall survival (OS) (p = 0.021, χ ² 5.3) with a mean OS of 53.39 months (range 45.5-61.3) vs. 61.4 (range 58.4-64.4) in patients with Hb ≥12 g/dL.

Conclusion: Although the presence of anaemia is frequent in patients with EC (53.2% of patients affected at cancer diagnosis) and influences the OS, Hb monitoring in patients receiving RT remains suboptimal (no controls during RT in 46.3%). There is a strong need to pay attention to blood test prescription for all the patients during and after RT.

Keywords: Anaemia monitoring; Endometrial cancer; Radiotherapy.