The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix

Michelle Grogan, Gillian M. Thomas, Iris Melamed, Frances L W Wong, Robert G. Pearcey, Paul K. Joseph, Lorraine Portelance, Juanita Crook, Keith D. Jones

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. It is unclear whether blood transfusion can overcome the negative impact of anemia before or during radiotherapy (RT) in patients with carcinoma of the cervix. The objective of this retrospective study was to examine the impact of anemia and blood transfusion on 605 patients with carcinoma of the cervix treated with radical RT at 7 centers across Canada in 1989, 1990, and 1992. METHODS. The data collected included hemoglobin (Hgb) levels from the time of diagnosis to the end of therapy; blood transfusions administered; and identifiable patient-, tumor-, and treatment-related factors. Survival, disease free survival, and pelvic control analyses were evaluated by univariate and multivariate analysis. RESULTS. The median follow-up was 41 months (range, 0-92 months). Presenting Hgb level, average weekly nadir Hgb (AWNH) during RT, and blood trans, fusion were correlated significantly with local control, disease free survival, and overall survival on univariate analysis. However, the AWNH remained significant on multivariate analysis, whereas Hgb at presentation and blood transfusion did not. The 5-year survival was 74% for patients with an AWNH ≥ 120 g/L, 52% for patients with AWNH levels 110-119 g/L inclusive, and 45% for patients with AWNH levels < 110 g/L (P < 0.0001). At each Hgb level, patients who were transfused and maintained a specific Hgb level had a survival rate that was not significantly different from patients who were at that level spontaneously. There was a significant reduction in both pelvic and distant recurrence (P < 0.0001 and P < 0.0006, respectively) in patients whose AWNH level during RT was ≥ 120 g/L compared with < 120 g/L. A reduction in the rate of distant recurrence was observed in patients with and without pelvic recurrence. CONCLUSIONS. AWNH is highly predictive of outcome for patients treated with RT for carcinoma of the cervix. Blood transfusion appears to overcome the negative prognostic effects of low presenting Hgb levels and AWNH levels.

Original languageEnglish
Pages (from-to)1528-1536
Number of pages9
JournalCancer
Volume86
Issue number8
DOIs
StatePublished - Oct 15 1999
Externally publishedYes

Fingerprint

Cervix Uteri
Hemoglobins
Radiotherapy
Carcinoma
Blood Transfusion
Recurrence
Disease-Free Survival
Survival
Anemia
Multivariate Analysis
Canada
Survival Rate
Retrospective Studies

Keywords

  • Cervical carcinoma
  • Hemoglobin level
  • Irradiation
  • Prognostic factor

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Grogan, M., Thomas, G. M., Melamed, I., Wong, F. L. W., Pearcey, R. G., Joseph, P. K., ... Jones, K. D. (1999). The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer, 86(8), 1528-1536. https://doi.org/10.1002/(SICI)1097-0142(19991015)86:8<1528::AID-CNCR20>3.0.CO;2-E

The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. / Grogan, Michelle; Thomas, Gillian M.; Melamed, Iris; Wong, Frances L W; Pearcey, Robert G.; Joseph, Paul K.; Portelance, Lorraine; Crook, Juanita; Jones, Keith D.

In: Cancer, Vol. 86, No. 8, 15.10.1999, p. 1528-1536.

Research output: Contribution to journalArticle

Grogan, M, Thomas, GM, Melamed, I, Wong, FLW, Pearcey, RG, Joseph, PK, Portelance, L, Crook, J & Jones, KD 1999, 'The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix', Cancer, vol. 86, no. 8, pp. 1528-1536. https://doi.org/10.1002/(SICI)1097-0142(19991015)86:8<1528::AID-CNCR20>3.0.CO;2-E
Grogan, Michelle ; Thomas, Gillian M. ; Melamed, Iris ; Wong, Frances L W ; Pearcey, Robert G. ; Joseph, Paul K. ; Portelance, Lorraine ; Crook, Juanita ; Jones, Keith D. / The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. In: Cancer. 1999 ; Vol. 86, No. 8. pp. 1528-1536.
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abstract = "BACKGROUND. It is unclear whether blood transfusion can overcome the negative impact of anemia before or during radiotherapy (RT) in patients with carcinoma of the cervix. The objective of this retrospective study was to examine the impact of anemia and blood transfusion on 605 patients with carcinoma of the cervix treated with radical RT at 7 centers across Canada in 1989, 1990, and 1992. METHODS. The data collected included hemoglobin (Hgb) levels from the time of diagnosis to the end of therapy; blood transfusions administered; and identifiable patient-, tumor-, and treatment-related factors. Survival, disease free survival, and pelvic control analyses were evaluated by univariate and multivariate analysis. RESULTS. The median follow-up was 41 months (range, 0-92 months). Presenting Hgb level, average weekly nadir Hgb (AWNH) during RT, and blood trans, fusion were correlated significantly with local control, disease free survival, and overall survival on univariate analysis. However, the AWNH remained significant on multivariate analysis, whereas Hgb at presentation and blood transfusion did not. The 5-year survival was 74{\%} for patients with an AWNH ≥ 120 g/L, 52{\%} for patients with AWNH levels 110-119 g/L inclusive, and 45{\%} for patients with AWNH levels < 110 g/L (P < 0.0001). At each Hgb level, patients who were transfused and maintained a specific Hgb level had a survival rate that was not significantly different from patients who were at that level spontaneously. There was a significant reduction in both pelvic and distant recurrence (P < 0.0001 and P < 0.0006, respectively) in patients whose AWNH level during RT was ≥ 120 g/L compared with < 120 g/L. A reduction in the rate of distant recurrence was observed in patients with and without pelvic recurrence. CONCLUSIONS. AWNH is highly predictive of outcome for patients treated with RT for carcinoma of the cervix. Blood transfusion appears to overcome the negative prognostic effects of low presenting Hgb levels and AWNH levels.",
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AU - Grogan, Michelle

AU - Thomas, Gillian M.

AU - Melamed, Iris

AU - Wong, Frances L W

AU - Pearcey, Robert G.

AU - Joseph, Paul K.

AU - Portelance, Lorraine

AU - Crook, Juanita

AU - Jones, Keith D.

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N2 - BACKGROUND. It is unclear whether blood transfusion can overcome the negative impact of anemia before or during radiotherapy (RT) in patients with carcinoma of the cervix. The objective of this retrospective study was to examine the impact of anemia and blood transfusion on 605 patients with carcinoma of the cervix treated with radical RT at 7 centers across Canada in 1989, 1990, and 1992. METHODS. The data collected included hemoglobin (Hgb) levels from the time of diagnosis to the end of therapy; blood transfusions administered; and identifiable patient-, tumor-, and treatment-related factors. Survival, disease free survival, and pelvic control analyses were evaluated by univariate and multivariate analysis. RESULTS. The median follow-up was 41 months (range, 0-92 months). Presenting Hgb level, average weekly nadir Hgb (AWNH) during RT, and blood trans, fusion were correlated significantly with local control, disease free survival, and overall survival on univariate analysis. However, the AWNH remained significant on multivariate analysis, whereas Hgb at presentation and blood transfusion did not. The 5-year survival was 74% for patients with an AWNH ≥ 120 g/L, 52% for patients with AWNH levels 110-119 g/L inclusive, and 45% for patients with AWNH levels < 110 g/L (P < 0.0001). At each Hgb level, patients who were transfused and maintained a specific Hgb level had a survival rate that was not significantly different from patients who were at that level spontaneously. There was a significant reduction in both pelvic and distant recurrence (P < 0.0001 and P < 0.0006, respectively) in patients whose AWNH level during RT was ≥ 120 g/L compared with < 120 g/L. A reduction in the rate of distant recurrence was observed in patients with and without pelvic recurrence. CONCLUSIONS. AWNH is highly predictive of outcome for patients treated with RT for carcinoma of the cervix. Blood transfusion appears to overcome the negative prognostic effects of low presenting Hgb levels and AWNH levels.

AB - BACKGROUND. It is unclear whether blood transfusion can overcome the negative impact of anemia before or during radiotherapy (RT) in patients with carcinoma of the cervix. The objective of this retrospective study was to examine the impact of anemia and blood transfusion on 605 patients with carcinoma of the cervix treated with radical RT at 7 centers across Canada in 1989, 1990, and 1992. METHODS. The data collected included hemoglobin (Hgb) levels from the time of diagnosis to the end of therapy; blood transfusions administered; and identifiable patient-, tumor-, and treatment-related factors. Survival, disease free survival, and pelvic control analyses were evaluated by univariate and multivariate analysis. RESULTS. The median follow-up was 41 months (range, 0-92 months). Presenting Hgb level, average weekly nadir Hgb (AWNH) during RT, and blood trans, fusion were correlated significantly with local control, disease free survival, and overall survival on univariate analysis. However, the AWNH remained significant on multivariate analysis, whereas Hgb at presentation and blood transfusion did not. The 5-year survival was 74% for patients with an AWNH ≥ 120 g/L, 52% for patients with AWNH levels 110-119 g/L inclusive, and 45% for patients with AWNH levels < 110 g/L (P < 0.0001). At each Hgb level, patients who were transfused and maintained a specific Hgb level had a survival rate that was not significantly different from patients who were at that level spontaneously. There was a significant reduction in both pelvic and distant recurrence (P < 0.0001 and P < 0.0006, respectively) in patients whose AWNH level during RT was ≥ 120 g/L compared with < 120 g/L. A reduction in the rate of distant recurrence was observed in patients with and without pelvic recurrence. CONCLUSIONS. AWNH is highly predictive of outcome for patients treated with RT for carcinoma of the cervix. Blood transfusion appears to overcome the negative prognostic effects of low presenting Hgb levels and AWNH levels.

KW - Cervical carcinoma

KW - Hemoglobin level

KW - Irradiation

KW - Prognostic factor

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